Overview of Transesophageal Echocardiogram
Echocardiography is a technique that uses sound waves, similar to an ultrasound, to visualize the heart and the large blood vessels that connect to it. These images are captured by using a device called an ultrasound probe. There are four essential views obtained from this process, which are the most effective in determining the reason behind a cardiac arrest. Getting these views is usually straightforward.
Why do People Need Transesophageal Echocardiogram
There are certain situations where a limited four-view rescue exam might be needed. These situations might involve a patient who is unstable with unknown disturbances in their blood flow. It might be needed in cases where there is suspected disease of the heart valves, or a problem with blood clots. This exam can also be used to guide CPR in emergency situations involving cardiac arrest. It can help doctors both diagnose the problem and monitor how effective the CPR is.
When a Person Should Avoid Transesophageal Echocardiogram
There are certain situations when a medical procedure might be too risky or not recommended. These could include if someone:
– Has known esophagus disease which might involve a narrowing of the esophagus (stricture), small pouches or pockets in the wall of the esophagus (diverticuli), swollen veins in the esophagus (varices), or tumors.
– Had earlier surgery on the esophagus or stomach.
– Has a ruptured organ in their body (perforated viscus).
– Is unwilling or unable to cooperate with the medical team.
There are also some cases where a medical procedure could be more risky than usual but still might be done. This might be if someone:
– Has neck (cervical spine) disease.
– Has a hiatal hernia, where a part of the stomach pushes up through the diaphragm muscle.
– Has a blood condition that makes it difficult to stop bleeding (coagulopathy).
– Has had radiation therapy to the chest in the past.
– Has injury to the face or airway.
Please remember your specific health situation is unique, and your doctor will discuss these risks with you when considering the best course of treatment.
Equipment used for Transesophageal Echocardiogram
The tools needed are a piece of equipment called a transesophageal (TEE) probe, a machine that uses sound waves to create images (known as an ultrasound machine), and a sufficient quantity of a special type of lubricant known as gel.
Preparing for Transesophageal Echocardiogram
Before placing the probe for a Transesophageal Echocardiogram (TEE) – a test that produces pictures of your heart – patients require a procedure called tracheal intubation. This involves inserting a tube into a patient’s windpipe through the mouth or nose to maintain an open airway. They will also have cardiac monitoring – a way of keeping track of the heart’s function throughout the process. These steps are important to ensure the patient’s safety during the procedure.
How is Transesophageal Echocardiogram performed
A TEE (transesophageal echocardiogram) is a type of test that uses a small, flexible tube with a device (probe) at the end to send out sound waves. Doctors use this probe to create detailed pictures of the heart. To do this, the doctor will gently place the well-lubricated TEE probe into the throat, then move it down into the esophagus (the tube that connects your throat to your stomach). They do this carefully, making sure the probe is in the right position.
The TEE probe is pretty special: it can be moved around to angle up or down, just like instruments doctors use to look at your throat or lungs (called a bronchoscope or flexible laryngoscope). The head of the TEE scope is flat and houses a movable part called the ‘multiplane’. This multiplane can be moved around or turned in different directions using a button. The doctor uses one hand to manage the scope, while the other hand makes sure it stays in the right position in the patient’s mouth. They get different views of your heart by turning this multiplane and pointing the tip of the scope in different directions.
The first important view is called the Midesophageal Four-Chamber view (MEFC). This is the easiest one to get and provides the most information about the heart. From this view, the doctor can see all four chambers of your heart and how well they’re working. They can check the blood flow, fluid status, and whether there’s any blood build-up around the heart. They can also check the heart function during chest compressions, identify a very slow and irregular heart rhythm called ventricular fibrillation (Vfib), and the presence of any large blood clots in the heart’s right chambers. Even though a TEE isn’t the best method for diagnosing blood clots in the lungs, it does provide helpful information, especially when the patient isn’t stable enough for other imaging tests like CT or MRI.
The second important view is called the transgastric, midpapillary, short axis (TGMPSA) view. This involves moving the probe farther into the patient’s stomach and turning the tip to face back towards the heart. From this angle, the doctor can examine the heart’s function, and check for any blockages in the coronary arteries, which supply blood to the heart. They can also examine the sack around the heart for any fluid build-up and estimate whether there’s too much fluid pressuring the heart (a condition called tamponade). This view gives better information about which coronary artery might be blocked, and therefore, which one should be treated first—things that can help save time in emergency situations.
Other views such as the Midesophageal Long Axis View (MELA) and the Midesophageal Bicaval View (MEBC) provide additional visual information about the heart’s valves and the size and structure of the heart’s other chambers. From the MEBC view, doctors can also screen for blood clots in the veins, evaluate the size of the right atrium, and check for a possible clot in case a condition like a pulmonary embolism (blocking of a lung artery by a blood clot) is suspected.
Understanding and mastering the use of these views is incredibly important, especially during emergencies or when treating conditions like a heart attack. Once all the required data is collected, the probe is reset to its initial position and carefully withdrawn.
Possible Complications of Transesophageal Echocardiogram
The riskiest complication after this procedure is a tear in the esophagus, which occurs very rarely – in about 0.03% of cases.
What Else Should I Know About Transesophageal Echocardiogram?
When a patient comes to the emergency department with a heart attack, a medical imaging technique known as Transesophageal Echocardiography (TEE) can offer important insights in a safe, quick, and low-risk manner. This can help in improving the recovery chances and survival rate of the patient.
In acute cases of heart attack, TEE can identify the weakened area of the heart muscle. This can guide the heart doctor to understand which blood vessel is affected, calculate the proportion of blood being pumped out of the heart during each beat (ejection fraction), assist in placing a balloon within the artery to improve blood flow, help understand the patient’s fluid levels, identify unpredictable causes, and direct the treatment plan.