Echocardiography Laboratory

Heart and Vascular Center

Diagnostic Laboratories and Imaging

Echocardiography (Cardiac Ultrasound) Laboratory

Echocardiography is an ultrasound test of the heart that uses sound waves to take moving pictures of the heart. An echocardiogram provides detailed images of the heart. These images can provide a wealth of information, including the size and shape of the heart, pumping strength, and the location and extent of damage to heart tissues.

Echocardiography is performed to check for many types of heart problems. It allows physicians to see the heart as it beats and to visualize many structures of the heart. Ultrasonographers in the state-of-the-art, all-digital Echo Lab perform nearly 7,000 echo procedures a year.

Digital echocardiography produces images on computer screens rather than on film. The images can instantly be distributed electronically to computer workstations, allowing for faster diagnosis and prompt feedback to physicians and patients. The digital images can be stored indefinitely, allowing physicians to view images from a computer at any time and track a patient’s history.

The Echo Lab at Froedtert & The Medical College of Wisconsin is accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL), signifying that the lab has been independently reviewed, examined and recognized as achieving a high level of quality.

Types of Ultrasound Tests Different types of ultrasound tests are performed in the lab.

Transthoracic echocardiography (TTE)

Transthoracic echocardiography is the most common procedure performed In the Echo Lab. In a TTE test, an ultrasound transducer, which emits sound waves, is placed on the chest in the area of the heart (transthoracic means “through the chest”). The Echocardiography Lab performs about 5,000 TTE procedures each year.

A TTE may be done to:

Detect a problem in a heart valve
Determine the size and functioning of the right and left ventricles that may have been damaged by a heart attack, high blood pressure or viruses
Evaluate the heart after a stroke to determine if a heart disorder may have caused the stroke
Check for fluid collection in and around the heart
Look for congenital defects of the heart

Transesophageal echocardiography (TEE)

Sometimes the ultrasound probe needs to be closer to the heart to provide clearer pictures. A test called transesophageal echocardiography (TEE) is designed for this use. A technician gently passes a tube down a patient’s throat and into the esophagus (the tube between the mouth and the stomach). The tube has a small ultrasound probe on the end of it. This produces a clearer ultrasound picture of the heart. In addition to diagnosing abnormalities of the heart, TEE can show the size of the heart, how well it pumps and damage to heart tissue.

TEE is performed to evaluate:

Heart-related causes of stroke
Heart valve problems
Congenital heart disorders

TEE is also performed in the Cardiac Catheterization Lab to monitor procedures to close atrial septal defect (ASD) and patent foramen ovale (PFO) defects of the heart.

3-Dimensional Transesophageal Echocardiography (TEE)

Since September 2007, Froedtert & The Medical College of Wisconsin have been testing new heart imaging technology created by Philips Medical. For the first time, live 3D technology has been transitioned to a transesophageal echocardiography probe (TEE), enabling cardiologists, cardiac surgeons and cardiac interventionalists to view new depths of information. This new technology is improving the way patients with heart problems are diagnosed.

Froedtert & The Medical College of Wisconsin are one of seven major medical centers in the country testing this technology. For patients with heart valve problems, the technology allows a cardiologist and surgeon to better estimate the chances of repairing a valve vs. replacing it when surgery is being considered.

Other uses for the Philips 3D TEE are diagnosing conditions related to congenital heart disease and viewing masses in the heart. The probe allows physicians to view the entire pathology of the heart. It also offers more perspectives of the heart, including the surgeon’s view.

Real time 3D views of the heart offer the ability to see the heart in 3D at the same time imaging is occurring. The new technology allows capturing the entire image of the heart in just 10 seconds, and images can be manipulated from numerous angles.

Echocardiography Stress Tests

The Echo Lab conducts various types of stress tests (stress echocardiography) to determine how the heart functions under stress. These tests are useful for diagnosing heart problems, showing the proper exercise level for a person, and predicting the risk of dangerous conditions such as heart attack. As the body works harder during the test, it requires more oxygen, so the heart must pump more blood. The test can show if the blood supply is reduced in the arteries that supply the heart.

Treadmill stress test. In a treadmill stress test, a patient walks on a treadmill for a few minutes, while an electrocardiogram (EKG) recording is made of the heart. Heart and blood pressure are also checked.

Supine bicycle test. In a supine bicycle stress test, the patient pedals a bike while lying flat in bed (the bike is attached to the bed). This test evaluates patients for coronary artery disease and evaluates/monitors patients with significant valvular disease.

Dobutamine stress test. A dobutamine stress test is done to evaluate heart and valve function when a person is unable to exercise on a treadmill or stationary cycle. The patient is given dobutamine, a medication that stimulates the heart and makes it “think” it is exercising. During this time, the patient is closely monitored.

Intracardic echocardiography (ICE)

Intracardic echocardiography provides unique ultrasound images from inside the heart muscle. ICE is designed for use in minimally invasive interventional (catheter-based) cardiac procedures. A tiny ultrasound probe is mounted on the tip of a catheter so it can be moved through the blood vessels directly into the heart. The patient only needs a sedative or local anesthesia (vs. general anesthesia) for this procedure. Compared to transesophageal echocardiography (TEE), ICE provides clearer images in less time.

ICE allows diagnostic and therapeutic information to be obtained during heart catheterization and electrophysiological procedures. It is particularly useful during interventional procedures to assist with closure of an atrial septal defect (ASD) and a patent foramen ovale (PFO), congenital defects that leave holes in the wall between the upper chambers of the heart.

In electrophysiology, ICE technology helps guide the precise placement of catheters for electrophysiological interventions. For example, the in-heart view provided by ICE offers a great advantage in the placement of energy-emitting catheters to treat a difficult arrhythmia (irregular heartbeat).

3-D Echocardiography

Three-dimensional (3-D) echocardiography provides a three-dimensional picture of a beating heart. The image can be manipulated so a physician can see the heart from any angle and see views that can’t be provided by traditional two-dimensional echo.

The Echo Lab has the longest clinical experience in the state using real-time, three-dimensional (3-D) echocardiography, which allows physicians to view the heart in greater detail and pinpoint problems in the heart’s structure. The lab was the first in the state to obtain the commercially available 3-D ultrasound technology by Philips.

3-D echo provides better visualization of complex structures of the heart than regular, two-dimensional echo. 3-D echo is especially useful for evaluating heart valve problems and congenital heart disease. It can also reveal abnormal growths and masses (benign and malignant) in the heart and measure the heart’s ejection fraction (its squeezing or pumping ability).

Cardiac resynchronization therapy evaluation

Cardiac resynchronization therapy (CRT) is an option for some people with congestive heart failure. CRT uses a specialized pacemaker to re-coordinate the beating of the right and left ventricles by pacing both ventricles simultaneously. In the Echo Lab, echocardiography can measure the amount of asynchrony (lack of synchronization) in a patient and determine if he or she is eligible for CRT treatment.

The Echo Lab also works with the Pulmonary Hypertension Clinic at Froedtert & The Medical College of Wisconsin by providing a special type of echocardiography to assess lung problems and how the lungs affect the heart.

Last Review Date: June 18, 2008

Online Editor(s): Richard Petre