general description
Echocardiography (EchoCG) is a method for studying morphological and functional changes in the heart and its valvular apparatus using ultrasound.
The echocardiographic research method allows:
- Quantitatively and qualitatively assess the functional state of the LV and RV.
- Assess regional LV contractility (for example, in patients with coronary artery disease).
- Assess LVMM and identify ultrasound signs of symmetric and asymmetric hypertrophy and dilatation of the ventricles and atria.
- Assess the condition of the valve apparatus (stenosis, insufficiency, valve prolapse, presence of vegetations on the valve leaflets, etc.).
- Assess the level of pressure in the PA and identify signs of pulmonary hypertension.
- Identify morphological changes in the pericardium and the presence of fluid in the pericardial cavity.
- Identify intracardiac formations (thrombi, tumors, additional chords, etc.).
- Assess morphological and functional changes in main and peripheral arteries and veins.
Indications for echocardiography:
- suspicion of acquired or congenital heart defects;
- auscultation of heart murmurs;
- febrile states of unknown cause;
- ECG changes;
- previous myocardial infarction;
- increased blood pressure;
- regular sports training;
- suspicion of a heart tumor;
- suspected thoracic aortic aneurysm.
Left ventricle
The main causes of local disturbances in LV myocardial contractility:
- Acute myocardial infarction (MI).
- Post-infarction cardiosclerosis.
- Transient painful and silent myocardial ischemia, including ischemia induced by functional stress tests.
- Constant ischemia of the myocardium, which has still retained its viability (the so-called “hibernating myocardium”).
- Dilated and hypertrophic cardiomyopathies, which are often also accompanied by uneven damage to the LV myocardium.
- Local disturbances of intraventricular conduction (blockade, WPW syndrome, etc.).
- Paradoxical movements of the IVS, for example, with volume overload of the RV or bundle branch blocks.
Right ventricle
The most common causes of impaired RV systolic function:
- Tricuspid valve insufficiency.
- Pulmonary heart.
- Stenosis of the left atrioventricular orifice (mitral stenosis).
- Atrial septal defects.
- Congenital heart defects accompanied by severe pulmonary arterial hydrangea (for example, VSD).
- PA valve insufficiency.
- Primary pulmonary hypertension.
- Acute right ventricular myocardial infarction.
- Arrhythmogenic pancreatic dysplasia, etc.
Interventricular septum
An increase in normal values is observed, for example, with some heart defects.
Right atrium
Only the value of the volumetric volume at rest is determined. A value of less than 20 ml indicates a decrease in EDV, a value of more than 100 ml indicates its increase, and an EDV of more than 300 ml occurs with a very significant increase in the right atrium.
Heart valves
Echocardiographic examination of the valve apparatus reveals:
- fusion of valve leaflets;
- insufficiency of one or another valve (including signs of regurgitation);
- dysfunction of the valve apparatus, in particular the papillary muscles, leading to the development of prolapse of the valves;
- the presence of vegetation on the valve flaps and other signs of damage.
The presence of 100 ml of fluid in the pericardial cavity indicates a small accumulation, and over 500 - a significant accumulation of fluid, which can lead to compression of the heart.
Why is cardiac echocardiography needed?
There are a myriad of reasons why a doctor might recommend an echocardiogram. A harmless and inexpensive procedure is indispensable for:
- constant pain in the chest, rapid heartbeat, disturbing in a calm state, after minor physical exertion;
- hypertension (stable high blood pressure);
- swelling of the lower extremities, when kidney disease is not diagnosed;
- breathing difficulties that occur after physical activity;
- feeling of a foreign object in the chest.
The attending doctor can prescribe a procedure, and then conduct a full interpretation of the ultrasound of the heart, in case of constant dizziness, arrhythmia, atherosclerosis, pericarditis, heart muscle defects, coronary artery disease. Indications are often multiple pregnancy, hereditary predisposition, medical examination at the enterprise.
Ultrasound cardiography is performed for both adults and children. When a baby is suspected of having abnormalities in myocardial development, shortness of breath appears without symptoms of an acute respiratory infection, loss of consciousness is observed, it is imperative to check the functioning of the main organ. The pediatrician can refer for diagnostics when, during the use of a phonendoscope, extraneous sounds were noticed against the background of normal contractile activity.
The above-mentioned cardiac examination also plays an important role for a teenager. The test is aimed at assessing the normal development of the organ during puberty, because it is at this time that a sharp increase in body size is often observed.
Norms
Left ventricular parameters:
- Left ventricular myocardial mass: men - 135-182 g, women - 95-141 g.
- Left ventricular myocardial mass index (often referred to as LVMI on the form): men 71-94 g/m2, women 71-89 g/m2.
- End-diastolic volume (EDV) of the left ventricle (the volume of the ventricle that it has at rest): men - 112±27 (65-193) ml, women 89±20 (59-136) ml.
- End-diastolic dimension (EDD) of the left ventricle (the size of the ventricle in centimeters that it has at rest): 4.6-5.7 cm.
- End systolic dimension (ESD) of the left ventricle (the size of the ventricle it has during contraction): 3.1-4.3 cm.
- Wall thickness in diastole (outside of heart contractions): 1.1 cm. With hypertrophy - an increase in the thickness of the ventricular wall due to too much load on the heart - this figure increases. Figures of 1.2-1.4 cm indicate slight hypertrophy, 1.4-1.6 indicate moderate hypertrophy, 1.6-2.0 indicate significant hypertrophy, and a value of more than 2 cm indicates high degree hypertrophy.
- Ejection fraction (EF): 55-60%. The ejection fraction shows how much blood relative to the total amount the heart ejects with each contraction; normally it is slightly more than half. When the ejection fraction decreases, heart failure is indicated.
- Stroke volume (SV) is the amount of blood that is ejected by the left ventricle in one contraction: 60-100 ml.
Right ventricle parameters:
- Wall thickness: 5 ml.
- Size index 0.75-1.25 cm/m2.
- Diastolic size (size at rest) 0.95-2.05 cm.
Parameters of the interventricular septum:
- Resting thickness (diastolic thickness): 0.75-1.1 cm. Excursion (moving from side to side during heart contractions): 0.5-0.95 cm.
Left atrium parameters:
- Size: 1.85-3.3 cm.
- Size index: 1.45-2.9 cm/m2.
Standards for heart valves:
- There is no pathology.
Norms for the pericardium:
- The pericardial cavity normally contains no more than 10-30 ml of fluid.
Interpretation of ultrasound of the heart
In order for the interpretation of cardiac echocardiography to be carried out without errors and completely, the patient’s age, general state of health, and the presence of chronic diseases (pancreatitis, tonsillitis, asthma, vasculitis, etc.) are taken into account. It is impossible to determine the pathology on your own (without knowledge and experience). Only a doctor can correctly assess the answer. There is no place for experiments and guesswork. It is inappropriate to look for answers on the Internet on the websites of companies with a dubious reputation. Trust your health to professionals who provide guarantees and value each patient.
Study parameters
Thanks to ultrasonic waves, you can accurately determine:
- myocardial parameters (sizes of all its parts);
- tissue structure, wall density;
- rhythms, abbreviations, etc.
Imaging will help detect scarring, thrombosis, benign and malignant tumors. The test informs about the condition of the mitral valve, blood volumes and the level of vascular blockage.
By interpreting cardiac echocardiography, the presence/absence of the following diseases can be determined:
- ischemia, when there is a persistent disturbance of blood supply against the background of vascular blockages;
- necrosis, during which tissue death occurs (infarction);
- blood pressure above or below normal (hypo-, hypertension);
- defect, that is, a structural defect of an acquired/congenital type;
- decompensation, when a whole syndrome of failures is noticeable;
- valvular dysfunction;
- rhythmic disruptions;
- rheumatism, when inflammation is observed;
- pericarditis, in which there is inflammation of the membrane;
- stenosis, which indicates a narrowing of the aortic lumen;
- vegetative-vascular dystonia.
Competent image decoding is the basis for success. After all, it is thanks to him that one can establish the fact whether there is a disease or not.
Among the research parameters, several main areas are distinguished. When interpreting cardiac ultrasound in children and persons over 13 years of age, the diameter of the left ventricle and left ventricle, the thickness of the posterior wall of the left ventricle, and more are determined. Each number has a meaning individually. Also, all indicators are taken into account together, because many of them are related to each other and often form a single clinical picture.
How it happens
A painless examination is carried out in a hospital setting or at home, if the situation requires it. The manipulation takes from 20 to 45 minutes. This is a safe way to assess the functioning of the heart muscle and blood vessels, which has no contraindications and is not harmful to health. Step by step it usually looks like this:
- The visitor bares his torso, undresses to the waist and takes a horizontal position, lying on his back with his head towards the diagnostician.
- A special gel is applied to the chest area to help conduct ultrasound waves better.
- A special sensor is used, thanks to which the diagnostician carries out an inspection. The detector is moved slowly across the area being examined to ensure that nothing is missed. The attentiveness of the diagnostician will help with echocardiography decoding.
- The specialist can correct the patient’s position and condition, for example, asking him to hold his breath, roll over, raise his arm, bend his knees, and more.
The response is assessed by a competent specialist, a doctor. It is important that all indicators are taken into account, as well as the individual parameters of the patient’s body. The time of the diagnostic procedure and the state of health, that is, the well-being of the person being diagnosed, are taken into account. Standards and actual figures are reviewed. A comparison is being made. Only after a thorough study can a diagnosis be made and a course of therapy formed. A person who has nothing to do with modern cardiology will not be able to understand the indicators, even if he uses a plate with standard figures for this. Only a properly qualified doctor should be involved in forming a conclusion!
Differences in men, women and children
Normally, data by age and gender is different. EchoCG interpretation helps to analyze the full cycle of myocardial activity (1 systole + 1 diastole). With a heartbeat of 70 beats in 60 seconds, 1 cycle is normally 0.85 seconds.
Adult women and men, as well as children, have different normal values. For example, the heart mass of a representative of the stronger sex aged 25-30 years is about 135 g. In a woman - up to 100 g. The EDV of the left ventricle in men normally reaches 193 ml, in women it does not exceed 136 ml.
The LV wall mass index is an indicator of the ratio of the weight of the organ to the surface area of the human body. The strong half of humanity is characterized by indicators from 71 to 95 g/m2, the fair sex is characterized by a range from 71 to 90 g/m2.
