2D- ECHOCARDIOGRAM

A two-dimensional (2D) echocardiogram is a medical imaging study of the heart that a doctor might recommend to
learn more about a heart condition or to follow up on a patient's treatment. In this study, the heart, a threedimensional organ, is rendered in a two-dimensional picture. There are a number of approaches
to echocardiography, and a patient might need several imaging studies to gather as much information possible
about the condition of the heart.
One type of 2D echocardiogram provides a picture of the heart in the chest, using ultrasoundwaves to help the
doctor determine the exact size, location and shape of the organ. It is possible to get a slice of the inside of the heart
by using ultrasound imaging, to look inside the chambers and identify issues such as valve malformations. The
doctor also can request an ultrasound with Doppler technology to trace the movement of blood through the
chambers of the heart and the neighboring blood vessels.
Two-dimensional images tend to be more limited in nature. A skilled technician can get a clear, crisp picture of the
heart with the right machinery, but the 2D echocardiogram might not provide as much information as a threedimensional imaging study. The doctor cannot rotate or manipulate the image to look from a new angle, for
example, and thus could miss issues that might be more visible on a different kind of imaging study.

What Is Heart Valve Disease?

Heart valve disease occurs when the heart valves do not work the way they should.

How Do Heart Valves Work?

Your heart valves lie at the exit of each of your four heart chambers and maintain one-way blood flow through your
heart. The four heart valves make sure that blood always flows freely in a forward direction and that there is no backward
leakage.
Blood flows from your right and left atria into your ventricles through the open tricuspid and mitral valves.
When the ventricles are full, the tricuspid and mitral valves shut. This prevents blood from flowing backward into the atria
while the ventricles contract.
As the ventricles begin to contract, the pulmonic and aortic valves are forced open and blood is pumped out of the
ventricles. Blood from the right ventricle passes through the open pulmonic valve into the pulmonary artery, and blood
from the left ventricle passes through the open aortic valve into the aorta and the rest of the body.

When the ventricles finish contracting and begin to relax, the aortic and pulmonic valves shut. These valves prevent blood
from flowing back into the ventricles.
This pattern is repeated over and over with each heartbeat, causing blood to flow continuously to the heart, lungs, and
body.
What Are the Types of Heart Valve Disease?
There are several types of heart valve disease:

Valvular stenosis. This occurs when a heart valve doesn't fully open due to stiff or fused leaflets. The narrowed opening
may make the heart work very hard to pump blood through it. This can lead to heart failure and other symptoms (see
below). All four valves can develop stenosis; the conditions are called tricuspid stenosis, pulmonic stenosis, mitral
stenosis, or aortic stenosis.
Valvular insufficiency. Also called regurgitation, incompetence, or "leaky valve", this occurs when a valve does not close
tightly. If the valves do not seal, some blood will leak backwards across the valve. As the leak worsens, the heart has to
work harder to make up for the leaky valve, and less blood may flow to the rest of the body. Depending on which valve is
affected, the condition is called tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, or aortic regurgitation.

What Causes Heart Valve Disease?

Heart valve disease can develop before birth (congenital) or can be acquired sometime during one's lifetime. Sometimes
the cause of valve disease is unknown.
Congenital valve disease. This form of valve disease most often affects the aortic or pulmonic valve. Valves may be the
wrong size, have malformed leaflets, or have leaflets that are not attached correctly.
Bicuspid aortic valve disease is a congenital valve disease that affects the aortic valve. Instead of the normal three
leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve may be stiff (unable to open or
close properly) or leaky (not able close tightly).
Acquired valve disease. This includes problems that develop with valves that were once normal. These may involve
changes in the structure or your valve due to a variety of diseases or infections, including rheumatic fever or endocarditis.

Rheumatic fever is caused by an untreated bacterial infection (usually strep throat). Luckily, this infection was
much more common before the introduction of antibiotics to treat it in the 1950s. The initial infection usually
occurs in children and causes inflammation of the heart valves. However, symptoms associated with the
inflammation may not be seen until 20-40 years later.
Endocarditis occurs when germs, especially bacteria, enter the bloodstream and attack the heart valves, causing
growths and holes in the valves and scarring. This can lead to leaky valves. The germs that cause endocarditis
can enter the blood during dental procedures, surgery, IV drug use, or with severe infections. People with valve
disease can be at higher risk for developing endocarditis.

What is rheumatic heart disease?

Rheumatic heart disease describes a group of short-term (acute) and long-term (chronic) heart disorders that can occur as a result of
rheumatic fever. One common result of rheumatic fever is heart valve damage. This damage to the heart valves may lead to a valve
disorder.
Rheumatic fever
Rheumatic fever is an inflammatory disease that may affect many connective tissues of the body, especially those of the heart, joints,
brain or skin. It usually starts out as a strep throat (streptococcal) infection. Anyone can get acute rheumatic fever, but it usually
occurs in children between the ages of 5 and 15 years. About 60% of people with rheumatic fever develop some degree of subsequent
heart disease.
Every part of the heart, including the outer sac (the pericardium), the inner lining (the endocardium) and the valves may be damaged
by inflammation caused by acute rheumatic fever. However, the most common form of rheumatic heart disease affects the heart
valves, particularly the mitral valve. It may take several years after an episode of rheumatic fever for valve damage to develop or
symptoms to appear.
Antibiotics can prevent streptococcal infection from developing into rheumatic fever. Any child with a persistent sore throat should have
a throat culture to check for strep infection. Penicillin or another antibiotic will usually prevent strep throat from developing into
rheumatic fever.
Symptoms
Symptoms of heart valve problems, which are often the result of rheumatic heart disease, can include: chest pain, excessive fatigue,
heart palpitations (when the heart flutters or misses beats), a thumping sensation in the chest, shortness of breath, and swollen
ankles, wrists or stomach.
Treatment of rheumatic heart disease
If heart damage from rheumatic fever is identified in childhood or young adulthood, daily antibiotics may be required until the age of
25 or 30, to help prevent recurrence of rheumatic fever and avoid the development of infective bacterial endocarditis, an infection of
the heart valves or lining of the heart. Additional treatment will depend on the type of heart damage.

Mitral stenosis
The mitral valve separates the upper and lower chambers on the left side of the heart. Stenosis is a condition in which the
valve does not open fully, restricting blood flow. Mitral stenosis is a disorder in which the mitral valve does not open fully.
Causes
Blood that flows between different chambers of your heart must flow through a valve. The valve between the two
chambers on the left side of your heart is called the mitral valve. It opens up enough so that blood can flow from the upper
chamber of your heart (left atria) to the lower chamber (left ventricle). It then closes, keeping blood from flowing
backwards.
Mitral stenosis means that the valve cannot open enough. As a result, less blood flows to the body. The upper
heart chamber swells as pressure builds up. Blood and fluid may then collect in the lung tissue (pulmonary
edema), making it hard to breathe. See also: heart failure.
In adults, mitral stenosis occurs most often in those who have had rheumatic fever (a condition that may develop after
untreated or poorly treated strep throat or scarlet fever). The valve problems develop 5 - 10 years or more after the
episode of rheumatic fever, and symptoms may not show up for even longer. Rheumatic fever is becoming rare in the
United States due to treatment of strep infections, so mitral stenosis is also less common.
Only rarely do other factors cause mitral stenosis in adults. These include:

Calcium deposits forming around the mitral valve

Radiation treatment to the chest
Some medications

Children may be born with mitral stenosis (congenital) or other birth defects involving the heart that cause mitral stenosis.
Often, there are other heart defects present with the mitral stenosis.
Mitral stenosis may run in families.

Tricuspid regurgitation
Tricuspid regurgitation is a disorder in which the heart's tricuspid valve does not close properly, causing blood to flow
backward (leak) into the right upper heart chamber (atrium) when the right lower heart chamber (ventricle) contracts.
Causes
The tricuspid valve separates the right lower heart chamber (the right ventricle) from the right upper heart chamber (right
atrium).
The most common cause of tricuspid regurgitation is enlargement of the right ventricle, which pumps blood to the lungs,
where it picks up oxygen. This enlargement may be a complication of any disorder that causes extra strain on the right
ventricle.
Tricuspid regurgitation may also be caused or made worse by problems with the valves on the left side of the heart (mitral
or aortic valve) or the left ventricle (which pumps blood from the heart to the rest of the body). It may also be due to any
cause of pulmonary hypertension (high pressure in the lung circulation).
Other diseases can directly affect the tricuspid valve. The most common of these is infective endocarditis, which is usually
due to unsanitary conditions during drug abuse. Anything that causes bacteria to enter the bloodstream can also cause
endocarditis.
Tricuspid regurgitation may be found in people with a type of congenital heart disease called Ebstein's anomaly.
Other, less common causes of tricuspid regurgitation include:

Carcinoid tumors, which release a hormone that damages the valve

Marfan syndrome
Injury
Rheumatoid arthritis
Radiation therapy
Rheumatic fever

Another important risk factor for tricuspid regurgitation is use of the diet medications called "Fen-Phen" (phentermine and
fenfluramine) or dexfenfluramine.
What is tricuspid valve regurgitation?
Tricuspid regurgitation is leakage of blood backwards through the tricuspid valve each time the right ventricle contracts.
What happens during tricuspid regurgitation?
As the right ventricle contracts to pump blood forward to the lungs, some blood leaks backward into the right atrium, increasing the
volume of blood in the atrium. As a result, the right atrium can enlarge, which can change the pressure in the nearby chambers and
blood vessels.
What causes tricuspid regurgitation?
Tricuspid regurgitation usually results from an enlarged lower heart chamber (called the ventricle) or from any other condition that
strains the blood flow to the lungs.
Sometimes long-standing disorders, such as emphysema or pulmonary stenosis can cause problems that affect the tricuspid valve
which is upstream from the lungs.
To compensate, the right ventricle enlarges so that it can pump harder, which sometimes causes the tricuspid opening to become
stretched out and floppy.
Other diseases may also affect the tricuspid regurgitation, most commonly infective endocarditis (valve infection), and less commonly,
marfan syndrome, rheumatoid arthritis, rheumatic fever, injury, and carcinoid tumors, and myxomatous degeneration (disorder where
the valve tissue becomes floppy with growths).
An important risk for tricuspid regurgitation is the use of the diet substance called Fen-Phen (phentermine and fenfluramine) or
dexfenfluramine