Are You Awake During A Transesophageal Echocardiogram
Transesophageal echocardiography (TEE) is an imaging technique used in cardiology clinics for more than 20 years. It’s also known as trans-oesophageal echo or “transgastric” because it involves passing sound waves into the oesophagus with a tiny ultrasound device inserted via the patient’s mouth.
The most common use of this technology is to diagnose atrial fibrillation (AF). In AF, blood clots form in the heart and cause strokes due to blockages in the arteries leading to the brain. When these clots are removed during surgery, they’re sent off for analysis to determine if there’s any sign of cancer cells.
Other uses include diagnosing endocarditis — inflammation of the lining of the heart — and congenital defects such as patent ductus arteriosus, where one artery doesn’t close properly after birth.
A transesophageal echocardiogram (also called a TEE) uses high frequency sound waves to create pictures of the inner structure of the heart. The equipment is similar to other ultrasound machines. Ultrasound beams pass from the machine’s headpiece over the skin and then down the body toward the area being scanned. As the sound waves travel through tissues, they bounce back and are received by the same headpiece. This allows the ultrasound technician to see what’s going on inside the body without having to cut open it.
During the test, you’ll lie on your side while receiving mild sedatives and pain medication. There will be some time between when the exam begins and when the actual data collection starts. An IV line may be started in case medications need to be administered quickly. You’ll also be monitored closely for any signs of bleeding in the gastrointestinal tract, which could happen during insertion of the long thin tube through the esophagus.
When the TEE is complete, you’ll leave the clinic with instructions about how to resume daily activities. You’ll have no bruising or scabs left behind.
First thing first: What’s involved with getting ready for the procedure? Here’s a rundown of everything you’ll need to do before, during and after the examination.
Before the Procedure
Your health care provider needs to run tests to ensure that the procedure can safely go forward. He/she might order blood work, chest X-rays, electrocardiograms (ECGs), blood pressure measurements and even urine samples. Sometimes additional tests like CT scans or MRI exams may be required.
If you’ve had previous radiation treatment, a special type of x-ray called fluoroscopy may be performed. Fluoroscopy creates moving images of your heart by sending small amounts of radiation out from an external source, allowing the technician to view the beating heart.
Also, depending on the reason for the exam, you might be asked to fast prior to the procedure. For example, patients undergoing cardiac catheterization are usually told not eat anything after midnight the night before. And those scheduled for electrophysiological testing must avoid caffeine and nicotine for several hours beforehand.
During the Procedure
Once you arrive at the hospital, you’ll check in with a nurse who will take your vital signs including temperature, pulse rate, blood pressure and blood sugar level.
Next, you’ll receive a local anesthesia injection near the site of the probe. Then a gastroenterologist will insert the feeding tube through the nose or mouth. Afterward, the gastroenterologist will explain the process of inserting the transducer through the mouth and into the oesophagus. Once he’s done that, you’ll be taken to the procedure room.
After entering the procedure room, someone will place a warming blanket around your torso to keep your core temperature regulated throughout the exam. At this point, you should begin taking whatever medication was prescribed ahead of time. Also, don’t smoke within 24 hours of the exam. Smoking increases the risk of bleeding.
Then, you’ll lay on your back while the gastroenterologist inserts the long plastic handle of the transducer through your nostril and down your throat. Next, he’ll pull the transducer up against your upper palate and press it firmly against your tongue. The part containing the scanning mechanism will slide along your soft palate until it touches your lower oesophagus.
The transducer transmits ultrasounds through the tissue of your oesophagus, which reflect back to the scanner and allow technicians to visualize your heart. They watch for signs of atrial flutter or fibrillation, valvular disease, vegetations on valves and other abnormalities.
An ECG is often recorded simultaneously to monitor heart rhythm and function. The TEE probe stays in place for approximately 30 minutes, but every two hours another scan is conducted to make sure it hasn’t slipped.
After the Procedure
Once the exam has been completed, you’ll get dressed in clean clothes. Someone will bring you home in a wheelchair since you won’t be able to walk unaided. Your discharge papers will tell you exactly what kind of recovery plan you’ll follow once you get home.
Recovery typically takes three days. No strenuous activity is allowed for five days. You’ll probably experience nausea and vomiting for a few days. Swelling around the eyes or ears may occur. Bruising isn’t uncommon. It’s important to drink plenty of fluids during your recuperation period.
For the next week or so, you’ll need to rest comfortably. Don’t drive yourself anywhere unless absolutely necessary. Be careful lifting anything heavy. Avoid swimming pools and saunas. Keep away from alcohol and drugs. Follow your physician’s orders carefully.
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