Echocardiography

Echocardiology is a team of professionally qualified Clinical Physiologists who undergo continuous training to provide the highest standard of service to our patients.

A Transthoracic Echocardiogram (TTE or 'Echo') is a painless scan of the heart using high frequency sound-waves to obtain pictures of the heart in a non-invasive manner. The pictures (digital video loops and still images) are obtained by placing a jelly covered transducer (a small probe) on various parts of the left side of your chest and acquiring information on the ultrasound machine.

The probe receives echoes reflected from various parts of the heart and shows them as an echocardiogram - a picture on a screen.

There are many reasons why your doctor may ask for you to have an echo. These would include:

Palpitations, Irregular heart rhythm, heart attack, prior to chemotherapy or surgery, following a stroke and Angina, amongst others.

The purpose of having an echo is to look at any structural abnormalities or underlying causes of your symptoms, or to assess for any damage caused by angina or heart attack. The echocardiogram can give accurate information about the pumping action of the heart and its valves as well as abnormalities in the structure of the heart or the valves that may be the cause of an arrythmia.

The Stress Echocardiography service provides testing for patients who require an insight in to how the heart performs under stress (i.e. through exercise or by using special medications). This can provide vital information on whether a patient can undergo major surgery or whether they may need further investigations for ischaemic heart disease.

We also provide Transoesophageal Echocardiography (TOE) which is a method of echo which requires placing a probe down the throat of a patient in order to gain clearer images of the heart without the barriers of lungs, ribs or chest wall. Sedation may sometimes be administered to perform this test.

Patients from every area of the hospital who may have an indication for an echo, as well as patients from GP surgeries and other hospitals.

Transthoracic Echo

You will be asked to undress from the waist upwards so that we can access your chest for the scan – a gown will be provided for you to wear. You will then be asked to lie on a couch on your left side. Your heart rate will be monitored through three electrodes placed on your upper chest. The lights in the room will be lowered and a technician will gain images of your heart by placing a transducer on different parts of your chest and acquiring images on the ultrasound machine. Occasionally you may be asked to change position or hold your breath during the scan in order to obtain the best images. The test takes between 30mins and one hour depending on the image quality and the information needed by the doctor.

Dobutamine/Exercise Stress Echo

The test takes place in the Cardiorespiratory Department and lasts about 60 minutes in all. During the procedure you will be looked after by a team, which includes a cardiologist, and a technician.

You will be assisted to lie on a couch. A small plastic tube will be inserted into a vein in your hand before the procedure. This is for the infusion (drip) and/or for a contrast agent to be used which will improve the image quality. A probe will be positioned over your chest to obtain heart images to be seen on the machine screen. You will have some electrodes placed on your chest to allow your DSE team to monitor your heart rate and rhythm.

The Dobutamine infusion will be administered through a controlled drip infusion system according to the instructions of the doctor supervising the procedure. The rate of the infusion will be increased until your target heart rate is reached, but it will be stopped if you begin to experience chest pain or any breathlessness. After stopping the infusion, the drug effects will start to reduce immediately and will completely resolve in about 15 minutes or less. During the test you may experience fast and bounding heart beats. This is an expected response and you should not be unduly alarmed. Further images of your heart will be scanned at different stages of the procedure and during recovery so that a comparison can be made between them.

If your stress test is exercise induced then you will be asked to walk on a treadmill at increasingly faster speeds until your target heart rate is achieved or you have come to the end of your exercise capacity, when you will be asked to lie back on the couch whilst further images are performed.

Transoesophageal Echo

You will lie down on a couch and a small needle will be inserted in the back of your hand. A local anaesthetic spray is used to numb your throat. A small mouth guard will then be placed in your mouth and you will be asked to gently bite on it. This guard protects your teeth from damage by the flexible tube and protects the tube from your teeth. A small amount of sedative drug will then be injected through a needle in the back of your hand to help make you feel relaxed and drowsy.

A probe (transducer) that has been reduced in size to just a few centimetres is mounted at the end of a flexible tube, which you will be asked to swallow.

The tube will then pass from your mouth down your gullet (oesophagus, food pipe) and into your stomach. In this position, the probe will lie directly behind and almost in contact with your heart so that the ultrasound waves can reach the heart very easily without being obstructed by lungs or ribs.

Your results will be sent to your referring Consultant/GP who will contact you or see you in clinic to discuss the results.

There are currently 14 Cardiac Physiologists providing echocardiograms within the Cardio-Respiratoyr department. We are supported by our two Imaging Specialist cardiac Consultants Dr Chenzbraun and Dr Sharma.

In our Royal Liverpool Hospital Site, the waiting area is a clean and airy space situated close to most test rooms a short distance from the main entrance. There is a cold water fountain within the waiting area along with male, female and disabled toilets which are situated within the department. There is a television screen that will advise on waiting times as well as national news and other Trust information. Patient information leaflets are available upon request.

The Broadgreen Hospital waiting area is situated in the corridor adjacent to the department. Toilets are situated in the outpatient waiting area approximately 50 yards away where a water fountain is also available.

There is a WRVS cafeteria/shop near to each department on both sites that visitors can use.

Cardio-Respiratory Department

The Royal Liverpool and Broadgreen University Hospital Trust,

Prescot Street,

Liverpool, L7 8XP

0151 706 2710

Fax - 0151 706 5855

Loop hearing services available at reception.

We are a British Society of Echocardiography (BSE) Accredited Department

BSE departmental accreditation is a recognised benchmark of quality. It indicates to patients, resource allocators and health professionals that an echo department meets realistic quality standards.