If you’ve ever experienced unexplained chest pains, a heart attack or a heart murmur, chances are you underwent echocardiography, a commonly performed imaging test sometimes referred to as just an”echo.”
The number of echoes performed each year in the U.S. and around the world has been steadily rising, leading to a perception that the test is being overused, explains cardiologist Christine Jellis, MD, with the Section of Cardiovascular Imaging at Cleveland Clinic. But a recent study, published in the Journal of the American College of Cardiology (JACC), suggests that, in fact, echocardiography is being underused. Researchers found that it is ordered for less than 10 percent of the patients who have appropriate indications for the test.
Dr. Jellis praised the study and noted that echocardiography is associated with lower rates of hospital mortality.
“I think this study will reach a wide cardiology and medical audience, where it will hopefully provide reassurance that echocardiography is not being overused, and will remind clinicians and patients that it is an important diagnostic tool to include in their medical evaluation,” she says.
Unlike X-rays or CT scans (which are essentially very sophisticated X-rays), echocardiography does not use radiation. Instead echocardiograms are produced with sound waves that create moving pictures of your heart. These images illustrate the function and structure of the heart, and can reveal any abnormalities.
They’re also useful to track the effectiveness of medications or a procedure or to see if a condition is worsening over time.
“It can be used to tell if someone has had a previous heart attack, has heart failure or valve problems amongst other things,” Dr. Jellis explains. “Compared with some other imaging techniques, such as nuclear imaging, CT and MRI, it is also much more portable and can be performed easily at the bedside. This is especially important for sick patients, where a diagnosis is often needed quickly.”
Another very important benefit of echocardiography is that it helps save lives by providing doctors detailed images used in diagnosing a condition or making changes to a treatment plan, Dr Jellis says.
“It can increase survival by improving the accuracy of initial diagnosis and then allowing monitoring of patients to ensure that they are receiving the appropriate treatment for their specific condition,” she explains. “For example, the echo images might suggest that the patient needs optimization of heart failure drug therapy, that the patient needs valvular heart surgery, or that the patient would be eligible for an implanted cardiac defibrillator.”
How It’s Done
Echocardiography is a non-invasive procedure. Typically, it’s done while you lie on your back or your left side. A special “jelly” is placed on a probe, which is moved around your chest by a trained sonographer. Ultra-high frequency sound waves are used to create images that appear on a nearby video screen.
“Performance of echocardiography is operator- and reader-dependent, so if in doubt always talk to your local medical practitioner and seek out an accredited echocardiography laboratory in your region,” Dr. Jellis says.
There is also a test, called stress echocardiography, or “stress echo,” in which a patient pedals a type of stationary bike or walks on a treadmill while heart activity is monitored. Another type of echocardiography is called transesophageal echocardiography (TEE). It’s used when a closer look at your heart is needed. In this test, a cardiologist will pass a tube down your throat as you swallow. At the end of the tube is a probe that produces images similar to those taken with standard echocardiography. Once the images are taken, the probe is removed.
Echocardiography takes about an hour and is painless. There are also no side effects. If your doctor orders echocardiography, feel free to ask why it’s necessary. During the test, ask questions, too. You may learn a little more about your heart along the way.