Transoesophageal Echocardiogram

Patient Information Leaflet

CHECKLIST BEFORE YOU ATTEND YOUR TEST –

1) Fast for 6hrs

– No solids or drinks for 6hrs.

– You can take your usual medications with small sips of water, up to 2hrs before test, unless advised otherwise.

2) Arrange an MRSA swab

– Russells Hall Hospital Outpatients

– Walk in service – Mon-Fri 10am-3pm, Room 16

– To be done no later than 5 days before test

– Contact 01384 456111 Ext 1657 to book

3) Blood thinners

– If you take Warfarin, please arrange an INR test for the day prior to the test.

4) Transport     

– Please arrange suitable transport as you will not be able to drive if you have sedation

For any queries: Contact the Cardiology Department on 01384 456111 ext 3082

WHAT IS A TRANSOESOPHAGEAL ECHOCARDIOGRAM (TOE)?

A TOE is an ultrasound scan of your heart, where a probe with a camera attached to the end is inserted into your oesophagus (food pipe) to view the heart.  This is performed by a doctor (cardiologist), or a trained specialist echocardiographer.  The benefit over a standard heart scan (transthoracic echocardiogram) is that the structures of the heart are seen with much better detail as there is no interference from the chest wall and lungs.  This is especially useful to get detailed images of the valves to help surgeons.

HOW SHOULD I PREPARE FOR THE TEST?

• Please see checklist. The most important thing is to fast for 6hrs before the test because the probe has to be inserted into your food pipe and stomach. You can drink small sips of water for up to 2hrs prior to the test, especially if you need to take your usual tablets, but do not drink any other fluids like tea, coffee or soft drinks.
• You should take all your usual tablets as normal. If you take warfarin, you need to arrange an INR test for the day before the test so that we can decide whether the TOE can be safely performed without an excessive risk of bleeding.  You are normally not required to stop other blood thinners like the new oral anticoagulants (e.g. – Rivaroxaban, Apixaban, Edoxaban) or Aspirin, unless your cardiologist has advised you otherwise.
• If you are a diabetic patient taking Insulin, please let us know to see if we can prioritise you to be done first thing in the morning.
• Please ensure that you have had your MRSA swab before the procedure (see check list on front page)

WHAT HAPPENS ON THE DAY?

• Please arrive at least 15minutes before your scheduled time, and report to the Cardiology Reception Desk (first left after the Main Reception, and follow the signs)
• A physiologist will take you into the scanning room, go through some routine checks and ask you to sign a consent form after explaining the procedure. Please feel free to ask any questions at this time.
• You will then be asked to change into a gown, and a cannula (plastic tube with a needle) will be inserted into your arm or hand to inject any sedative medication.
• Your throat will be sprayed with a special solution, which will numb the throat and reduce the discomfort during intubation. This has a slightly unpleasant taste and might make you cough a little.
• We can give you a sedative through the cannula if you find the procedure to be uncomfortable.
• You will also have oxygen given through small rubber tubes in your nostrils.
• We will monitor your oxygen levels, blood pressure and ECG during the test.
• We understand that you might be apprehensive about swallowing the probe. The probe is only as thick as a finger, and you would normally swallow much larger pieces of food.
• You will have a plastic mouth guard placed to protect the probe. Dentures can usually be kept in but may need to be removed if loose.
• The doctor or physiologist will then place the probe in your mouth and ask you to swallow as the probe is gently pushed in. It is important that you try to remain. Thinking of the probe as a lump of food (that you would normally swallow) might help. The probe is in your food pipe and not in the airway so gentle breathing through the nose will help. The doctor may give you some sedation at this time to make it more comfortable, but some people do not require any sedation.

IS IT PAINFUL?

The procedure can be a little uncomfortable for some but should not be painful.

IS IT SAFE?

TOE is a very safe procedure. Your throat might feel a little sore for a while, and there may be mild blood staining of your saliva, but serious bleeding is extremely rare. Serious injury to the food pipe (oesophageal perforation) happens in less than 1 in 10,000 of cases. The other serious but rare side effects are allergic reactions to medications, and respiratory depression (breathing difficulty) from the sedatives.

HOW LONG DOES THE PROCEDURE TAKE?

The duration of the procedure depends on the how well it is tolerated, the ease with which images are obtained (each patient is different) and the complexity of the case (e.g. We may have to look at several valves in detail and perform additional tests like injecting saline bubbles). It is usual for a normal straightforward scan to take about 30-60 minutes allowing for preparation time.

AFTER THE PROCEDURE

• If you have had no sedation, you would normally be allowed to leave after the procedure.
• You can start to drink fluids after the numbness in your throat wears off, which could take up to half an hour. We advise to start with a cold drink first to ensure that your swallowing and sensation in the throat is normal before you take hot drinks or solids.
• If you have had sedation, we will observe you until the sedative wears off. You might feel drowsy or groggy for several hours.

Until the following day, please do not,

• Drive or ride a motorcycle/bicycle
• Consume alcohol or sedatives/sleeping tablets
• Use potentially hazardous machinery or sharp tools/utensils
• Sign important legal documents
• If you experience continuous bleeding from your throat, severe pain in your throat or tummy, or pass dark tarry stools or blood, please attend A&E.
• The report will be sent to the doctor who requested the test and he/she will convey the results to you.

Further Information

If you are concerned about your condition, please call the department for advice:

Cardiology Department, Russells Hall Hospital 01384 244582

Your doctor may have requested other tests and if that is the case information about them should be enclosed with this letter. It is important that all the tests arranged are carried out. If you have any questions, please ask the cardiac physiologist or doctor. We are here to help you.

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on 01384 456111 and ask for the relevant department who issued this leaflet.

If you have any feedback on this patient information leaflet please email dgft.patient.information@nhs.net

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.