Echocardiography shows how the heart manages blood flow in different dynamic conditions, such as during and after exercise; revealing abnormalities that are not easy to detect when the heart is at rest.
Dr Antonis Pantazis explains: "Echocardiography is a non-invasive non-irradiating, imaging technique for the heart. It is extremely good at generating both two-dimensional and three-dimensional images of the heart. It also generates moving images which allow us to study the function of the heart as a whole and in detail."
Sophisticated technology produces high resolution and dynamic imaging
Dr Pantazis says: "Compared with traditional ultrasound, this technique produces very high resolution images, and has the ability to record the dynamic changes within a moving organ. This gives us much more information with which to make our diagnosis."
"There is a great deal of very sophisticated technology and science behind echocardiography." This sophistication means that almost all heart conditions can be usefully investigated.
"It allows us to perform what we call tissue characterisation, where we study the properties of the heart muscle itself. For example, we can study cardiomyopathies, which are inherited diseases of the heart muscle. Together with the detailed imaging of thin moving structures of the heart, we can also measure the pressure in the different chambers."
"It has been extensively used to study valve diseases because it generates detailed imaging of thin moving structures of the heart and also measures the pressure in the different chambers."
"It is also useful for diagnosing ischaemic heart disease, a condition affecting the blood supply in the heart, and can even be used to rule out any structural abnormalities when we encounter electrical conditions where we don’t expect structural changes."
The development of 3D imaging has been a huge step forward. Dr Pantazis explains, "It helps us to understand the pathology of a condition better because we can examine the abnormality in its correct structural context. And once the condition has been identified, the three-dimensional images can also guide both interventional and surgical management."
Echocardiography in hypertrophic cardiomyopathy
Dr Pantazis has a specialist interest in cardiomyopathy — inherited diseases of the heart.
He explains: "Especially in hypertrophic cardiomyopathy, where there is often dynamic obstruction in the heart causing limiting symptoms, echocardiography is paramount for the identification of the nature of the problem and the guidance of the invasive treatment."
"In experienced hands, echocardiography can provide a great deal of information. It is wonderful for diagnosing the condition, and managing its treatment and long-term monitoring. And one of the best aspects is that from the patient’s perspective these extraordinary images come from a simple and pain-free procedure."
A non-invasive detailed study of blood flow within the heart and dynamic imaging is very powerful
"It is wonderful what we are able to do non-invasively," Dr Pantazis says, with real enthusiasm.
"We can watch how the heart is managing the blood flow to see whether it’s doing what we expect it to. And, very importantly, it allows us to do this under different dynamic conditions, such as during and after exercise, which can reveal abnormalities that are not easy to detect when the heart is at rest. We can also see how the heart manages the change from one stage to the other."
"Advances in the software tools available to us for constructing, analysing and interpreting the image mean we can ask extremely sophisticated questions of the images echocardiography generates."
There are, however, some areas where imaging may struggle. In some positions the ‘acoustic window’ — the route the sound waves take from the transducer to the heart — can be limited. In this case, Dr Pantazis would use another method such as a cardio MRI scan. "I always say that the best echocardiography service is supported by the best MRI service and the best MRI service is supported by the best echocardiography service."
Consultant cardiologist; Clinical lead for cardiomyopathy services
Special interest in echocardiography – investigating complex heart conditions, including heart muscle diseases, valve diseases, ischaemic heart disease with advanced echocardiography imaging.