ECHO is, together with ECG, one of the basic examinations in cardiology. The characteristics of ultrasound (sound of very high frequency over 20 000 Hz, which is not detected by human ears) are used in this method. During an ECHO examination, the ultrasound is transmitted by a probe, which is pressed against the chest. The ultrasound reflects off each heart structure. These reflections are transmitted back to the probe and then converted by a computer into a picture. Thanks to that, medical experts are able to consider and measure the size and thickness of individual parts of the heart and their function. Thanks to so called Doppler effect, they can even measure the speed of blood flow in different part of the human heart.

Picture 12: ECHO (authors: Patrick J. Lynch a C. Carl Jaffe)

Picture13: Doppler ECHO (author: J. Heuser)

Similar to an ECG, even in case of ECHO there are no specific findings that could diagnose myocarditis. ECHO primarily provides information about changes in the heart´s structure and function. It shows disorders of systolic and diastolic function of the ventricles (during the contraction and filling of the ventricles). It is also used to exclude other possible causes of patient´s problems (e.g. valvular diseases).

Some of the most common ECHO findings during myocarditis are changes mostly of the structure and function of the left ventricle – dilatation (“widening”) of the heart ventricles, disorder of contractility, alternatively even changes of thickness of the heart wall. A common complication shows up in ECHO, is pericardial effusion (see Picture 13); sometimes clots are observed. The finding can be also normal.

During more complicated cases of myocarditis, signs of heart failure are observed. They indicate a worsening heart function and are observed in the left ventricle and some cases even in the right ventricle.

Apart from above mentioned information, ECHO is also used for observing the systolic “performance” of the left ventricle – ejection fraction of left ventricle. It is a ratio between thevolume of blood pumped by the left ventricle during systole and total bloody volume in case of maximal fulfilment of the left ventricle during diastole (“filling”). Essentially it is the ratio between “filled” blood and “pumped” blood. The ratio is expressed as a percentage and gives doctors an information, how much blood is pumped from heart ventricles to the body during systole. Usually the value of the left ventricle ejection fraction is between 55 and 70 %.

Picture 14: Pericardial effusion (author: Kalumet); PE – Pericardial effusion; LA – Left atrium; LV – Left ventricle; RV – Right ventricle

Authors of the opening picture: Kalumet; Espinola-Zavaleta N, Soto ME, Castellanos LM, Játiva-Chávez S, Keirns C.