Transthoracic Echocardiography

What is transthoracic echocardiography?

Transthoracic echocardiography, usually shortened to TTE, is an ultrasound scan of the heart taken through the chest wall. A small handheld probe called a transducer is pressed against the skin with a layer of gel. It sends harmless high-frequency sound waves into the chest, then listens for the echoes that bounce back from heart muscle, valves, and blood. A computer turns those echoes into moving pictures on a screen. The study shows the size and shape of each chamber, and how strongly the heart squeezes. It also shows whether valves open and close properly, and how blood moves through the heart. It involves no radiation, no needles, and no dye. Nothing is inserted into the body. Most scans take thirty to forty five minutes, and you lie on an exam table throughout. This is the standard echocardiogram. It is the most common heart imaging test performed.

The scan can be done in the office, which makes it a practical first look when heart symptoms appear.

Why Dr. Nanavati may recommend this

An echocardiogram answers questions that a physical exam and an electrocardiogram cannot. It shows structure and pumping function rather than electrical activity.

Common reasons include:

• Shortness of breath, fatigue, swelling in the legs, or reduced exercise tolerance.
• A heart murmur heard during an exam.
• Chest pain that needs a broader heart evaluation.
• Known or suspected valve disease, and periodic follow-up once it is diagnosed.
• Assessment of the heart's pumping strength, reported as the ejection fraction.
• Follow-up after a heart attack, or during treatment that can affect the heart, such as some chemotherapy.
• High blood pressure that may have thickened the heart muscle.

The National Heart, Lung, and Blood Institute describes the range of problems echocardiography can identify.

How to prepare

Preparation is minimal, which is one reason this test is used so often.

• No fasting is needed for a standard study. Eat a light meal rather than a large one, since a full stomach can push against the diaphragm and blur images.
• Take your usual medicines unless you are told otherwise.
• Shower beforehand, and skip lotions, oils, powders, and body sprays on your chest. They interfere with gel contact.
• Wear a two-piece outfit. You will undress from the waist up and wear a gown that opens at the front.
• Bring a list of your medicines and any previous heart test results.
• Allow about an hour at the office, including check-in and gowning.
• Tell the technologist about recent chest surgery, breathing difficulty lying flat, or chest tenderness.

What happens during the procedure

You lie on an exam table, usually on your back first and then turned onto your left side. Turning to the left brings the heart closer to the chest wall and improves the pictures. Small electrodes are placed on your chest or limbs to track your heartbeat during the scan.

Warm gel is applied to the chest. The technologist, called a sonographer, presses the transducer against the skin. The probe moves slowly between the ribs, below the breastbone, and at the base of the neck. Firm pressure is sometimes needed to get a clear window. That can feel uncomfortable but should not be painful. Say so if it is.

You will hear whooshing and pulsing sounds. Those are Doppler recordings of blood flowing, and they are a normal part of the test. You may be asked to hold your breath briefly, to breathe out fully, or to stay still while a clip is recorded. The room is often dim, so the sonographer can see the screen clearly.

Recovery and results

There is no recovery period. The gel is wiped off, you dress, and you leave. Driving, eating, working, and exercise are all fine immediately.

The sonographer records the images, but a cardiologist interprets them. Measurements are compared against normal ranges, and the moving clips are reviewed frame by frame. A written report is usually available within one to a few business days.

Dr. Nanavati will explain the findings in practical terms. He will say how strongly the heart is pumping, and whether any valve needs watching. Many findings simply mean a repeat scan in a year. Others lead to further testing. Advanced stress testing follows if reduced blood flow is suspected, and a transesophageal echocardiogram gives a closer view of a valve or the upper chambers. Treatment may involve medication changes, blood pressure control, or referral for valve care.

Risks and safety

Transthoracic echocardiography is among the safest tests in medicine. Ultrasound at diagnostic levels has no known harmful effects, and the study can be repeated as often as needed. It is safe in pregnancy and safe for children.

The only discomforts are minor. Pressure from the transducer can be tender, especially over the ribs or after chest surgery. The gel feels cool at first, though it is often warmed. Some patients find lying on the left side awkward. Electrode stickers occasionally irritate sensitive skin.

One honest limitation is worth knowing. Image quality depends on your body's acoustic windows. Lung disease, obesity, chest deformity, or scarring can make pictures harder to obtain. A contrast agent may then be used to brighten the chamber borders, or a different test may be recommended. MedlinePlus offers a general overview of heart conditions this study helps evaluate.

Related services and conditions

• Nuclear stress test when blood flow needs assessment.
• Holter monitoring for rhythm questions.
• Heart anatomy explained in plain language.
• Vascular ultrasound for arteries and veins outside the heart.
• Cardiology services at our Bonita, San Diego, and Redding offices.