Some things are scary. Like when your healthcare provider refers you for a procedure that involves bubbles injected into your veins and flowing through your heart.
I told my PCM the thought of it kind of freaked me out. She said it was perfectly safe. Just a routine procedure. No big deal.
So I went home and researched the procedure. I found an article from a reliable source that explained the procedure simply and thoroughly and assured patients that “The bubble study is extremely safe.”
And the rational part of my mind believed them. But some other, irrational, part of my mind kept thinking of all the TV shows in which the villain kills someone by injecting an air bubble into their IV. (Medical personnel hate Hollywood for this, by the way.)
I’m not the type to worry about things and get anxious, so I didn’t spend the days between the doctor’s visit and the bubble study obsessing about it. But I didn’t sleep very well the night before, and I was pretty anxious on the ride to the hospital. I did breathing exercises to try to relax, and, of course, cracked dark jokes about things Spousal Unit needed to know in case I didn’t survive. (Not sure Spousal Unit appreciated that.)
What ultimately helped me relax was talking to the tech who performed the bubble injection part of the procedure. She told me three reasons not to worry:
1) The saline solution is being injected into a vein, not an artery, and therefore there is less risk;
2) The bubbles are very small, and could not block a vein;
3) The bubbles go through your heart to your lungs, and your lungs handle them just like they handle every other gaseous fluid (bubble). That’s what lungs are made for.
In other words, your body knows what to do with the bubbles, and it’s no big deal.
That’s when the rational part of my mind won, the irrational part of my mind stopped freaking out, and I relaxed. More breathing exercises helped me release the tension as well.
So, what exactly *is* an echocardiogram? It’s basically just an ultrasound of your heart.
Most of us have seen an obstetric ultrasound on TV, where the technician looks at a pregnant woman’s fetus in the womb. The technique for an echocardiogram is pretty much the same – sound waves are used to get images of your heart.
But unlike an obstetric ultrasound, where the woman lies on her back, for a cardiac ultrasound you lie on your left side. This helps the technician get a better image of your heart.
My technician explained to me that the ultrasound cannot get images through your bones, so they have to manipulate the wand around all the bones in your chest, like your sternum (breastbone) and ribs. The ultrasound also cannot get images through air, so they have to avoid your lungs as well.
Since your heart is already off-set to the left of your chest, lying on your left side allows the heart to fall a bit further left, away from your sternum.
So, you take off your shirt and put on a hospital gown (open to the front), and the technician attaches some electrodes to your chest with sticky patches so they can monitor the electrical currents of your heart. (For a good overview of the entire procedure, see this Mayo Clinic article.) Then you lie down on your left side, and move your left arm up near your head.
The technician lubes up the wand (a.k.a. probe or transducer) and moves it around on your skin until they can get clear images of your heart. (The gel helps improve the conduction of the sound waves, and makes sure there’s no air between the wand and your skin.)
Since they are dodging your bones and your lungs, the wand can wind up feeling like it’s trying to dig under your ribs as the technician attempts to get the clearest image, which can be a bit uncomfortable. It’s not really painful, just a bit…insistent. This is another time when the breathing exercises can come in handy. Although it was rather uncomfortable a few times, I didn’t have any bruising afterward.
The technician takes a series of images from multiple angles, so they move the wand around
and dig it in to new uncomfortable places to get the various images. This may cause them to re-apply more gel as well. My technician also asked me to take a deep breath, hold it, and exhale at various points in the procedure. (She only forgot to tell me to resume breathing once.)
I appreciated that the technician explained to me what she was doing as she was doing it, and didn’t mind me watching the monitor as she was working. An echocardiogram allows you to see the heart beating, and the heart valves opening and closing, and it’s fascinating to watch.
I particularly enjoyed watching the Doppler portion of the procedure:
The first part of the procedure took about 20-25 minutes, and then it was time for the Bubble Study (a.k.a. saline contrast study). My PCM ordered a bubble study because she wanted to determine if there was a hole in my heart.
In a normal heart, the bubbles that are injected for the test enter the right side of the heart through the vein and then go through to the lungs and are removed from the bloodstream before the blood circulates to the left side of the heart. If there is a hole between the right and left sides of the heart, the technician can see the bubbles flow through the hole to the left side, where they don’t belong.
Don’t Panic! The bubble study is less freaky than it sounds. Nothing is injected directly into your heart. (Also, if you do have a hole in your heart, and the bubbles leak though to the left side, it’s ok. Your body will still process the bubbles safely.)
A second technician came into the room, we had the conversation about bubbles and why they aren’t dangerous, and she inserted an IV line into my right arm (since I still needed to lie on my left side for the procedure). The IV line had a valve, so that the tech could start and stop the flow of the saline contrast solution.
The second tech told me that at several points during the bubble study, I would need to do a valsalva maneuver, but she described it as “the way you would bear down during a bowel movement”. Well, that’s not the way I learned to do a valsalva maneuver during aerospace physiology, so we had a conversation until I figured out that what they *really* wanted was an anti-G straining maneuver (except they wanted me to hold my breath during the maneuver, and not exhale in a big gust when they told me I could exhale).
With that cleared up, we proceeded with the bubble study. The first technician would signal that she was ready, the second technician would release a stream of bubbles into the vein near my elbow, and they would tell me when they wanted me to do the straining maneuver.
Then we would watch the stream of bubbles rush into my heart. The bubbles appear white on the monitor, and they are very obvious. Sometimes the second tech would massage my arm a bit to help the bubbles flow faster or something.
The saline bubble solution felt a little bit weird when it first went into my arm, but then I didn’t feel it anymore. The first batch of bubbles felt weird when it entered my heart – my heart seemed to flutter a little bit. But it didn’t hurt, and I didn’t feel it with the subsequent bubble batches.
We repeated the sequence four or five times, until there was no more saline solution, and the first tech was satisfied that she had all the images she needed. They were both very impressed with my straining technique. 🙂
Then the second tech removed the IV line, the first tech removed the electrode sticky pads, and they left me to wipe the gel off my chest and get dressed.
The whole procedure took about an hour, and I had no residual effects. Turns out, the bubble study really *was* no big deal.
Also, since having a hole between the two sides is congenital (something you’re born with), I’ll never have to have this procedure again. Once they’ve determined whether the hole is there or not, that doesn’t change and you never need to check again.