Every medical test has its own limitation, so is the case with Ultrasound. Therefore, go by the holistic method for diagnosis and treatment together with the evidence based method of Ultrasound. This was the advice given by eminent cardiologist Dr Sudhir Naik, Dean, Mediciti Institute of Medical Sciences, to the participants at the Echo Cardiography workshop organized by Mediciti Hospitals and Institute of Medical Sciences, Hyderabad, on Sunday.

Inaugurating the one-day workshop, he said though the advancement in Echo Cardiography had revolutionized the diagnosis and treatment of cardio diseases, care should be taken in reaching a conclusion based on the tests. This is because the penetration of Ultrasound would be different for different persons. "Look at the patient first and find out whether there is any mismatch with the results. Also the man behind the machine is very important, not the machine alone," Dr Naik told the participants.

The workshop was attended by about 40 senior resident doctors, practicing physicians and post-graduate students, all from the cardiology departments of various hospitals in Andhra Pradesh and Karnataka.

Course Director Dr S V Krishna Rao said that Mediciti was planning to bring out an Echo Manual and would conduct another advanced workshop shortly. The objective of the workshop was to train the participants in correctly identifying cardiac diseases through Echo Cardiography.

Introducing the subject, Dr Krishna Rao said Echo Cardiography was a non-invasive simple method to diagnose most of the cardiological diseases. Being non-invasive, it can be repeated any number of times.

Ultrasound is sound having a frequency of more than 20,000 cycles per second (CPS). Utilising probes which are capable of producing Ultrasound, it is an excellent tool to confirm or rule out cardiac diseases. With the Echo Cardiography machines becoming much economical, these tests are considered as an extension of clinical examination.

Earlier, doctors had to do catheterization for diagnosing many cardiac diseases. Now with the advancement in Echo Cardiography, especially with the clinical application of Doppler, they are able to avoid catheterization. They can even take the patients for surgery with the information available on Echo Cardiography.

According to Dr Rao, there are many causes of chest pain, most of which can be readily differentiated based on a detailed history and physical examination of the patient. However, there are occasions when the pain of myocardial ischemia (MI) or infraction cannot be distinguished from pericarditis, pulmonary embolism, aortic dissection or pain of non-cardiac origin (eg. cholecystitis, pneumothorax and esophageal spasm). The two-dimensional (2-D) Echo Cardiography is most useful in differentiating cardiac from non-cardiac chest pain, particularly when the patient is experiencing pain virtually ruling out ischemic pain.

The major disadvantage of Ultrasound is that it penetrated poorly through a gaseous medium. The quantum of Ultrasound reflected depends on the acoustic mismatch. Thus when the beam traveled through tissues containing gases and solids, almost the entire sound is reflected and penetration becomes poor. A dense substance such as bone, calcium or metal will also reflect almost the entire energy. Hence lungs, ribs and prosthetic material offer distinct challenge for Echo Cardiographic examination. Therefore, the Ultrasound producing element or transducer must have airless contact with the body during the examination of a patient.

Dr Dayasagar Rao, senior cardiologist, Andhra Mahila Sabha Hospital, advised the doctors to spare adequate time while conducting Echo Cardiogram or a Doppler examination to ensure accurate diagnosis. Dr Sailendra Singh, Director of Cardiology Division, Mediciti, stressed the need for medical professionals with specialisation in Echo Cardiography.

Dr V Rajasekhar, Dr Sumeet Sinha and Dr B G K Sudhakar gave presentation on different branches of cardiology like coronary artery disease (CAD), valvular heart disease, myocardial and pericardial diseases and common congenital heart diseases. There was also live demonstration of patients being diagnosed using colour Doppler machines.