Echocardiography, also known colloquially as cardiac ultrasound or cardiac echo, is one of the most important and informative examinations in modern cardiology. At the KardioPro practice, Dr. Raphael Bruno uses this ultra-modern, painless and risk-free method to obtain a detailed, moving image of your heart in real time. The Echocardiography enables us to precisely assess the heart structure, the pumping function and the heart valves and is therefore an indispensable component in the diagnosis and monitoring of heart disease.
Echocardiography: a painless view of the beating heart
The basic principle of Echocardiography is the same as for other ultrasound examinations, for example in gynecology or at the family doctor. A small transducer emits ultrasound waves that are inaudible to the human ear. These waves penetrate the tissue of the chest and are reflected back to varying degrees by the structures of the heart, such as the walls and valves.
The transducer receives this „echo“ again and a powerful computer converts the signals into a two-dimensional, black and white or color-coded image on a monitor. This happens in real time so that your cardiologist can watch the heart at work live. The examination does not require any X-rays at all and is therefore completely harmless and can be repeated as often as required.1 This security makes the Echocardiography a central diagnostic tool for your heart specialist.
What can an echocardiogram visualize?
The with the Echocardiography The information obtained is extremely diverse and invaluable for the experienced examiner. Dr. Raphael Bruno can use the ultrasound images to assess a wide range of parameters that are crucial for diagnosis and treatment planning.
The most important aspects that are assessed include:
- The pumping function of the heart: We measure the size of the heart chambers and assess the force with which the heart muscle contracts.2 A key value here is the ejection fraction (EF), which indicates the percentage of blood ejected from the left ventricle per heartbeat.3
- The heart valves: The function of all four heart valves is analyzed in detail.4 We can recognize whether a valve is narrowed (stenosis) or no longer closes properly (insufficiency).5
- The thickness of the heart walls: A thickening of the heart muscle (hypertrophy) can be an important indication of long-standing high blood pressure or other diseases.6
- Movement disorders of the heart wall: After a heart attack, parts of the heart muscle may be scarred and no longer move properly. Such areas are in the Echocardiography clearly recognizable.
- The pericardium: Accumulations of fluid in the pericardium (pericardial effusion) can be reliably diagnosed.
- Congenital heart defects: Structural abnormalities that have existed since birth can also be visualized using cardiac ultrasound.7
- Blood clots: Blood clots (thrombi) in the heart cavities, which pose a risk of stroke, can often be identified.
This comprehensive analysis enables a precise and rapid diagnosis to be made for a wide range of cardiological conditions.8
The different types of echocardiography
Depending on the medical issue, different types of ultrasound examination are used. In our practice, we offer transthoracic echocardiography and stress echocardiography.
Procedure | Implementation | Advantages / Goals | Patient preparation |
Transthoracic echocardiography (TTE) | The transducer is placed on the chest from the outside. | Standard procedure, fast, non-invasive, comprehensive basic diagnostics. | No special preparation necessary. |
Transesophageal echocardiography (TEE) | A thin, flexible transducer is inserted via the esophagus („swallowing echo“). | Very detailed imaging, as it is closer to the heart; particularly good for heart valves and atria. | Sobriety required; usually in hospital. |
Stress echocardiography | TTE is performed before and immediately after physical or medical stress. | Detection of circulatory disorders that only occur under stress. | Bring sportswear, do not eat a lot beforehand. |
The transesophageal echocardiography (TEE) is usually performed in a hospital if the image quality of the TTE is not sufficient or if special questions (e.g. search for small blood clots before cardioversion) need to be clarified.
Echocardiography: The examination procedure for you as a patient
A normal transthoracic Echocardiography in our practice is very uncomplicated and comfortable for you as a patient. We attach great importance to a calm and relaxed atmosphere.
- Preparation: You will be asked to expose your upper body. You will then lie down on an examination table, usually on your left side. This position brings the heart closer to the chest wall and improves the image quality.
- Important for women: Please bring a suitable comfortable bra with you, as the practice of Dr. Bruno Women only clothed and not be examined naked. Please refrain from wearing bodysuits.
- Attaching the ECG electrodes: Three ECG electrodes are attached to your chest. This enables us to continuously compare the ultrasound image with your electrical heart action.
- Application of the ultrasound gel: A special, water-based gel is applied to the transducer and your breast. This gel is necessary to ensure optimal coupling of the transducer to the skin and to avoid air between the transducer and the skin.
- The investigation: Dr. Raphael Bruno will now move the transducer with gentle pressure over different areas of your chest to view the heart from different angles and planes. You may be asked to hold your breath briefly or change your breathing position to make certain parts of the heart more visible.
- Conclusion: The examination usually takes between 15 and 35 minutes. The gel is then removed and you can get dressed again. Dr. Bruno will usually explain the findings to you immediately afterwards.
Stress echocardiography: assessing the heart under stress
A special form of Echocardiography is stress echocardiography.9 It is a very valuable method for detecting coronary heart disease (CHD), i.e. circulatory disorders of the coronary arteries.
The basic idea is simple: at rest, the blood flow to the heart is often still sufficient, even if there are already constrictions in the coronary arteries. Only under stress, when the heart needs more oxygen, does the constriction become noticeable. Ultrasound shows this as a wall movement disorder - part of the heart muscle then moves more poorly than at rest.10
Exercise is performed either dynamically on a bicycle ergometer or medically by administering a drug that increases the heart rate.11 Your cardiologist will take ultrasound images before exercise, at the peak of exercise and during the recovery phase and compare them carefully. If new wall motion abnormalities occur during exercise, this is a strong indication of a relevant CHD. Stress echocardiography is not yet offered.
Frequently asked questions about echocardiography (cardiac ultrasound)
Here we answer some of the most common questions that patients ask us about echocardiography.
Is echocardiography harmful or does it have side effects?
No, the Echocardiography is one of the safest examinations in medicine. It is based on ultrasound waves, not X-rays.12 There is no radiation exposure and the examination is absolutely painless and free of side effects.13 It can therefore be repeated as often as required, even for pregnant women or children.
Do I have to be sober for a normal echocardiogram?
No, you do not need to be fasting for the standard external examination (transthoracic echocardiography). You can eat and drink normally before the appointment and take your medication as usual. An exception is stress echocardiography, before which you should not eat a large meal.
How long does an echocardiogram take?
The duration depends on the question being asked and the examination conditions. A normal Echocardiography usually takes between 20 and 40 minutes. Stress echocardiography, including the stress and recovery phase, takes a little longer; please allow about an hour for this.
Can I feel anything during the examination?
You will feel absolutely nothing of the ultrasound waves themselves. You will only notice the cool gel on your skin and the slight pressure of the transducer that the examiner exerts on your chest. The examination is not painful.
Why do I have to lie on my left side?
This position is for the Echocardiography optimal. If you are lying on your left side, gravity moves the heart out of the lung field and closer to the chest wall. This creates a better „window“ to the heart for the ultrasound and significantly improves the quality of the images.
What does the term „ejection fraction (EF)“ mean?
The ejection fraction, often abbreviated to EF, is one of the most important values that can be measured in a Echocardiography can be determined. It is a measure of the heart's pumping power and indicates the percentage of blood ejected from the left ventricle with each beat. A normal value is over 55 percent.
My doctor said something about „Doppler“. What is that?
The Doppler technique is a special procedure within the Echocardiography.14 It makes the speed and direction of blood flow in the heart and in the large vessels visible and measurable.15 With color Doppler, the blood flow is displayed in color (usually red for the flow towards the transducer and blue for the flow away from the transducer), which is particularly important for assessing valvular heart defects.16
Can an echocardiogram predict a heart attack?
One Echocardiography cannot predict whether and when a heart attack will occur. However, it can show the consequences of a heart attack that has already occurred (e.g. scars, wall movement disorders) and reveal important risk factors such as poor pumping function or severe wall thickening.17 Stress echocardiography can also indicate relevant constrictions that increase the risk of a heart attack.
Why is the examiner's experience so important?
The quality of a Echocardiography depends crucially on the experience and care of the doctor performing the procedure. The correct positioning of the transducer, the correct adjustment of the device and, above all, the expert interpretation of the often complex images require years of training and practice. Only in this way can subtle but important findings be reliably recognized and evaluated.
Does echocardiography replace an ECG?
No, the two examinations complement each other perfectly, but they cannot replace each other. The ECG measures the electrical activity of the heart and is unbeatable in the diagnosis of cardiac arrhythmias.18 The Echocardiography on the other hand, assesses the mechanics and structure - i.e. the anatomy and pumping function.19 A comprehensive cardiological picture can only be obtained by combining both procedures.
Precise diagnostics for your heart health
The Echocardiography is a window to the heart - it enables us to assess your heart health precisely, safely and quickly. At the Kardio Pro practice, this examination, carried out by your experienced cardiologist Dr. Raphael Bruno, is a central component of responsible diagnostics and treatment. If an ultrasound examination of your heart is advisable or if you are concerned about your heart, please make an appointment.
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