Echocardiogram

An echocardiogram is a diagnostic test that gives the doctor an idea of how the heart appears in motion. An echo uses ultrasound waves to pick up echoes from different parts of your heart. An echocardiogram throws light on the size of the heart and the condition of the heart valves. The pumping capacity of the heart is determined with an echocardiogram. Any damage to heart muscles or valves can be diagnosed with an echocardiogram. An echocardiogram is helpful in detecting any structural problems of the heart, its chambers or blood vessels surrounding it. An echocardiogram is used to detect any blood clots within the heart. This diagnostic test is used to check for causes of irregular heartbeats, enlarged heart or heart murmurs. The functioning of the heart after an attack can be checked with an echocardiogram.

Trans thoracic echocardiogram is the standard cardiogram where the doctor monitors sound wave echoes that bounce off the heart and other internal structures.

Doppler echocardiogram is based on Doppler signals that change pitch when they bounce off the heart and blood vessels. This feature is often part of other cardiogram procedures.

Stress echocardiogram is taken when a patient is undergoing a treadmill stress test.

Trans esophageal echocardiogram involves passing a probe through the throat into the chest wall. The transducer then shows clear images of the heart. This type of echocardiogram can be uncomfortable and is often performed under sedative. Trans esophageal echocardiogram is also used during surgery to monitor the heart function. Abnormal blood flow between the heart's chambers can be detected.

Mitral Valve Prolapse

Mitral Valve Prolapse (MVP) is one of the most common cause for heart murmurs. This condition occurs when the mitral valve, responsible for preventing back flow of blood during heart contraction malfunctions. Consequently the mitral valve allows a tiny amount of blood to leak through and might shut off with a faint clicking sound. A faulty flap of the heart valve moves back into the atrium when the heart beats, allowing blood flow from the ventricle back into the atrium. Mitral valve prolapse is also referred to as click-murmur syndrome, Barlow's syndrome or Floppy valve syndrome. It is genetic in nature and is seen to run in families. Women are more likely to suffer from mitral valve prolapse when compared to men. Slender women with long and tapering fingers are at increased risk of suffering from MVP. Factors that might trigger a mitral valve prolapse are hypoglycemia, magnesium deficiency, chemical sensitivity, rheumatic fever, heart disease and hypothyroidism. A person suffering from MVP notices symptoms such as migraine headache, dizziness, cold hands and feet and hyperventilation. There might be insomnia, vertigo and balance problems. Such a person usually has a hypersensitive startle reflex. There might be intermittent chest pain and a feeling of the heart skipping beats.

There are various diagnostic tools used to detect mitral valve prolapse:

• ECG - Echocardiogram uses high-frequency sound waves to image your heart structures and its rhythm. This allows the physician to view the mitral valve and flow of blood through it.
  
• Chest x-ray can help identify any malfunctioning valve in the heart.
  
• Doppler ultrasound aids in assessing the functioning of the heart valve.

Moderate regular exercise has extensive benefits on alleviating some of the symptoms of mitral valve prolapse. Avoid too much sugar and Monosodium glutamate (MSG) in the diet. Sufficient amounts of magnesium, l-carnitine, acetyl-l-carnitine and B vitamins can help in relieving the symptoms of mitral valve prolapse. Prophylactic use of antibiotics is useful in preventing infection of the heart valve.

Valsalva Maneuver

Valsalva Maneuver is a technique that involves forced expiratory efforts wherein the person forcefully exhales while keeping the mouth and nose closed. The Valsalva Maneuver is performed sometimes by fighter pilots by grunting and tightening abdominal muscles to prevent blackouts during high performance flying. Valsalva Maneuver is used in medical and fitness fields for different purposes. However, it is normally adopted as a diagnostic tool to evaluate the heart condition of the patient. Valsalva Maneuver is often used in conjunction with echocardiography to assess heart abnormalities.

Valsalva Method

• Draw in air through nose or preferably through mouth to the maximum extent possible.
  
• Hold your chest/stomach muscles tight as if you are straining to initiate a bowl movement.
  
• Hold this position for a short while - about 10 seconds or as per your comfort level.
  
• Blow out the air sharply through the nostrils
  

Four different phases of hemodynamic changes occur while performing the Valsalva Maneuver.

1. At first phase of Valsalva Maneuver, pressure rises inside the chest cavity and pushes the blood out of the pulmonary circulation into the left atrium. This increases the blood pressure slightly.

2. During second phase, output of the heart is reduced and blood pressure falls, while the heart rate and peripheral vascular resistance are both increasing thereby raising aortic pressure.

3. The third phase involves releasing of breath which results in immediate drop in intrathoracic pressure. The compression of the heart chambers is eased out and the venous return is smooth, increasing the pre load.

4. During fourth phase, sudden increase in cardiac output and aortic pressure occurs due to rise in venous blood volume. As the intra-aortic pressure rises, heart rate reduces and also causes vagal (parasympathetic) stimulation.

Any deviation from these normal responses indicates abnormality of heart and autonomic nervous control of the heart. It is particularly useful in diagnosing left-sided heart failure and heart murmurs. If the patient is suffering from hypertrophic obstructive Cardiomyopathy, the murmur of the heart becomes louder with Valsalva Maneuver. In case of aortic valvular stenosis, the noise of the murmur decreases with Valsalva as less blood will be released through the aortic valve.

It also acts as a corrective measure, to treat abnormal heart rhythms or relieve chest pain. When Valsalva maneuver is carried out, the blood pressure of the patient spikes and thus allows the heart to respond by correcting its rhythm and beating more slowly.

This Maneuver is also used to treat particular ear disorders. It is in fact named after Italian physician-anatomist Antonio Maria Valsalva, who recommended it for clearing pus from an infected middle ear.

Valsalva maneuver is also useful to patients with multiple sclerosis as it helps them to empty the bladder completely. The Valsalva maneuver is also widely used in the field of fitness, particularly while performing lifts. The Valsalva Maneuver increases the intra-abdominal pressure, providing more support for the back during lifts.

Valsalva maneuver is also useful for correcting air pressure blocking your ears when climbing high altitude or scuba diving.