OBT356 LIFESTYLE DISEASES

UNIT III
CARDIOVASCULAR DISEASES
Coronoary atherosclerosis – Coronary artery disease; Causes -Fat and lipids, Alcohol
abuse -– Diagnosis - Electrocardiograph, echocardiograph, Treatment, Exercise and
Cardiac rehabilitation

CARDIOVASCULAR DISEASES
Cardiovascular disease (CVD) is a general term for conditions affecting the heart
or blood vessels.
It's usually associated with a build-up of fatty deposits inside the arteries
(atherosclerosis) and an increased risk of blood clots.
It can also be associated with damage to arteries in organs such as the brain, heart,
kidneys and eyes.
CVD is one of the main causes of death and disability but it can often largely
be prevented by leading a healthy lifestyle.

Types of CVD

There are many different types of CVD. 4 of the main types are.
1.Coronary heart disease
Coronary heart disease occurs when the flow of oxygen-rich blood to the heart muscle is
blocked or reduced.
This puts an increased strain on the heart, and can lead to:

 angina – chest pain caused by restricted blood flow to the heart muscle
 heart attacks – where the blood flow to the heart muscle is suddenly blocked
 heart failure – where the heart is unable to pump blood around the body
properly
2.Strokes and TIAs
A stroke is where the blood supply to part of the brain is cut off, which can cause brain
damage and possibly death.
A transient ischaemic attack (also called a TIA or "mini-stroke") is similar, but the blood
flow to the brain is only temporarily disrupted.
The main symptoms of a stroke or TIA can be remembered with the word FAST, which
stands for:

 Face – the face may have drooped on one side, the person may be unable to
smile, or their mouth or eye may have dropped.
 Arms – the person may not be able to lift both arms and keep them there
because of arm weakness or numbness in one arm.
 Speech – their speech may be slurred or garbled, they may not be able to talk at
all or they may not be able to understand what you are saying to them.
 Time – it's time to dial 999 immediately if you see any of these signs or
symptoms.
3.Peripheral arterial disease
Peripheral arterial disease occurs when there's a blockage in the arteries to the limbs,
usually the legs.
This can cause:

 dull or cramping leg pain, which is worse when walking and gets better with rest
 hair loss on the legs and feet
 numbness or weakness in the legs
 persistent ulcers (open sores) on the feet and legs
4.Aortic disease
Aortic diseases are a group of conditions affecting the aorta. This is the largest blood
vessel in the body, which carries blood from the heart to the rest of the body.
One of most common aortic diseases is an aortic aneurysm, where the aorta becomes
weakened and bulges outwards.
This doesn't usually have any symptoms, but there's a chance it could burst and cause
life-threatening bleeding.

Causes of CVD
The exact cause of CVD isn't clear, but there are lots of things that can increase your risk
of getting it. These are called "risk factors".
The more risk factors you have, the greater your chances of developing CVD.
If you're over 40, you'll be invited by your GP for an NHS Health Check every 5 years.
Part of this check involves assessing your individual CVD risk and advising you how to
reduce it if necessary.
1.High blood pressure
High blood pressure (hypertension) is one of the most important risk factors for CVD. If
your blood pressure is too high, it can damage your blood vessels.
2.Smoking
Smoking and other tobacco use is also a significant risk factor for CVD. The harmful
substances in tobacco can damage and narrow your blood vessels.
3.High cholesterol
Cholesterol is a fatty substance found in the blood. If you have high cholesterol, it can
cause your blood vessels to narrow and increase your risk of developing a blood clot.
4.Diabetes
Diabetes is a lifelong condition that causes your blood sugar level to become too high.
High blood sugar levels can damage the blood vessels, making them more likely to
become narrowed. Many people with type 2 diabetes are also overweight or obese,
which is also a risk factor for CVD.
5.Inactivity
If you don't exercise regularly, it's more likely that you'll have high blood pressure, high
cholesterol levels and be overweight. All of these are risk factors for CVD.
Exercising regularly will help keep your heart healthy. When combined with a healthy
diet, exercise can also help you maintain a healthy weight.
6.Being overweight or obese
Being overweight or obese increases your risk of developing diabetes and high blood
pressure, both of which are risk factors for CVD.
You're at an increased risk of CVD if:
  your body mass index (BMI) is 25 or above – use the BMI healthy weight
calculator to work out your BMI
 you're a man with a waist measurement of 94cm (about 37 inches) or more, or a
woman with a waist measurement of 80cm (about 31.5 inches) or more
7.Family history of CVD
If you have a family history of CVD, your risk of developing it is also increased.
You're considered to have a family history of CVD if either:
 your father or brother were diagnosed with CVD before they were 55
 your mother or sister were diagnosed with CVD before they were 65
Tell your doctor or nurse if you have a family history of CVD. They may suggest checking
your blood pressure and cholesterol level.
8.Ethnic background
In the UK people of south Asian and Black African or African Caribbean background
have an increased risk of getting CVD.
This is because people from these backgrounds are more likely to have other risk
factors for CVD, such as high blood pressure or type 2 diabetes.
9.Other risk factors
Other factors that affect your risk of developing CVD include:

 age – CVD is most common in people over 50 and your risk of developing it
increases as you get older
 gender – men are more likely to develop CVD at an earlier age than women
 diet – an unhealthy diet can lead to high cholesterol and high blood pressure
 alcohol – excessive alcohol consumption can also increase your cholesterol and
blood pressure levels, and contribute to weight gain
Preventing CVD
A healthy lifestyle can lower your risk of CVD. If you already have CVD, staying as
healthy as possible can reduce the chances of it getting worse.
1.Stop smoking
If you smoke, you should try to give up as soon as possible.
2.Have a balanced diet
A healthy, balanced diet is recommended for a healthy heart.
A balanced diet includes:

 low levels of saturated fat – try to include healthier sources of fat, such as oily
fish, nuts and seeds, and olive oil, and avoid unhealthy fats such as fatty cuts of
meat, lard, cream, cakes and biscuits
 low levels of salt – aim for less than 6g (0.2oz or 1 teaspoon) a day
 low levels of sugar
 plenty of fibre and wholegrain foods
 plenty of fruit and vegetables
3.Exercise regularly
Adults are advised to do at least 150 minutes of moderate activity a week, such as
cycling or brisk walking.
If you find it difficult to do this, start at a level you feel comfortable with and gradually
increase the duration and intensity of your activity as your fitness improves.
Visit your GP for a health check if you haven't exercised before or you're returning to
exercise after a long break.
4.Maintain a healthy weight
If you're overweight or obese, a combination of regular exercise and a healthy diet can
help you lose weight.
If you're struggling to lose weight, your GP or practice nurse can help you come up with
a weight loss plan and recommend services in your area.
5.Cut down on alcohol
If you drink alcohol, try not to exceed the recommended limit of 14 alcohol units a week
for men and women.
If you do drink this much, you should aim to spread your drinking over 3 days or more.
A unit of alcohol is roughly equivalent to half a pint of normal-strength lager or a single
measure (25ml) of spirits. A small glass of wine (125ml) is about 1.5 units.
Your GP can give you help and advice if you're finding it difficult to cut down your
drinking.
6.Medicine
If you have a particularly high risk of developing CVD due to high blood cholesterol,
your GP may recommend taking medicines called statins to reduce your risk.

Link to study CVD

https://www.youtube.com/watch?app=desktop&v=qJq5hA4pnOk

CORONOARY ATHEROSCLEROSIS - CORONARY ARTERY DISEASE

Atherosclerosis -- sometimes called hardening of the arteries -- can slowly narrow the
arteries which supply oxygen-rich blood to the heart and to your body.

When atherosclerosis affects arteries that carry blood to the heart muscle, it’s called coronary
artery disease, or CAD. That’s the No. 1 killer. Most of those deaths are from heart attacks
caused by blood clots.

Atherosclerosis can create life-threatening blockages -- without you ever feeling a thing.
Since we’re all at risk for coronary artery disease, it’s worth learning more about
atherosclerosis.

Causes of CAD
Clogged arteries lead to heart attacks.

 Cigarette smoking
 High bad cholesterol
 Low good cholesterol
 Obesity
 Lack of physical activity
 High blood pressure
 Diabetes
 Low fruit and vegetable consumption
 Poor socioeconomic status
 Tobacco
 No proper sleep
 Use of hormonal birth control
 Chronic kidney disease

Symptoms:

 You may have no symptoms of coronary artery disease for a long time. Plaque buildup
takes many years, even decades. But as your arteries narrow, you may notice mild
symptoms. These symptoms mean your heart is pumping harder to deliver oxygen-rich
blood to your body
 Some people feel short of breath during light physical activity
 Stable angina/ temporary - chest pain or discomfort that comes and goes in a
predictable pattern
 Heart attack

Complications
 The main complication of coronary artery disease is a heart attack. This is a medical
emergency that can be fatal. Your heart muscle starts to die because it’s not
receiving enough blood. You need prompt medical attention to restore blood flow to
your heart and save your life
 Over the years, CAD can also weaken your heart and lead to complications,
including
 Abnormal heart rhythms
 Cardiac arrest
 Cardiogenic shock
 Heart failure
Diagnosis and Tests
Tests to help diagnose or watch coronary artery disease include:

Blood tests. Blood tests can check blood sugar and cholesterol levels. A high-sensitivity
C-reactive protein (CRP) test checks for a protein linked to inflammation of the arteries.

 Electrocardiogram (ECG or EKG). This quick test checks the electrical activity of
the heart. It shows how the heart is beating. Sticky patches called electrodes attach
to the chest and sometimes the arms and legs. Wires connect the electrodes to a
computer, which prints or displays the test results. The ECG signal patterns can
show if you had or are having a heart attack.

 Echocardiogram. This test uses sound waves to show blood flow through the
heart. Parts of the heart that move weakly may be caused by a lack of oxygen or a
heart attack. This may be a sign of coronary artery disease or other conditions.

 Exercise stress test. If your symptoms usually occur during exercise, your
healthcare professional may recommend this test. You walk on a treadmill or ride
a stationary bike while your heart is checked. Because exercise makes the heart
pump harder and faster than it does during most daily activities, an exercise stress
test can show heart problems that might otherwise be missed. If you can't exercise,
you may be given a medicine that affects the heart like exercise does. Sometimes
an echocardiogram is done during an exercise stress test.

 Nuclear stress test. This test shows how blood moves to the heart at rest and
during activity. It uses a small amount of radioactive material, called a tracer or
radiotracer. The substance is given by IV. An imaging machine takes pictures of
how the tracer moves through the heart arteries. This helps find areas of poor
blood flow or heart damage.

 Heart CT scan. A CT scan of the heart can show calcium deposits and blockages in
the heart arteries. Calcium deposits can narrow the arteries. Sometimes dye is
given by IV during this test. The dye helps create detailed pictures of the heart
arteries. If dye is used, the test is called a CT coronary angiogram.

 Cardiac catheterization and angiogram. This test can see blockages in the heart
arteries. A doctor places a long, thin flexible tube called a catheter in a blood
vessel, usually in the groin or wrist. It's guided to the heart. Dye flows through the
catheter to arteries in the heart. The dye helps the arteries show up more clearly
on X-ray images and video. Heart treatments may be done during this test.

Treatment
Treatment for coronary artery disease may include:

 Lifestyle changes such as not smoking, eating healthy and exercising more.
 Heart procedure or heart surgery.
 Medications
Many medicines are available to treat coronary artery disease,
  Cholesterol medicine. Your healthcare professional might recommend this type
of medicine to lower "bad" LDL cholesterol and reduce plaque buildup in the
arteries. Such medicines include statins, niacin, fibrates and bile acid sequestrants.

 Aspirin. Aspirin helps thin the blood and prevent blood clots. Daily low-dose
aspirin therapy may be recommended for the primary prevention of heart attack
or stroke in some people.

Daily use of aspirin can have serious side effects, including bleeding in the stomach
and intestines. Don't start taking a daily aspirin without talking to your healthcare
team.

 Beta blockers. These medicines slow the heartbeat and lower blood pressure. If
you've had a heart attack, beta blockers may reduce the risk of future heart
attacks.

 Calcium channel blockers. One of these medicines may be suggested if you can't
take beta blockers or beta blockers don't work for you. Calcium channel blockers
can help reduce chest pain.

 Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor

blockers (ARBs). These medicines lower blood pressure. They may help keep
coronary artery disease from getting worse.

 Nitroglycerin. This medicine widens the heart arteries. It can help control or
reduce chest pain. Nitroglycerin is available as a pill, spray or patch.

 Ranolazine. This medicine may help people with long-term chest pain. It may be
prescribed with or instead of a beta blocker.
Surgeries or other procedures

Coronary artery stent Coronary artery bypass surgery

Surgery may be done to fix a blocked artery and improve blood flow. Surgeries or
procedures for coronary artery disease may include:

 Coronary angioplasty and stent placement. This treatment opens clogged blood
vessels in the heart. A tiny balloon on a thin tube, called a catheter, is used to
widen a clogged artery and improve blood flow. A small wire mesh tube called a
stent may be placed to keep the artery open. Most stents are coated with medicine
that helps keep the artery open. This treatment also is called percutaneous
coronary intervention.

 Coronary artery bypass graft (CABG) surgery. This is a type of open-heart

surgery. During CABG, a surgeon takes a vein or artery from somewhere else in the
body. The surgeon uses the blood vessel to create a new path for blood to go
around a blocked or narrowed heart artery. The surgery increases blood flow to
the heart.

If a patient had coronary artery bypass surgery, your healthcare professional may
suggest cardiac rehabilitation. This is a program of education, counseling and exercise
training that's designed to help improve the health after heart surgery.

ELECTROCARDIOGRAM

An electrocardiogram (ECG or EKG) is one of the simplest and fastest tests used to
evaluate the heart. Electrodes (small, plastic patches that stick to the skin) are placed at
certain spots on the chest, arms, and legs. The electrodes are connected to an ECG
machine by lead wires. The electrical activity of the heart is then measured, interpreted,
and printed out. No electricity is sent into the body.

Natural electrical impulses coordinate contractions of the different parts of the heart to
keep blood flowing the way it should. An ECG records these impulses to show how fast
the heart is beating, the rhythm of the heart beats (steady or irregular), and the timing
of the electrical impulses as they move through the different parts of the heart. Changes
in an ECG can be a sign of many heart-related conditions.

Principle:

With modern machines, surface ECGs are quick and easy to obtain at the bedside and
are based on relatively simple electrophysiological concepts. However junior doctors
often find them difficult to interpret.

An ECG is simply a representation of the electrical activity of the heart muscle as it

changes with time, usually printed on paper for easier analysis. Like other muscles,
cardiac muscle contracts in response to electrical depolarisation of the muscle cells. It is
the sum of this electrical activity, when amplified and recorded for just a few seconds
that we know as an ECG.

The normal cardiac cycle begins with spontaneous depolarisation of the sinus node, an
area of specialised tissue situated in the high right atrium (RA). A wave of electrical
depolarisation then spreads through the RA and across the inter-atrial septum into the
left atrium (LA).
The atria are separated from the ventricles by an electrically inert fibrous ring, so that
in the normal heart the only route of transmission of electrical depolarisation from atria
to ventricles is through the atrioventricular (AV) node. The AV node delays the
electrical signal for a short time, and then the wave of depolarisation spreads down the
interventricular septum (IVS), via the bundle of His and the right and left bundle
branches, into the right (RV) and left (LV) ventricles. Hence with normal conduction the
two ventricles contract simultaneously, which is important in maximising cardiac
efficiency.

After complete depolarisation of the heart, the myocardium must then repolarise, before
it can be ready to depolarise again for the next cardiac cycle.

Basic electrophysiology of the heart

Measurement:

The ECG is measured by placing a series of electrodes on the patient’s skin – so it is

known as the ‘surface’ ECG.

The wave of electrical depolarisation spreads from the atria down though the IVS to the
ventricles. So the direction of this depolarisation is usually from the superior to the
inferior aspect of the heart. The direction of the wave of depolarisation is normally
towards the left due to the leftward orientation of the heart in the chest and the greater
muscle mass of the left ventricle than the right. This overall direction of travel of the
electrical depolarisation through the heart is known as the electrical axis.

A fundamental principle of ECG recording is that when the wave of depolarisation

travels toward a recording lead this results in a positive or upward deflection. When it
travels away from a recording lead this results in a negative or downward deflection.

The electrical axis is normally downward and to the left but we can estimate it more
accurately in individual patients if we understand from which ‘direction’ each recording
lead measures the ECG.
Orientation of the limb leads showing the direction from which each lead 'looks' at the
heart
By convention, we record the standard surface ECG using 12 different recording lead
‘directions,’ though rather confusingly only 10 recording electrodes on the skin are
required to achieve this. Six of these are recorded from the chest overlying the heart
– the chest or precordial leads. Four are recorded from the limbs – the limb leads. It is
essential that each of the 10 recording electrodes is placed in its correct position,
otherwise the appearance of the ECG will be changed significantly, preventing correct
interpretation.

The limb leads record the ECG in the coronal plane, and so can be used to determine the
electrical axis (which is usually measured only in the coronal plane). The limb leads are
called leads I, II, III, AVR, AVL and AVF. Figure 2 shows the relative directions from
which they ‘look’ at the heart. A horizontal line through the heart and directed to the left
(exactly in the direction of lead I) is conventionally labelled as the reference point of 0
degrees (0 o). The directions from which other leads ‘look’ at the heart are described in
terms of the angle in degrees from this baseline.

The electrical axis of depolarisation is also expressed in degrees and is normally in the
range from -30 0 to + 90 0. A detailed explanation of how to determine the axis is beyond
the scope of this article but the principles mentioned here should help readers to
understand the concepts involved.

The chest leads record the ECG in the transverse or horizontal plane, and are called V1,
V2, V3, V4, V5 and V6
Transverse section of the chest showing the orientation of the six chest leads in relation to
the heart
Voltage and timing intervals
It is conventional to record the ECG using standard measures for amplitude of the
electrical signal and for the speed at which the paper moves during the recording. This
allows:

 Easy appreciation of heart rates and cardiac intervals and

 Meaningful comparison to be made between ECGs recorded on different
occasions or by different ECG machines.

The amplitude, or voltage, of the recorded electrical signal is expressed on an ECG in the
vertical dimension and is measured in millivolts (mV). On standard ECG paper 1mV is
represented by a deflection of 10 mm. An increase in the amount of muscle mass, such
as with left ventricular hypertrophy (LVH), usually results in a larger electrical
depolarisation signal, and so a larger amplitude of vertical deflection on the ECG.

An essential feature of the ECG is that the electrical activity of the heart is shown as it
varies with time. In other words we can think of the ECG as a graph, plotting electrical
activity on the vertical axis against time on the horizontal axis. Standard ECG paper
moves at 25 mm per second during real-time recording. This means that when looking
at the printed ECG a distance of 25 mm along the horizontal axis represents 1 second in
time.

ECG paper is marked with a grid of small and large squares. Each small square
represents 40 milliseconds (ms) in time along the horizontal axis and each larger
square contains 5 small squares, thus representing 200 ms. Standard paper speeds and
square markings allow easy measurement of cardiac timing intervals. This enables
calculation of heart rates and identification of abnormal electrical conduction within the
heart
Sample of standard ECG paper showing the scale of voltage, measured on the vertical axis,
against time on the horizontal axis

The normal ECG

It will be clear from above that the first structure to be depolarised during normal sinus
rhythm is the right atrium, closely followed by the left atrium. So the first electrical
signal on a normal ECG originates from the atria and is known as the P wave. Although
there is usually only one P wave in most leads of an ECG, the P wave is in fact the sum of
the electrical signals from the two atria, which are usually superimposed.

There is then a short, physiological delay as the atrioventricular (AV) node slows the
electrical depolarisation before it proceeds to the ventricles. This delay is responsible
for the PR interval, a short period where no electrical activity is seen on the ECG,
represented by a straight horizontal or ‘isoelectric’ line.

Depolarisation of the ventricles results in usually the largest part of the ECG signal
(because of the greater muscle mass in the ventricles) and this is known as the QRS
complex.

 The Q wave is the first initial downward or ‘negative’ deflection

 The R wave is then the next upward deflection (provided it crosses the
isoelectric line and becomes ‘positive’)
 The S wave is then the next deflection downwards, provided it crosses the
isoelectric line to become briefly negative before returning to the isoelectric
baseline.

In the case of the ventricles, there is also an electrical signal reflecting repolarisation of
the myocardium. This is shown as the ST segment and the T wave. The ST segment is
normally isoelectric, and the T wave in most leads is an upright deflection of variable
amplitude and duration

The major waves of a single normal ECG pattern

Example of a normal 12 lead ECG; notice the downward deflection of all signals recorded
from lead aVR. This is normal, as the electrical axis is directly away from that lead
Normal intervals
The recording of an ECG on standard paper allows the time taken for the various phases
of electrical depolarisation to be measured, usually in milliseconds. There is a
recognised normal range for such ‘intervals’:

 PR interval (measured from the beginning of the P wave to the first deflection of
the QRS complex). Normal range 120 – 200 ms (3 – 5 small squares on ECG
paper).
 QRS duration (measured from first deflection of QRS complex to end of QRS
complex at isoelectric line). Normal range up to 120 ms (3 small squares on ECG
paper).
 QT interval (measured from first deflection of QRS complex to end of T wave at
isoelectric line). Normal range up to 440 ms (though varies with heart rate and
may be slightly longer in females)

Heart rate estimation from the ECG

Standard ECG paper allows an approximate estimation of the heart rate (HR) from an
ECG recording. Each second of time is represented by 250 mm (5 large squares) along
the horizontal axis. So if the number of large squares between each QRS complex is:

 5 - the HR is 60 beats per minute.

 3 - the HR is 100 per minute.
 2 - the HR is 150 per minute.

-----------------------------------------------------------------------------------------------------------------
ECHOCARDIOGRAM
An echocardiogram is an ultrasound image of the heart. Echocardiograms can help
doctors diagnose a range of heart problems, such as heart attacks, blood clots, heart
valve disease, and more.
Doctors use echocardiograms to help them diagnose heart problems, such as damaged
cardiac tissue, chamber enlargement, stiffening of the heart muscle, blood clots in the
heart, fluid around the heart, and damaged or poorly functioning heart valves.
It is a noninvasive medical procedure that produces no radiation and does not typically
cause side effects.
During an echocardiogram, a doctor can see:
 the size and thickness of the chambers
 how the valves of the heart are functioning
 the direction of blood flow through the heart
 any blood clots in the heart
 areas of damaged or weak cardiac muscle tissue
 problems affecting the pericardium, which is the fluid-filled sac around the heart
 causes of a stroke
Doctors also use echocardiography when they want to examine a person’s general heart
health, especially after a heart attack or stroke.
Echocardiograms are noninvasive and relatively quick procedures that require minimal
preparation.
Below, we discuss what to expect before, during, and after an echocardiogram.
Method:
Preparation
In cases where a healthcare professional takes the echocardiogram from the outside of
the body, the person will not need to prepare.
For people who get a transesophageal echocardiogram, a doctor
will recommendTrusted Source avoiding eating or drinking anything for at least 6 hours
before the exam. People can resume eating and drinking about 1–2 hours after the
echocardiogram once the local anesthetic has worn off.
During the test

A sonographer will perform the transthoracic (external) echocardiogram. Sonographers

are healthcare professionals who specialize in using ultrasound devices to produce
images and videos for diagnostic purposes.
During the test, the person receiving the echocardiogram will remove their clothes from
the waist up. They can wear a hospital gown if they wish to cover themselves during the
exam.
The sonographer will then instruct the person to lie on a table, on either their back or
their left side. They may inject a saline solution or dye into the person’s veins, which
makes the heart appear more defined on the echocardiogram.
The exact procedure depends on the type of echocardiogram.
For instance:
Transthoracic echocardiogram
If a doctor ordered a transthoracic echocardiogram, the sonographer will apply a gel to
the chest. The sonographer will then move the transducer around the chest to get
different images of the heart.
During the exam, the sonographer may ask someone to change positions or take or hold
a deep breath. They might press the transducer into the chest to get a better picture of
the heart.
Transesophageal echocardiogram
A doctor might order a transesophageal echocardiogram if they want more detailed or
clearer images of the heart than those that a transthoracic echocardiogram can produce.
During a transesophageal echocardiogram, the person may receive a mild sedative to
help relax the muscles in their throat, and a local anesthetic to numb the gag reflex.
Once the sedative and local anesthetic take effect, a doctor will guide a small transducer
on the end of a long tube down the throat and esophagus until it reaches the back of the
heart.
The sonographer will record images of the heart as the doctor moves the transducer
around the esophagus. The person should not feel the transducer or the tube in their
esophagus after initially swallowing the probe.
After the test
Most people can return to their regular activities after having a transthoracic
echocardiogram.
People who have a transesophageal echocardiogram may need to stay at the hospital or
healthcare clinic for a few hours after the exam. They may have a sore throat initially,
but it should improve within a few hours to a day.
Individuals who received a sedative before the exam should not drive for several hours
after the echocardiogram.
What does it diagnose?
Doctors can use echocardiograms to see the size, structure, and activity of various parts
of the heart.
They do this to diagnose heart problems, determine the need for more tests, decide on
their next actions, and monitor changes and improvements.
More specifically, doctors may use this procedure to check for signs or symptoms that
may be indicative of:
 Heart attack: the test can check for impaired blood supply in heart muscle
tissue, wall abnormalities, and blood flow, which can indicate a heart attack.
 Blood clots (thrombus) or tumors: A 2021 study found that echo can be an
alternative to cardiac magnetic resonance in detecting thrombosis. A 2020
study also saw it as an essential noninvasive tool in checking for cardiac masses
such as tumors.
 Atherosclerosis and coronary artery disease (CAD): While an echo cannot
show blockages in arteries, narrowing and clogged arteries can affect the heart’s
 pumping ability and wall motion. This is more evident during stress, making
a stress echo a good diagnostic test.
 Aortic aneurysm and aortic dissection: An echo can screenTrusted Source for
wide, weakened aorta, unruptured aneurysms, and their size, as well as the
formation of fibrosis and thrombus in the vessel.
 Cardiomyopathy: The test can see the size and function of the heart and
correlate it with wall thickness, weak heart muscle, leaky heart valves, heart
failure, or high blood pressure.
 Pulmonary hypertension: The test can assessTrusted Source the pressure in
the heart, which can indicate the presence of pulmonary hypertension, helping
doctors to determine the next diagnostic steps.
 Congenital heart disease: The test can identify congenital heart abnormalities
in infants and young children, such as septal defects and holes.
 Heart valve disease: The test looks for abnormalities in heart blood flow,
leakage, narrowing, infection, and blockage in heart valves.
 Problems with the pericardium: The test can check the status of the sac
surrounding the heart (pericardium) for inflammation (pericarditis)
or becoming filled with fluid or blood(pericardial effusion).
 Heart failure: It can detect weak or stiff and thickened heart muscle, which can
be a sign of heart failure.
Doctors also often use the test to assess the reasons for an abnormal electrical test of
the heart, called an electrocardiogram (EKG).
They also use the procedure to monitor how well the heart responds to different heart
treatments, such as heart failure, medications, artificial valves, and pacemakers.
A doctor will order an echocardiogram if they suspect that someone has heart problems.
Signs and symptoms that may indicate a heart condition include:
 an irregular heartbeat (arrhythmia)
 shortness of breath
 high or low blood pressure
 leg swelling
 abnormal EKG results
 unusual sounds between heartbeats, known as heart murmursTrusted Source
Types of echocardiogram
Doctors can order different types of echocardiograms, all of which use high-frequency
sound waves. The common types include those below.
The transthoracic echocardiogram is the most commonTrusted Source type of
echocardiogram test.
This test involves placing an ultrasound wand called a transducer on the outside of the
chest, near the heart. The device sends sound waves through the chest and into the
heart.
Applying a gel to the chest helps the sound waves travel better. These waves bounce off
the heart and create images of the heart structures on a screen.
Transesophageal echocardiogram
A transesophageal echocardiogram uses a thinner transducer that attaches to the end of
a long tube. The individual will swallow the tube to insert it into the esophagus, the
organ that connects the mouth and stomach, which runs behind the heart.
This type of echocardiogram provides more detailed pictures of the heart compared
with the traditional transthoracic echocardiogram because it gives a “close up” view of
this organ.
Doppler ultrasound
Doctors use doppler ultrasounds to check the flow of blood. They do this by generating
sound waves at specific frequencies and determining how the sound waves bounce off
and return to the transducer.
Doctors can use color doppler ultrasounds to map the direction and velocity of blood
flow in the heart. Blood that flows toward the transducer appears red, while blood that
flows away looks blue. It can also determine the degree of blockages.
The results of a doppler ultrasound can reveal problems with valves or holes in the
walls of the heart and help doctors assess how the blood is traveling through it.
Learn more about a Doppler ultrasound here.
3D echocardiogram
A 3D echocardiogram creates detailed 3D images of the heart. Doctors can use 3D
echocardiograms to:
 assess valve functionality in people who have heart failure
 diagnose heart problems in infants and children
 plan heart valve or structural interventional surgery
 assess the function of the heart in 3D
 image complex structures within the heart
Stress echocardiogram
A doctor can order an echocardiogram as part of a stress test. A stress testTrusted
Source involves physical exercise, such as walking, jogging on a treadmill, or riding a
bike.
During the test, the doctor will monitor heart rate, blood pressure, and the heart’s
electrical activity.
A sonographer will take a transthoracic echocardiogram before and after the exercise.
Doctors use stress tests to diagnose:
 ischemic heart disease
 coronary heart disease
 heart failure
 problems affecting the heart valves
Point-of-care (POC) echocardiogram
A POC echocardiogram is a type of echocardiogram that a doctor can conduct at a
person’s bedside. These can help to answer specific questions a doctor may have
regarding potential differential diagnoses.
There are two typesTrusted Source of POC echo — limited and focused.
A limited echocardiogram helps a doctor identify the cause and effects of the injury that
affected the heart. A doctor performs a focused echo to help to narrow down the list of
other potential diagnoses or answer a particular question they may have.
A POC echocardiogram can assess how well the left or right ventricles pump the blood
with each heartbeat.
Fetal echocardiogram
Doctors can use a fetal echocardiogram to view an unborn baby’s heart. This exam
usually takes place at about 18–22 weeksTrusted Source of pregnancy.
Echocardiograms do not use radiation, so they are not harmful to the mother or baby.

Interpreting the results

After the exam, the sonographer will send the echocardiographic images to the doctor
who ordered the test. The doctor will review the images and look for signs of heart
problems, such as:
  damaged heart muscle tissue
 pumping function of the heart
 thick or thin ventricle walls
 abnormal chamber size
 poorly functioning valves
 chamber size
 masses in the heart, such as blood clots or tumors

Drawbacks
Echocardiograms are especially helpful in looking at structural problems of the heart.
However, they may not be the best procedure to check the coronary arteries.
Blockages can cause changes in the heart structure. Doctors can usually detect changes
in the heart function or weak muscles or thinner heart walls, which cause them to run
further tests such as a coronary angiogram.
Echocardiograms also cannot check for conduction disorders or electrical problems of
the heart that affect its rhythm, but can assess the effects of these abnormalities on the
heart.
Echocardiogram vs. electrocardiogram
People should not confuse an echocardiogram with another diagnostic test called an
electrocardiogram or EKG. An EKG measures the electrical impulses or waves that
travel through cardiac muscle tissue.
The electrical activity in the heart causes the heart muscle tissues to contract and relax,
which creates the rhythmic heartbeat that people can hear through a stethoscope.
A trained technician, nurse, or doctor can take an EKG by placing electrodes on the skin
of the chest, arms, or legs. These electrodes record electrical activity and send the
information to a computer that converts it into a graph, which a doctor can print out.

----------------------------------------------------------------------------------------------------------------
DIFFERENCE BETWEEN ECG AND ECHO

------------------------------------------------------------------------------------------------------------
CARDIAC REHABITATION EXERCISES

 Warm-up or stretching exercises

 Cardio exercises
 Strengthening exercises
 Cool-down exercises
Before starting blood pressure and heart rate are checked, warm-up is done for 15
minutes, then start the main exercise end with the cooldown exercise for 10 minutes
and again check the blood pressure and heart rate.

Warm-up:

Always warm-up for 15 minutes with light exercise e.g. walking, marching on the spot,
or low-level cycling, followed by stretching of the muscles, that reduces the risk of
injuries.

Stretching Exercises Include:

1: Upper back stretch

Lock the fingers together with the arms stretched in front. Lower the head forward to
look at the floor with feet moving. Hold the stretch for 10-15 seconds.

2: Chest stretch

Place the hands on the lower back. Gently move the elbows towards each other by
keeping the back straight and feet moving. Hold the stretch for 10-15 seconds

3: Calf stretch

Press the heel of the back leg into the floor till a gentle stretch is felt in the back of the
lower leg. Adjust the position by moving the back foot further back and the hips forward
in case the stretch is not felt. Hold the stretch for 10-15 secs for each leg.

4: Hamstring stretch

Stand and lean forward slightly with one leg in front of the other and hands-on the hips.
Slightly bend the back leg, straighten the front leg. Lean until a stretch is felt in the back
of the leg placed. Hold for 10-15 seconds. Repeat on the other leg.

5: Front of thigh stretch

Put the left hand on the wall for support. Lift the right knee in front and hold the right
ankle. Keeping the back straight, push the hip forward until a gentle stretch is felt. Hold
the stretch for 10-15 secs and repeat with the other leg.

5: Pulse raising activities

During the last 5 minutes of warm-up, pulse-raising activities at a slightly higher

intensity like walking, marching, cycling, etc are done. This helps to increase the heart
rate and prepares the person for the main exercise session.

Cardiovascular Exercises:
After a warm-up and stretching exercises, cardio exercises are started. These exercises
strengthen the heart muscles and help them to pump harder and faster. These aerobic
exercises include:

 Stationery biking
 Elliptical machine exercising
 Jumping rope
 Walking
 Jogging
 Running
 Swimming
 Dancing
 Playing sports like soccer, tennis, basketball, etc.
Strengthening Exercises

Strengthening exercises keep the body in shape and increase the strength for daily
activities like opening a jar or carrying groceries.

1: Monitoring the exercise level

One should ensure that the body is not pushed too hard during the rehabilitation
program, there are various ways by which this can be checked, so that the exercises are
done safely and effectively, under the supervision of a trained physiotherapist.

2: Measuring your heart rate (pulse)

Heart rate is the no, of times the heartbeats per minute. It is an indicator of how hard
the patient is working. During exercise the heart rate increases to fulfill the demand of
working muscles to supply blood and oxygen.

The heart rate can be palpated between the tendons in the middle of the wrist and the
bone on the outside of the up-turned arm, about 1 inch from the base of the thumb.

 Gently place the index and middle fingers over the area, feeling a slight pulse in
the heart pushes blood around the body.
 Count the number of beats that are felt for 15 secs.
 Multiply this by 4 and this will give, how many times per minute the heart beats,
this gives the heart rate.
 The heart rate should be measured soon after each exercise before it starts to
slow down
 There is a recommended heart rate range when the exercise is started. The
target heart rate is just a guide. Certain medications, like beta-blockers, affect the
way the heart rate responds to exercise. It might not increase much. In case the
top end of this range is reached there is no need to worry just reduce the level.

3: Effort score

Another way of measuring how hard the exercise is, measure the level of effort and give
it a score of between 1 and 10.

During the stage of recovery moderate, somewhat strong exercise is recommended, if

the effort level is strong, then the exercise is too hard and needs to slow down. The
exercise level should be checked and kept within comfortable limits.
4: Talk test

This is another simple way of assessing how hard the exercise is. This test can be done
by asking the person to talk, if the person is able to speak in complete sentences, then
the exercise level is correct. Shortness of breath or gasp indicates that exercise is too
hard and needs to slow down.

COOLDOWN:

Cooldown exercises are done for 10 minutes to bring the body back to its resting state,
this reduces the risk of dizziness or fainting that can occur due to a sudden drop in
blood pressure as a result of suddenly stopping exercise. Stretching during the cool
down also helps to reduce muscle soreness that may be caused by the activity. The cool-
down exercise should be performed at a slower speed.

-----------------------------------------------------------------------------------------------------------------

CARDIAC REHABILITATION

Cardiac rehabilitation is done to improve health in those with a heart condition or a

history of heart surgery. The goals of cardiac rehabilitation are to:

 Get stronger

 Reduce the risk of future heart problems

 Prevent the heart condition from worsening

 Improve quality of life

Cardiac rehabilitation is an option for people with many forms of heart disease. Your
provider may recommend cardiac rehab if your medical history includes:

 Angioplasty and stenting

 Cardiomyopathy

 Certain congenital heart diseases

 Chest pain (stable angina)

 Coronary artery bypass surgery

 Coronary artery disease

 Heart attack

 Heart failure

 Heart or lung transplant

 Heart valve repair or replacement

 Peripheral artery disease with pain in the arms or legs during activity
(claudication)