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Cardiac Tests : What They Are
1. 2D Echo with Colour Doppler
What It Is: Echocardiography uses sound waves to produce 2-dimensional images of the heart by using ultrasound. These high-frequency sound waves are aimed at the heart and its various structures. The heart then reflects these waves, producing an image of a cross-section or ‘slice’ of the beating heart on a monitor.

These 2D images provide details about the structure and physiology of the heart – the heart muscle, its individual chambers, the valves and major blood vessels that enter and exit from the organ. They reveal damage and other abnormalities that may be present.

The 2D Echo test requires no special preparation, and though it uses sophisticated technology, it is easy to conduct.

Electrodes are attached to your chest and shoulders and connected to wires. A gel is applied to your chest and an echo-transducer is moved over it. The echo-transducer sends out ultrasound signals to different parts of your heart as it moves across your chest.

The images received are visible on a monitor and recorded on CD.

Colour Doppler:
The Colour Doppler test is a special part of the 2D Echo test that measures the speed, direction and flow of blood through the vessels of the heart (as opposed to assessing only heart structures).

Named after its inventor, Johann Christian Doppler, this test works on the principle of the Doppler Effect, where the pitch of a sound (ultrasound) alters with a change in the movement and direction of blood flowing through the organ. This test also produces images on a monitor as the sound waves from the transducer bounce off the blood cells and are reflected from them.

Why It’s Done: The 2D Echo test along with a Colour Doppler test help diagnose a range of heart ailments such as cardiomyopathy due to akinesia or dyskinesia due to heart aneurysms, fluid in the pericardium, congenital heart diseases, blood clots or tumours inside the heart, infection of the valves, abnormally elevated pressure within the lungs, and the impact of many other types of heart disease. It can also assess foetal abnormalities in this vital organ.

2. Transesophageal Echocardiogram (TEE)
What It Is: This test is used to get a closer view of the heart than a 2D Echo test can provide as it eliminates interference with ultrasound waves from the lungs and rib cage. For this test, an endoscope is inserted through your oesophagus or ‘food pipe’ till it is appropriately positioned near the heart.

Next, ultrasound waves are then sent out to the heart to obtain clear and precise images of the organ’s chambers and valves.

The TEE is combined with the Color Doppler test to assess the blood flow across the heart’s valves. It can thus evaluate the pumping action of the heart.

Precautions: A TEE requires you to abstain from eating anything 6-7 hrs before and 2 hours after the test. No pungent food should be eaten all day, both before and after the test as this may irritate the gastrointestinal tract. Also, if you are on any medication for either diabetes or heart conditions, you need to inform your cardiologist of the same. Also, you may be drowsy for a short while after the test as you may receive intravenous medication to help you relax.

Why It’s Done:
This test is used to assess the presence of heart diseases such as valvular heart disease, myocardial disease, pericardial disease, cardiac masses and congenital heart disease. It can also be used post-surgery to assess the success of surgical intervention.

3. Dobutamine Stress Echo
What It Is: Dobutamine is a drug that stimulates cardiac output in acute conditions such as cardiac arrest, congestive heart failure and cardiac shock. Thus, when administered, the medication increases the work done by the heart, which also increases when you use a treadmill. Hence, this test is administered to individuals who are not mobile or who cannot use a treadmill.

In the Dobutamine Stress Echo test, you are administered dobutamine through an intravenous (IV) line, while being continuously monitored. While the heart is ‘under stress’, an echocardiogram is then administered to view the impact of such stress on the structure and functioning of the organ and its various structures.

As is the case with other types of echocardiograms, this test too is usually combined with a Colour Doppler to determine blood flow through the heart’s blood vessels and chambers.

Precautions
: This test requires you to observe certain precautions with regard to food and medications before and after the test. Patients are advised not to eat for up to 2 hours before the test and to avoid caffeine or any other stimulants for up to 24 hours before the test. You need to observe certain precautions with regard to medications as well. Hence, kindly inform your cardiologist of any drugs you may be taking.

Why It’s Done
: A Dobutamine Stress Echo is performed to determine the effect of ‘stress’ on the heart. In other words, it assesses how well your heart tolerates stress or exertion. It may also be used to assess the likelihood of coronary artery disease or simply how effective your cardiac treatment plan may be.
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