All About The 2D Echo

Has your doctor recently referred you for an echocardiogram, or a 2D echo? If so, you’re not alone! Over 10 million echocardiograms are done in the United States every year. But maybe this is an exam you’ve never heard of before.  If you’re asking yourself, what a 2D echo or echocardiogram is, then keep on reading.

The 2D echo is a 100% noninvasive test. The relative low cost of a 2D echo test and the fact that this heart ultrasound can be performed quickly, the 2D echocardiogram has become one of the standard diagnostic tools in cardiology.

In addition, cardiac ultrasound has the potential to thoroughly evaluate left and right ventricular systolic function, the left ventriular ejection fraction, diastolic function, regional wall motion, valvular disease and pericardial diseases.

The 2D Echo

An echocardiogram, or 2D echo or heart ultrasound an ultrasound examination that uses very high frequency sound waves to make real time pictures and video of your heart.  Things that will be seen during a 2D echo test are the heart’s chambers, heart valves, walls and large blood vessels that are attached to your heart.

Why Do I Need A Heart Ultrasound?

Your doctor may use a 2D echo test to look at your heart’s structure and check how well your heart functions.  Some of the more common things an echocardiogram can help your doctor find are:

• Your hearts ability to pump blood to the rest of your body
• The overall shape and size of your heart.
• The thickness of your heart muscle
• Assess the health and function of your heart valves (valve disease)
• See if any clots or tumors have developed inside your heart
• To check for fluid around your heart
• Health of the perciardium, or lining, around your heart
• Look at the larger vessels attached to your heart
• See if there are any holes in your heart where there shouldn’t be any

What Are Some Of The Indications To Have An Echocardiogram?

Some of the more common indications doctors would order an echocardiogram are:

• Heart murmur
• Shortness of breath or dyspnea
• Heart rhythm abnormalities, such as atrial fibrillation and SVT.
• An abnormal Electrocardiogram
• Palpitations or heart fluttering
• History of heart disease
• Congestive heart failure (CHF)
• History of myocardial Infarction (heart attack)
• Congenital abnormalities

These are just a few of the reasons why you could have a heart ultrasound.  The actual list of indications for a 2D echo is very extensive.

What To Expect During An Echocardiogram

Echocardiograms are performed by specially trained ultrasound technicians. Your 2D echo can be completed in your doctor’s office, in an emergency room, an operating room, an outpatient clinic or a hospital room. These ultrasounds of the heart usually take between 30 to 45 minutes to complete.

Where The Echocardiogram Be Performed

An echocardiogram can be done in the doctor’s office or a hospital. After undressing from the waist up, you’ll lie on an examination table or bed. The technician will attach sticky patches (ecg electrodes) to your body to help detect and conduct the electrical currents of your heart.

What You Will Wear During An Echocardiogram

Before the heart ultrasound begins, you will be asked to undress from the waist up. Female patients are asked to wear a gown. After undressing, you will be asked to lie down on an examination table or bed.

The Echo Tech will place 3 EKG electrodes (EKG stickers) on our chest and attach a wire to each sticker.  The purpose of the electrodes is so the echo tech can monitor your heart rhythm. This is also how the echo machine captures the images, or loops. Once this is set up, you’ll be asked to lie on your left side.  You can ask the technician for additional pillows if needed.

The Procedure

The ultrasound technician may dim the lights in the exam room. This is done so the technician can better visualize the echo images on the screen. The technician will apply a small amount of ultrasound gel to the transducer and apply it to the center of your chest.

A transducer is a small, plastic device that sends and receives the ultrasound waves. The purpose of the gel is to help transmit the high frequency sound waves from the transducer to your body, and eliminates the thin air gap between your skin and the transducer.

The cardiac sonographer will follow a set echo protocol to ensure that all of the required images are captured for your doctor to review. This can range anywhere from a total of 60 to 100 echo images.

2D Echo Imaging Windows

The ultrasound technician will move the transducer around several different locations around your heart. They will most likely start in the center of your chest then move down onto the left side of your chest.  For females, this will be the area underneath your left breast. In order to reach this area while you are positioned on your left side, the ultrasound tech will drop a “trap door” in the bed or remove a “drop out”.  Next, echo images will be taken from your upper stomach, looking at your heart from underneath your rib cage. Finally, the technician may need additional images looking down at your heart from the middle of your neck.

Other Things To Expect During A 2D Echo

Throughout the entire ultrasound exam, sound waves are continuously creating images of your heart on a monitor. The ultrasound technician will frequently pause the recording to take measurements and record the images. You may hear beeps and other noises while this is taking place.

You’ll also hear a whooshing sound which is the ultrasound recording the blood flowing through your heart. Many people say that the sound of the blood moving through your heart sounds like an old time washing machine.

Most of the time, a 2D echo take less than an hour to complete, but the timing may vary depending on why you’re having the test done. During the heart ultrasound, you may be asked to breathe in a certain way, hold your breath or roll onto your right side in addition to your left.

Not every patient is photogenic. Sometimes the ultrasound transducer must be held firmly against your chest which can at times be uncomfortable. But please note, that this helps the technician produce the best images of your heart.

If the technician still is unable to see the images he needs, it may be necessary to use an image enhancing agent, or imaging contrast.  Although this is not a true contrast, it will help significantly with acquiring the images the doctor needs to make a good interpretation. The use of image enhancing agents does require an IV.

Risks Associated With Echocardiography

The 2D echo does not come with any risks and it should not be extremely painful. If you have a sensitivity to the adhesive on EKG stickers, then you should make sure that the ultrasound technician knows this.  Also, if you have a known allergy to image enhancing agents, such as Definity, let them know this too.

How To Prepare For A 2D Echo Test

There is no preparation for the echocardiogram. You can eat and drink like normal before the ultrasound. You may just want to make sure that you use the restroom before you check in for your echo, as you may be in the exam room for 30 minutes or more.

What Is An Echocardiogram: FAQ

What Will A Heart Ultrasound Show?

The amount of information that’s shown on an echocardiogram is huge, and the answer to this question can be very long. To give a quick answer, an echocardiogram will show the overall function of your heart.  What does this mean?

The Ejection Fraction

One of the most common things doctors want to know from an echocardiogram is the left ventricular ejection fraction, or EF.  The ejection fraction is a measurement of how efficiently the left ventricle is pumping.  The LV EF is measured as a percentage of blood that is pumped out of the left ventricle with each cardiac cycle.

To measure the left ventricular ejection fraction, the cardiac sonographer will measure the volume of the left ventricle in diastole, when it’s at its fullest, then again in systole, when the ventricle is at its emptiest. This measurement is taken in two different views.

Depending on the type of ultrasound machine that is used for your echocardiogram exam, the cardiac sonographer may also measure your left ventricular ejection fraction by using 3D ultrasound.

Monitoring Valvular Disease

Other common information that doctors request from 2D echo is heart valve health.

Over time, heart valves can begin to narrow. As the valve narrows, the heart must work harder in order to pump blood through the narrowing. Over time, the heart muscle begins to fail and can lead to heart failure.

Narrowing of the heart valves is also a condition that some people are sometimes born with.  In both cases, echocardiography is used to monitor the severity and any changes in the narrowing.

Valvular regurgitation, or blood flowing backwards through the valve, is another common valvular disease.  Typically, it is normal for trace amounts of blood to flow backwards through the heart valves.  This is called physiologic regurgitation.  For numerous reasons, blood can begin to flow backwards through a closed valve.

Over time, valvular regurgitation can become significant enough that the heart chambers can begin to overload and eventually lead to heart failure.

Can An Echocardiogram Show Clogged Arteries?

Generally speaking, no. A heart ultrasound does not show clogged arteries.  The reason a 2D echo doesn’t show clogged arteries is because the coronary arteries are simply just too small to see with ultrasound.

However, the larger arteries surrounding your heart can easily be seen with ultrasound. For example, it is standard practice to view the aorta and the pulmonary artery during a routine echocardiogram.

This doesn’t mean that we can’t see any of the coronary arteries with ultrasound though.  With the advancement in ultrasound technology, it is quite common to see the origin of the left and right coronary arteries on a good quality 2D Echo. But we usually can only follow those arteries for a centimeter or two before we are no longer able to track them.

On pediatric echocardiogram, viewing the origin of the coronary arteries is a very important part of the test. But for adults, it’s just too difficult to do.

The medical exam that is usually used to view clogged arteries is the angiogram. This is when they introduce die into your coronary arteries and can visualize blockages and pinpoint exactly where they are located.

Final Thoughts

I hope this guide has been able to answer some of the questions you might have had regarding what and echocardiogram is and what it does.

If you still have any questions, please don’t hesitate to leave a comment below…or shoot me an email.  I always respond to both.  Thanks!

Echocardiogram Video