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Cardiac echocardiography is a safe and non-invasive test that provides the clinical team with important cardiac function data. This functional data is needed to care for patients with many pathologies and used to diagnose a number of diseases. This activity discusses echocardiography procedure details including relevant anatomy, clinical indications, and potential limitations and highlights the role of an interprofessional team in caring for patients requiring this valuable diagnostic test. Objectives: Identify the indications of echocardiography. Describe the equipment/personnel needed in performing echocardiography. Review the clinical significance of various echocardiographic modalities. Outline interprofessional team strategies for improving care coordination and communication to advance echocardiography and improve outcomes. Access free multiple choice questions on this topic.

Echocardiography is the use of ultrasound to evaluate the structural components of the heart in a minimally invasive strategy. Although, prior to the invention of today's routinely used 2-dimensional echocardiography, there was motion-based (M-mode) echocardiography. In 1953, Inge Edler, regarded as the father of echocardiography, first described M-mode technology, which began the era of diagnostic noninvasive echocardiography.[1] M-Mode echocardiography was the combination of amplitude-based (A-mode) ultrasonography with Brightness-based (B-mode) techniques, which allowed the addition of a "time" dimension when the B-mode was swept across the oscilloscope; however this was not a picture, per se, but how structures evolved through the cardiac cycle.[2] This was the primary technology until two-dimensional (2D) ultrasonography was developed over the next decades. In 1973, S.L. Johnson developed 2D ultrasonography and doppler technology, which ultimately allowed physicians to detect blood flow in vessels, and, in 1979, Holen and Hatle found that by using the Bernoulli equation they could detect pressure gradients.[1] The combination of all these technologies is the echocardiography that is commonly used every day in today's medical profession. The most commonly used technique among these is transthoracic echocardiography (TTE). This allows the clinician to obtain real-time sizes, structure, and function of the heart during the cardiac cycle. Another useful and important use of these methods is stress echocardiography. Stress echocardiography is the combination of standard transthoracic echocardiography and either pharmacological or physical stress to the cardiac structures to assess wall motion abnormalities. Physical stresses may include running on a treadmill, and pharmacological stress, including medications.[3] When higher resolution imaging of cardiac structures, including valves, is required, transesophageal echocardiography (TEE) is considered. TEE is more invasive than standard TTE, as it requires the insertion of a probe into the patient's esophagus to obtain images not hindered by the patient's chest wall, including; muscle, tissue, and bone. When more accurate and even higher-resolution imaging is needed, during intracardiac procedures, intracardiac echocardiography (ICE) is an option that can be considered.

The most commonly used technique among these is transthoracic echocardiography (TTE). This allows the clinician to obtain real-time sizes, structure, and function of the heart during the cardiac cycle. Another useful and important use of these methods is stress echocardiography. Stress echocardiography is the combination of standard transthoracic echocardiography and either pharmacological or physical stress to the cardiac structures to assess wall motion abnormalities. Physical stresses may include running on a treadmill, and pharmacological stress, including medications.[3] When higher resolution imaging of cardiac structures, including valves, is required, transesophageal echocardiography (TEE) is considered. TEE is more invasive than standard TTE, as it requires the insertion of a probe into the patient's esophagus to obtain images not hindered by the patient's chest wall, including; muscle, tissue, and bone. When more accurate and even higher-resolution imaging is needed, during intracardiac procedures, intracardiac echocardiography (ICE) is an option that can be considered. Echocardiography is a low cost, at times minimally invasive, and readily available test that can provide information that can change the treatment course, and in some cases, provide real-time life-saving information. Many of the clinical uses of echocardiography are multidisciplinary in practice, and the overlap between the different utilities of echocardiogram is large. The addition of contrast to echocardiography, or the addition of strain to TTE are all examples of combinations of these utilities. The utilization of echocardiography is vast and can be applied in a variety of ways and a wide range of situations, and these forms will be discussed in detail.

There is limited risk associated with TTE. There are, however, risks of esophageal perforation and bleeding with TEE. In those undergoing stress echocardiography, there is a risk of cardiac arrhythmias when administering medications to increase a patient's heart rate. Intracardiac echocardiography has an additional risk of bleeding as venous access must be obtained to insert the catheter.[21] Furthermore, there is a risk of puncture to the cardiac structures while the catheter is in the heart anatomy, including wall rupture, hematoma, effusion, or tamponade.

The decision to order an echocardiogram requires an interprofessional team approach. The assessment of fluid status is a physical exam finding that can be performed not only by physicians but also by the nursing staff, and this can be used to help aid in the decision to order an echocardiogram. Interprofessional communication is important when treating any patient, including those with a cardiac history, and it is vital for all staff to continuously assess a patient's fluid status and need for further imaging assessments. Adequate communication about the specific indication for echocardiography for each specific patient, will help ensure optimal views and help improve the clinical utility of this test.