The echocardiogram is an ultrasound
of the heart. Thousands of pilots have
had this test as part of the
recertification process. Using standard
ultrasound techniques, two-dimensional
slices of the heart can be imaged. The
latest ultrasound systems employ 3D
real-time imaging.
In addition to creating two-dimensional
pictures of the cardiovascular system,
the echocardiogram can also produce
accurate assessment of the velocity of
blood and cardiac tissue at any
arbitrary point using Pulsed or
Continuous wave Doppler ultrasound. This
allows assessment of cardiac valve areas
and function, any abnormal
communications between the left and
right side of the heart, any leaking of
blood through the valves (valvular
regurgitation), and calculation of the
cardiac output as well as the ejection
fraction.
Echocardiography is usually performed by
cardiologists or cardiac sonographers.
Your
AME may be experienced in performing
and interpreting this test, you he / she
may refer you to a cardiologist or other
specialist. Regardless of where you get
the test, the results will be routed
back to your AME and forwarded to the
FAA.
Types of
Echocardiograms
Transthoracic Echo (TTE)
The standard echocardiogram required
by the FAA is also known as a
transthoracic echocardiogram, or TTE. In
this case, the echocardiography
transducer (or probe) is placed on the
chest wall (or thorax) of the subject,
and images are taken through the chest
wall. This is a non-invasive, highly
accurate and quick assessment of the
overall health of the heart. A
cardiologist can quickly assess a
patient's heart valves and degree of
heart muscle contraction (an indicator
of the ejection fraction).
The TTE is commonly used to help
diagnose endocarditis. Diagnostic
findings by the Echocardiogram include
definitive evidence of vegetation or
thrombus on valves or other endocardiac
structures, abscesses, or disruption of
a prosthetic heart valve.
The TTE is highly accurate for
identifying vegetations, but the
accuracy can be reduced in up to 20% of
adults because of obesity, chronic
obstructive pulmonary disease, or
chest-wall deformities. Transesophageal
echocardiography, if available, may be
more accurate than TTE because it
excludes the variables previously
mentioned and allows closer
visualization of common sites for
vegetations and other abnormalities.
Transesophageal echocardiography also
affords better visualization of
prosthetic heart valves.
TransEsophageal Echo (TEE)
Another way to perform an
echocardiogram is to insert a
specialised scope containing an
echocardiography transducer (TEE probe)
into the patient's esophagus, and record
pictures from there. This is known as a
transesophageal echocardiogram, or TEE.
The advantages of TEE over TTE are
usually clearer images. The transducer
is closer to the heart and doesn't have
the ribs and lungs to deflect the
ultrasound beam. Some structures are
better imaged with the TEE. These
structures include the aorta, the
pulmonary artery, the valves of the
heart, and the left and right atria.
While TTE can be performed easily and
without pain for the patient, TEE may
require light sedation and a local
anesthetic lubricant for the esophagus.
Unlike the TTE, the TEE is considered an
invasive procedure. In some situations,
the FAA may require that the airman
undergo a TEE instead of a TTE. Work
closely with your
AME so you know what to expect and
avoid unnecessary testing.
In some centers, sedation is used to
ease the discomfort to the individual.
The use of local anesthetic agents and
sedation can decrease the gag reflex,
making the ultrasound probe easier to
pass into the esophagus. The transducer
and cable are then coated in a
lubricant, placed in the patient’s
mouth, and then passed down the
patient's throat. The patient is
instructed to swallow while the probe is
being passed down, to prevent it from
going into the trachea. Although the
placement of the thumb-wide transducer
is uncomfortable, there are very few
complaints of gagging from the patient
once the transducer is in the correct
location.
Stress Echo
Finally, some of the FAA protocols
refer to a "stress echo," which is a
specialized form of echocardiogram with
greater sensitivity for coronary heart
disease. During this test, the pilot has
an echocardiogram is done both before
and after the heart is stressed either
through exercise or by injecting a
medicine that makes your heart beat
harder and faster. A stress
echocardiogram is usually done to find
out if you might have decreased blood
flow to your heart. Be sure to clarify
with your
AME which type of Echocardiogram you
will need.
Echocardiogram
Normal: |
The heart chambers
and walls of the heart
are of normal size and
thickness, and they move
normally.
|
Heart valves are
working normally, with
no leaks or narrowing.
There is no sign of
infection.
|
The amount of blood
pumped from the left
ventricle with each
heartbeat (ejection
fraction) is more than
55%.
|
There is no excess
fluid in the sac
surrounding the heart,
and the lining around
the heart is not
thickened.
|
There are no tumors
and blood clots in the
heart chambers.
|
Abnormal: |
Heart chambers are
too big. The walls of
the heart are thicker or
thinner than normal. A
thin heart wall may mean
poor blood flow to the
heart muscle or an old
heart attack. A thin,
bulging area of the
heart wall may indicate
a bulge in the ventricle
(ventricular aneurysm).
The heart muscle walls
do not move normally
because of a decreased
blood supply from
narrowed coronary
arteries.
|
One or more heart
valves do not open or
close properly (are
leaking) or do not look
normal. Signs of
infection are present.
|
The amount of blood
pumped from the left
ventricle with each
heartbeat (ejection
fraction) is less than
55%.
|
There is fluid around
the heart (pericardial
effusion). The lining
around the heart is too
thick.
|
A tumor or blood clot
may be found in the
heart.
|
|