A transthoracic echocardiogram ( TTE ) is the most common type of echocardiogram , which is a still or moving image of the internal parts of the heart using ultrasound . In this case, the probe (or ultrasonic transducer ) is placed on the chest or abdomen of the subject to get various views of the heart. It is used as a non-invasive assessment of the overall health of the heart, including a patient's heart valves and degree of heart muscle contraction (an indicator of the ejection fraction ). The images are displayed on a monitor for real-time viewing and then recorded.
41-463: TTE may refer to: Medicine and science [ edit ] Transthoracic echocardiogram 1,1,2-Trichloro-1,2,2-trifluoroethane , chemical compound Transport [ edit ] Babullah Airport , Indonesia (by IATA code) Travelling ticket examiner , the title of train conductors in India. Other [ edit ] This Toilet Earth ,
82-423: A bike or treadmill, or by medicine given through an IV along with a contrast agent to make the bodily fluids show up brighter. It allows a comparison between the heart at rest and the heart when it is beating at a faster rate. (Transthoracic Echocardiogram, n.d.) There are some risks associated when having an echocardiogram performed. It is possible that the images will not show up clearly enough, which can cause
123-424: A full study, or can be done as "point of care" to answer specific questions in the appropriate setting. For example, critically ill patients often have "bedside ultrasounds" performed to assess particular questions the treating team has about their status. This could be looking for cardiac tamponade and acute valve regurgitation. Often, this may include examination of other organ systems such as lungs for effusions or
164-620: A heavy metal album Time-Triggered Ethernet , a fault-tolerant strategy for synchronized time in Ethernet networks TotalEnergies , traded on the New York Stock Exchange and the Euronext Paris as TTE Toyota Team Europe Topics referred to by the same term [REDACTED] This disambiguation page lists articles associated with the title TTE . If an internal link led you here, you may wish to change
205-473: A misdiagnosis. There are numerous indications for a TTE: A typical TTE examination is done by either a cardiologist or a cardiac sonographer. It is a non-invasive test that can be done in many settings that include clinic exam room, inpatient rooms, and exam rooms dedicated to echo imaging. Examination involves using an echo probe at various positions or windows to obtain views of the heart (thus capturing images/videos for later playback while formally "reading"
246-447: Is a blood clot ( thrombus ) in the left ventricle of the heart. LVT is a common complication of acute myocardial infarction (AMI). Typically the clot is a mural thrombus, meaning it is on the wall of the ventricle. The primary risk of LVT is the occurrence of cardiac embolism , in which the thrombus detaches from the ventricular wall and travels through the circulation and blocks blood vessels. Blockage can be especially damaging in
287-425: Is abbreviated "TEE". Pronunciation of "TTE" and "TEE" are similar, and full use of "transthoracic" or "transesophageal" can minimize any verbal miscommunication. A TTE is a clinical tool to evaluate the structure and function of the heart. All four chambers and all four valves can be assessed by TTE, but the quality and visibility of these structures varies from person to person. Other structures visible on TTE include
328-425: Is also of limited use for the structures at the back of the heart, such as the left atrial appendage. Transesophageal echocardiography may be more accurate than TTE because it excludes the variables previously mentioned and allows closer visualization of common sites for vegetation and other abnormalities. Transesophageal Echocardiography also affords better visualization of prosthetic heart valves and clots within
369-446: Is an imaginary line from the apex of the heart through the center of the tricuspid/mitral valve (depending on ventricle of reference). The short axis is perpendicular to the long axis and shows the heart in cross section. Axes are also defined for each valve with long-axis defined as that of blood flow, and short-axis is the plane perpendicular to the flow. Evaluation of the heart with echocardiography requires having "acoustic windows" of
410-455: Is better for showing flow through a small volume. Spectral doppler is often used for quantification of flow. For example, the aortic valve area can be estimated using the continuity equation by measuring the velocity time integral (VTI) of the aortic valve & LV outflow tract; the VTI is calculated by tracing the flow on the spectral doppler curve. Spectral doppler is also useful for calculating
451-407: Is expected to interpret their own study as it is performed. Pocket-sized TTE devices are growing in popularity. TTE is inherently limited in what it is capable of doing. Notably, it must be used through the skin, and ultrasound waves must go through skin and soft tissue before reaching the heart. This is in contrast to transesophageal echo (TEE) in which the probe is directly behind the left atrium in
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#1732802344849492-411: Is obtained to the left of the sternum and views the heart in its long axis. In this view, the mitral valve, aortic valve, right ventricular outflow tract, base of the left ventricle, and the left atrium can be visible. Angulation in this view can bring the right ventricular inflow tract and tricuspid valve into view, and angulation the opposite way can bring the pulmonary valve into view. In this view, it
533-412: Is possible in some people to see roughly equivalent views of the apical four chamber and parasternal short views. In some people, this may afford these common views but at a subcostal window that may not be obtained through the parasternal and/or apical windows because of various reasons such as chest wall trauma, open wounds, or poor acoustic windows. However, the subcostal window is the only window to view
574-452: Is possible to appreciate the long-axis cross section of the mitral and aortic valves. The classic "hockey stick" shape of rheumatic mitral stenosis can be appreciated in this view. However, the angle of the probe with these valves can lead to under-appreciation of valve dysfunction. The parasternal long view of the pulmonary valve is the only view of the posterior leaflet. Structures visible: Measurements in this view can be used to quantify
615-432: Is possible to assess whether a thrombus will become an embolus through echocardiography. Mobility and protrusion of the thrombus are two characteristics associated with increased embolic potential. After an AMI, people should be treated to prevent LVT formation. Aspirin plus an oral anticoagulant such as warfarin are suggested for individuals at risk for thromboembolic events. Anticoagulants are also shown to reduce
656-466: Is the visibility of the left atrial appendage. This structure is known to form clots in atrial fibrillation and the LAA is rarely seen on TTE but readily seen on TEE. Cardioversion of atrial fibrillation in someone not on anticoagulation would require TEE to best visualize the LAA to rule out a thrombus. (If a thrombus is present, there is a much higher risk of stroke if returned to a sinus rhythm.) Like all of
697-399: The focused assessment with sonography for trauma . Interpretation of the exam can be done by anyone trained in reading echocardiograms. However, this is often limited to cardiologists for "formal reading" of these studies. Anesthesiologists can perform intra-operative TEEs during surgical cases and they interpret their own studies. Anyone performing a bedside or "point of care" echocardiogram
738-468: The absence of monocytes and macrophages, chances of LVT formation are very high. Failure to clear cellular debris from the infarct compromises the endothelial lining of the left ventricle and exposes the damaged tissue to the blood. The response is to build a thrombus composed of fibrin , red blood cells and platelets . For several days after AMI, the levels of tissue factor and D-dimer , which are involved in coagulation , are high, which increases
779-463: The aorta, the pericardium, pleural effusions, ascites, and inferior vena cava. It can be used to diagnose a heart attack, enlargement/hypertrophy of the heart, infiltration of the heart from an abnormal substance (e.g. amyloidosis ), weakness of the heart, and cardiac tumors. With advanced measurements of the movement of the tissue with time ( Tissue Doppler ), it can measure diastolic function, fluid status, and ventricular dyssynchrony . TTE in adults
820-403: The apical four chamber and then rotation of the probe. In this view, the mitral valve is visible with the left atrium and left ventricle. Structures: Measurements in this view can be used to quantify the heart: This view is obtained below the sternum and at the top part of the abdomen. In this view, the junction of the inferior vena cava with the right atrium is best seen. From this window, it
861-421: The changes in flow with time due to the higher frame rate with M-mode. Spectral doppler is presented similarly to M-mode in which the doppler information is plotted as a spectrogram. This can be both "continuous" and "pulse" wave where the former shows the spectrum along a specific line and the latter shows within a small window along that line. Continuous wave is better at showing maximal velocities and pulse wave
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#1732802344849902-536: The descending aorta can show signs of coarctation of the aorta . Examples of TTE views of various structures of the heart. Routine TTE exams can provide a significant wealth of information about the heart's structure and function: All function dysfunction is graded on a scale (normal, trace, mild, moderate, or severe) based on various criteria. Grading of valve function is used for prognosis and helps determine management as valve dysfunction progresses. Echo societies have published normal ranges for various features of
943-424: The esophagus and has far less tissue to penetrate, which means images from TEE are far superior in quality. Extremes in body sizes (obesity and cachexia) limit the acoustic windows and degrade the image quality of TTEs. TTE is also limited in its views of structures. Being a surface modality, the structures closest to the skin are better visualized than those deeper to the skin. A common example that demonstrates this
984-435: The four chambers of the heart. This type of Echocardiogram may be a better option for patients with thick chests, abnormal chest walls, chronic obstructive pulmonary disease and the obese. However, transthoracic is often superior to transesophageal for visualization of the apex of the left ventricle (e.g., left ventricular thrombus ) and visualization of the ventricular size of mechanical valves. "Bubble contrast TTE" involves
1025-404: The heart on various views to promote TTE as a quantifiable assessment of the heart. Quantitative echo utilizes a number of equations to calculate aspects of the heart structure and function. Simplified Bernoulli equation and continuity equation are two common equations used. Others are used in grading valve function (e.g., EROA, PISA). Left ventricular thrombus Left ventricular thrombus
1066-492: The heart or brain ( stroke ). LVT occurs most often during the first 2 weeks following AMI. AMI patients most at risk display the 3 characteristics of Virchow's triad : The risk of LVT formation increases as infarction size increases. A larger infarction means a larger area of tissue injury, which may be akinetic or dyskinetic, resulting in stagnation of ventricular blood. Monocytes and macrophages play important roles in healing after myocardial infarction. With
1107-481: The heart. Bone reflects the ultrasound waves and so all structures directly behind bone are not visible with ultrasound. This requires that the heart be viewed between bones and, in particular, between ribs. The most common views are the parasternal, apical, subcostal, and suprasternal windows.. There are several typical views obtained during a routine TTE. Views outside of the typical views can be considered "off axis" and may be obtained for specific purposes. This view
1148-424: The heart: This view is obtained in the same window as the parasternal long, but with the probe rotated 90°. In this view, the aortic valve is seen in cross-section with the right ventricular inflow & outflow tracts visible with the tricuspid valve as well. Pulmonary valve is not visible in this view. Both the right and left atria are visible. The standard PSAX view is at the level of the aortic valve, but moving
1189-439: The inferior vena cava that can help support an estimation of the central venous pressure based on size and collapsibility during respiration. Other non-cardiac structures are visible in this view and some pathologies — such as ascites — can be observed. This view is obtained above the sternum in the suprasternal notch. In this view, the aortic arch and portion of the descending aorta can be seen. Color and spectral doppler through
1230-469: The injection of agitated saline into a vein, followed by an Echocardiographic study. The bubbles are initially detected in the right atrium and right ventricle. If bubbles appear in the left heart, it may indicate a shunt, such as a patent foramen ovale , atrial septal defect , ventricular septal defect or arteriovenous malformations in the lungs. If a doctor deems it necessary, a stress TTE may be performed. It can be accomplished by either exercising on
1271-467: The kinds of echocardiography, TTE is limited to structure and function. It is not, for example, able to determine perfusion of the myocardium, which would require a metabolic imaging modality such as PET or SPECT stress testing. Perfusion can be inferred based on wall motion, however. This is the most common modality used today. A two-dimensional plane is formed by sweeping the ultrasound waves to obtain an image that varies with angle and depth. Evaluation of
TTE - Misplaced Pages Continue
1312-470: The link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=TTE&oldid=1122468689 " Category : Disambiguation pages Hidden categories: Short description is different from Wikidata All article disambiguation pages All disambiguation pages Transthoracic echocardiogram Often abbreviated "TTE", it can be easily confused with transesophageal echocardiography which
1353-419: The maximum flow and mean flow through a valve (used to grade valve stenosis). Tissue doppler can be used to determine motion of myocardial tissue. This can be used to measure motion of the septal and lateral mitral annulus to suggest diastolic heart failure . The images obtained with echocardiography are in reference to the heart itself. Two key axes of the heart are the long axis and short axis. The long axis
1394-500: The mitral valve and aortic valve are in view and is roughly similar to the parasternal long axis. In this view, the LV outflow tract is best in alignment with the probe and so gives the best estimate of flow through the LVOT, which is commonly used to estimate aortic stenosis. Structures: Measurements in this view can be used to quantify the heart: This view is obtained at the same window as
1435-403: The probe along the long-axis can review the LV outflow tract, LV at the base, and LV at the midsection. Structures visible: Measurements in this view can be used to quantify the heart: This view is obtained at the apex of the heart and looking toward the base of the heart (where the valves are). In this view, the mitral valve, tricuspid valve, and all four chambers are visible. This view shows
1476-421: The right ventricle from base to apex and is a useful view to estimate RV systolic function. TAPSE (= tricuspid annular plane systolic excursion) is also measured in this view with M-mode through the lateral tricuspid annulus. Structures: Measurements in this view can be used to quantify the heart: This view is obtained at the same window as the apical four chamber and then rotation of the probe. In this view,
1517-413: The risk of LVT formation. LVT may be good for the heart when tissues are severely damaged because it acts to thicken the wall, thus protecting it against rupture. Echocardiography is the main diagnostic tool for LVT. A distinct mass is visible in the left ventricle. Computed Tomography and Magnetic Resonance Imaging are effective, but less common ways to detect LVT, due to their costs and risks. It
1558-421: The risk of embolisms when a thrombus is already formed. Heparin , an injectable, fast-acting anticoagulant, is effective in high doses for preventing LVT formation after AMI. Systemic anticoagulation is considered first-line medical therapy for LVT, as it reduces the risk of systemic embolism. There are also surgical procedures for removal of a thrombus ( thrombectomy ). The rate of LVT formation after AMI
1599-425: The structures is done in this view. This modality is obtained at a single angle and then plotted against time to obtain an image. It can be used to watch the movement of structures with time Color doppler is a form of 2D echo in which the doppler shift of the structures is shown as color. Typically, this is shown as red and blue with red indicating movement toward the transducer and blue indicating movement away from
1640-412: The study to come up with the findings). Examination is usually done while lying flat and tilted onto the left side to bring the heart into better view. Ultrasound gel is used to improve the acoustic windows and increase quality of the captured images. Overall, an uncomplicated TTE exam takes less than 30 minutes. Limited studies (i.e., looking at only specific structures) can be done as a follow-up exam to
1681-405: The transducer. This can be used to show blood flow through the valves to visually indicate the direction of blood flow. Abnormal blood flow can reflect stenosis and regurgitation of the valve. Color doppler can also show blood flow in abnormal locations such as with septal defects (ASD or VSD). Color doppler can also be applied to M-mode. Using color doppler in this way gives better visualization of