For avid fishermen, the ability to 'see' underwater to determine choice fishing spots is key to a successful day of fishing. Some of them use ultrasound to help them find schools of fish. The ultrasound waves are created and beamed through the water, and when they encounter fish—marked by a change in the density of the water—the ultrasound bounces back to the fisherman in the boat. The fisherman's ultrasound equipment can analyze the beam to determine the shape and size of the objects bouncing back. So with the aid of ultrasound, the lucky fisherman has found fish.
Rodney Graber, MD, FACC, a cardiologist at Augusta Health who enjoys fishing, also uses ultrasound when diagnosing and managing heart disease with his patients. He uses echocardiograms, a test that uses ultrasound to make images of the heart's chambers, valves, walls and blood vessels.
"The echocardiogram provides sophisticated and advanced imaging," explained Dr. Graber. "It's capable of displaying a cross-sectional "slice" of the beating heart. We can see a lot of things with an echo in addition to simply the size and the shape of the heart. We can see if the valves are working correctly, or if there is narrowing or leakage of the valves, and if present, determine the severity of the leakage. We can evaluate murmurs, and determine if there is scarring from an infection or rheumatic fever. We can also see scars or thickened walls. We can diagnosis fluid in the outer lining of the heart (or pericardium), and evaluate blood clots and tumors. It's an incredibly useful tool for both diagnosis and ongoing treatment."
Dr. Graber often performs echocardiograms on patients with long-standing high blood pressure, heart murmurs, previous heart attacks or heart failure. That's because the test can determine the thickness and 'stiffness' of the wall of the heart or the size of the heart attack.
"When the heart pump function is reduced in patients with prior heart attacks or heart failure, the heart tends to dilate, or enlarge," said Dr. Graber. "We can tell if the pumping power of the heart is normal or reduced to a mild or severe degree. This measurement is called the 'ejection fraction' or EF. A normal EF is 55% to 65%, while below 35% represents a decrease in the pumping strength of the heart."
An echocardiogram, which is performed by a specially trained technician does not hurt and has no side effects. During the test, the technician will place sticky patches with electrodes on the patient's body. These patches are connected to a machine that records an electrocardiogram (EKG) to track the heartbeat during the test to help time the various cardiac events. The technician will also put gel on the chest to help the ultrasound waves pass through the skin. A probe called a transducer is placed on the patient's chest, which produces the ultrasound waves that bounce back (or echo back) from the heart and create images. These images are recorded for the doctor to analyze.
Depending on what the images reveal, cardiologists like Dr. Graber make a diagnosis and develop a course of treatment.
Will Clark, RCS, RVS, is the lead registered cardiac sonographer at Augusta Health Cardiology with more than 18 years experience in his profession. The Cardiac Sonographers perform several tests for cardiac patients, including adult transthoracic echo, stress echo (exercise and pharmacological) and assist the cardiologists with transesophageal echo.
"With an echocardiogram, we are assessing the beating heart's function and its entire structure from multiple angles. We do this in real time as well as record still frame and sequential loops of the beating heart. The echocardiogram also includes a single lead EKG (electrocardiogram) so we can confirm the synchronization of the heart as it beats," he explains. "While a Doppler echo can be used to measure the velocity of the blood. An exercise stress echo focuses on the left ventricle, the main pumping chamber of the heart that supplies oxygenated blood to the organs of the body. The echocardiogram is used in conjunction with a 12 lead EKG to obtain information about the heart under stress. The cardiologist evaluates the overall response of the heart from rest to peak to determine if all parts of the heart muscle contribute equally to the contraction of the heart. With this, we are able to use various types of echocardiograms to help us precisely diagnose and treat heart disease."
Clark has worked in the field long enough to experience many advancements in echocardiography. Echocardiogram equipment has improved image quality from single and cross-sectional dimensions to real 3D images. When he first entered the field, the three-dimension loop process took 20 minutes to develop a single heartbeat, and now a complete 3D study can be performed in real-time in high definition. The volumes at Augusta Health have grown, too, and the staff now completes 450 to 500 echocardiograms each month.
"The echocardiogram is a versatile, yet precise, tool for finding, diagnosing and treating heart disease in our patients, without having to make an incision or insert a tube or wire," summarizes Dr. Graber. "While some of our patients do require other, more invasive treatments, many are treated non-invasively. Those with symptoms of high blood pressure or heart disease should discuss their risks and symptoms with their physician to determine if an echocardiogram or diagnostic procedure is the most appropriate for them."
Rodney Graber, MD, FACC, is a cardiologist at Augusta Health Cardiology. He completed his undergraduate studies at Eastern Mennonite University and medical school at the Medical University of Ohio in Toledo. His residency was at the University of Virginia and he completed a fellowship in Cardiovascular Medicine at Ohio State University. He is Board-Certified in Internal Medicine, Cardiovascular Medicine, Adult Echocardiography and Nuclear Cardiology. He is also an avid fisherman and outdoorsman.
Originally published in the Staunton News Leader's Heart Healthy Section on February 12, 2017.