The gel allows the passage of high frequency sound waves from the probe to the following: heart chambers, heart valves, heart muscle, carotid (neck) arteries, the arteries and veins in the arms and legs, and renal (kidney) arteries. Sound waves reflect off the tissue structure sending information back to the probe creating sounds and moving images on a monitor screen. The images are recorded for the physician to review and interpret. Because ultrasound does not involve any radiation, as opposed to an x-ray, it is a very safe test.

The ultrasound equipment has several new features that will help the physician to better diagnose and treat their patients. Some of these features include:

• Color Kinesis analyzes left ventricular heart muscle, segment by segment, to determine areas of the left ventricle wall motion. This technique assigns color to define blood and tissue borders that might otherwise be impossible to distinguish.
• Acoustic Quantification provides objective heart data used to evaluate left ventricular size and function.
• Tissue Synchronization Imaging allows the technologist and physician to determine if all left ventricular wall motion is not beating symmetrically. This is especially beneficial in diagnosing and managing Congestive Heart Failure (CHF) to improve long term outcome.

In addition to this equipment, the Cardiac and Vascular Ultrasound department has moved to a new larger area of the hospital. This additional space allows the department to have digital capability equipment. Images taken by the technologist can be stored digitally then sent on to the interpreting cardiologist or radiologist within minutes of completing the study.

There are several types of Echocardiogram’s including:

Echocardiogram, more commonly called “Echo” (Cardiac Ultrasound). An echocardiogram uses sound waves to produce images of the heart as it is beating. This allows evaluation of your four heart valves, the strength and thickness of your heart muscle and the size of the four chambers in your heart. Typically, Cardiac Doppler is also performed during the echocardiogram. The cardiac doppler reveals the speed and direction of blood flow within the heart. It is also helpful in evaluating valve function. The doppler uses sound waves which reflect off the moving red blood cells within the heart chambers. Color Flow Mapping is usually done in conjunction with the Doppler test. It shows speed and direction of blood flow, but the images are in color. The color allows the technologist and physician to “map” abnormalities in blood flow. This test is interpreted by a cardiologist.

Stress Echocardiogram. An echocardiogram performed while the patient exercises in a controlled manner on a treadmill with speed and elevation increasing every three minutes until the patient becomes fatigued. The wall motion of the heart’s pumping chamber before and immediately after exercise may reveal evidence of a lack of blood supply to certain areas of the heart muscle. This can help detect blockages in the heart arteries. The patient is to refrain from eating or drinking four hours prior to the procedure.

Chemical (Dobutamine) Stress Echocardiogram. This type of stress test is given to patients who are unable to perform physical activity. A Dobutamine stress echocardiogram measures the reaction of the heart under chemically induced stress in order to assess the wall motion of the heart muscle. The drug causes the heart to react as if the person were exercising, though the patient is actually at rest. This test can help detect blockages in the heart. The patient is to refrain from eating or drinking four hours prior to the procedure. This procedure can take up to an hour to perform.

Contrast Echocardiogram. This test may be performed during an Echocardiogram on any patient who has poor images. During the echocardiogram the technologist will inject a contrast medium into a vein that causes blood vessels and heart structures to stand out more clearly. It’s like turning on a light bulb inside the heart.

Transesophageal Echocardiogram (TEE). This type of test is minimally invasive. It requires a transducer to be inserted down the patient’s throat into the esophagus (the long tube that connects the throat with the stomach). Because the esophagus is located so close to the heart, very clear images of the heart structures and valves can be obtained from the inside of the body instead of the outside which can have interference from the chest wall and lungs.

An echocardiogram is often given to patients who have experienced signs and symptoms such as: An abnormal heart sound called a heart murmur, chest pain also known as angina, an abnormal electrocardiogram (EKG), an abnormal rhythm of the heart called arrhythmia, an abnormal chest x-ray showing an abnormal heart structure, shortness of breath, and heart failure to name a few.

The information obtained from the echocardiogram enables the physician to:

• Check the health and performance of heart valves
• Measure the heart wall shape and check for abnormalities in heart wall motion
• Detect disease or accumulation of fluid in the sac around the heart
• Identify blood clots
• Measure ejection fraction (strength of the left ventricle)
• Check the condition of certain blood vessels
• Conditions that can be diagnosed with an echocardiogram include:
• Valvular heart disease includes narrowing or leaking heart valves.
• Rheumatic heart disease.
• Bacterial endocarditis which is an infection in one or more of the heart valves.
• Cardiomyopathy which is a disease of the heart muscle that is unusually thick, stiff, dilated or weak.
• Heart failure which is a condition where blood flow and circulation are not adequately maintained by one or more valves or chambers of the heart.
• Pericarditis is an inflammation of the thin fluid-filled sac surrounding the heart.
• Tumors in the heart.
• Coronary artery disease is an obstruction of blood flow to the heart due to hardened arteries.
• Cardiac ischemia is a condition where the heart is not getting enough oxygen, usually because of hardened arteries.
• Heart attack will show scarring, or death, of heart muscle because the heart was deprived of oxygen.
• Shunt is an abnormal connection between the hearts four chambers.
• Pulmonary hypertension which is high blood pressure in the blood vessels that supply oxygen to the lungs

• Peripheral Vascular Ultrasound. This procedure uses sound waves to obtain images and measure speed (velocity) of blood flow in carotids (neck), arms, legs, and renal (kidney) blood vessels. The images are analyzed to determine whether or not you have blockages in your arteries, or blood clots in your veins. The Peripheral Vascular Ultrasound images are interpreted by a radiologist.
• Upper or Lower Arterial Ultrasound. If you have blockages in your arteries, “intermittent claudication” (leg pain which occurs with walking, relieved at rest), previous balloon angioplasty/stent placement or bypass grafts of the legs, this test can determine the severity of the blockages, or patency of the angioplasty/stented areas or bypass grafts. You may be asked to walk on a treadmill to determine the effects of exercise on your circulation. Blood pressure cuffs are placed on your arms and legs to obtain measurements during the procedure.
• Upper or Lower Venous Ultrasound. This test determines if there are blood clots in the veins or your arms or legs.
• Carotid Ultrasound. This procedure uses sound waves to obtain color images of the arteries in your neck. The images determine what extent the arteries are blocked and how much blood is flowing to your brain and eyes. There is one carotid artery on each side of your neck, therefore, both sides will be evaluated during this procedure.
• Renal Duplex Ultrasound. This test may be ordered to determine if blockages are present in the renal (kidney) arteries that interfere with the blood supply to the kidneys.
• Peripheral Vascular Disease is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged. This interferes with the normal flow of blood. The term ‘Vascular’ is used interchangeably with ‘circulatory,’ and refers to the whole network of vessels outside the heart that carries blood through the body.

Symptoms of Peripheral Vascular Disease include pain in arms or legs, poor or no pulse, numbness or tingling, inability to move legs or arms, swelling of arms or legs, enlargement of superficial veins, heaviness of limbs, cramping, leg or hip pain while walking (known as claudication), changes in skin color or temperatures, loss of hair on toes or feet, burning or aching pain in feet or toes when resting, sore on leg or foot that won’t heal.

Risk factors for Peripheral Vascular disease are past history, obesity, drug therapy, cancer, injury, cardiac disease, age over 50, surgery, blood disorders, diabetes, hypertension, high cholesterol, stress and smoking.