Detecting heart problems with echocardiogram

Echocardiogram - also called an echo test - is a heart ultrasound that takes moving pictures of the heart with sound waves to spot potential abnormalities.

“It is a basic and non-invasive method of examining the overall function of a patient’s heart,” said Dr Goh Ping Ping, a cardiologist at Mount Elizabeth Hospital in Singapore.

She added that this instrument allows cardiologists to capture the size and structure of a patient’s heart from different angles, while also measuring the efficiency of its chambers and valves.

This information is vital in identifying a range of heart abnormalities such as an enlarged heart, narrowed or leaking valves, a blood clot or the presence of fluid around the heart, to name a few.

It could also help rule out certain heart conditions early so that patients may not require more invasive tests.

“Through this test, we can also measure the condition of the heart muscles after a heart attack,” explained Dr Goh.

On top of that, an echo test is a painless examination with no age limitations, making it a viable method to detect congenital heart defects in newborns.

According to Dr Goh, most patients who exhibit symptoms such as chest pain, breathlessness, irregular heartbeat or loss of stamina, are recommended to undergo an echo test.

Patients with abnormal test results that could suggest risks of developing a heart condition, such as high blood pressure or abnormal levels of low-density lipoprotein (LDL) cholesterol, are also advised to do an echo test.

Different echos for different needs

Depending on the information needed, a patient may require one or a combination of several types of echocardiograms.

Transthoracic echocardiogram is the most basic as well as non-invasive echo test, said Dr Goh.  

The test involves moving a special probe around the chest or upper abdominal area of the patient to detect several heart dysfunctions like cardiomyopathy (thick or weakened heart muscles), heart failure, enlarged muscle chambers or congenital defects.

“If a clearer view of the heart or further assessment is required, then we may need to use a different kind of echo test,” she explained.

One option is to carry out a transesophageal echocardiogram. The procedure involves inserting a flexible tube into the oesophagus to gather more details of the heart from behind the heart chambers, without the interference of the ribs and muscles of the chest wall. Patients are usually given a sedative drug during this procedure to remain at ease.

Compared to transthoracic echo, this approach offers an improved visualisation that allows cardiologists to detect more specific conditions such as valve leakage, a hole in the heart, blood clots and any infections.

Since physical activity may worsen some heart problems, patients are sometimes asked to do some exercise in order to measure their ability to cope with it. These problems - mainly to detect decreased blood flow to the heart muscles or coronary artery blockage - are evaluated using a stress echocardiogram.

The examination usually involves running on a treadmill to put the patient’s heart under supervised stress and assess its ability to pump blood effectively.

However, some patients are unable to do many physical activities, hence they are given an infusion of dobutamine – a medication that mimics the effects of exercise on the cardiovascular system by making the heart beat harder and faster.

“Dobutamine echo doesn’t present any increased risk compared to an exercise stress echo because dobutamine is like the substances the body normally produces when we get active,” said Dr Goh.

The main goal of a stress echocardiogram is to detect the presence of a blockage in the arteries – a condition that may result in a heart attack. However, the test cannot determine the exact position of the blockage.

In order to do that, a more comprehensive assessment is required. This may involve other diagnostic tests that are more invasive or present more risks than an echo, such as cardiac computerised tomography (CT), coronary angiogram or MRI.

Dr. Goh Ping Ping is a cardiologist practising at Mount Elizabeth Hospital in Singapore with a vast experience in treating patients with a wide range of cardiovascular diseases. In addition, she is trained in specialised procedures including echocardiogram and coronary angiogram.

Asian Heart & Vascular Centre
3 Mount Elizabeth #16-07
Mount Elizabeth Medical Centre
Singapore 228510
Tel: (+65 6887 3422)