Understanding Your Transesophageal Echocardiogram (TEE)

Welcome to the Non-Invasive Cardiac Laboratory (NICL) at Hospital Sultan Idris Shah.

A Transesophageal Echocardiogram (TEE) is an advanced, high-resolution ultrasound procedure that provides exceptionally detailed views of your heart’s inner structures, chambers, and valves. This guide explains what the procedure involves, essential preparation steps, and what to expect during and after the test.

What is a Transesophageal Echocardiogram?

A Transesophageal Echocardiogram (TEE) is a specialized diagnostic test where a thin, flexible tube (probe) equipped with a miniature ultrasound transducer is gently passed through your mouth and guided down into your esophagus (the food pipe that connects your throat to your stomach).

In a standard chest ultrasound (Transthoracic Echo), sound waves must travel through skin, fat, ribs, and lungs, which can sometimes produce faint or obstructed images. Because the esophagus lies directly behind the heart, a TEE bypasses these obstacles. It allows the cardiologist to capture ultra-clear, close-up, high-definition images and videos of heart structures that cannot be seen clearly from the outside of the chest.

Why has your doctor recommended a TEE?

Your cardiologist may order a TEE to:

  • Check for blood clots: Inspect the heart—especially the left atrial appendage—for hidden blood clots before undergoing electrical cardioversion or catheter ablation for atrial fibrillation (AFib).
  • Investigate sources of stroke: Identify whether an unexplained stroke or transient ischemic attack (TIA) was triggered by a blood clot originating in the heart or aorta.
  • Detect valve infections (Infective Endocarditis): Detect microscopic bacterial or fungal growths (vegetations) or abscesses on heart valves.
  • Evaluate artificial (prosthetic) valves: Assess whether a mechanical or tissue valve replacement is leaking, infected, or failing.
  • Identify structural and congenital defects: Examine conditions such as atrial septal defects (ASD) or patent foramen ovale (PFO).
  • Assess the aorta: Check for tears, aneurysms, or dissections in the thoracic aorta.

How to Prepare for Your Test

Because a probe is passed down the esophagus under sedation, strict adherence to these preparation steps is vital for your safety.

1. Strict Fasting (Nil by Mouth) 🚫🍽️

  • Do not eat any food or chew gum for at least 6 hours before your appointment.
  • Do not drink any liquids (including plain water) for at least 4 hours prior to the test.
  • Why? Having an empty stomach prevents nausea and stops stomach contents from accidentally entering your lungs (aspiration) while your throat is numbed.

2. Medications 💊

  • Take your regular morning medications with a small sip of water early in the morning, unless instructed otherwise.
  • Diabetes medications / Insulin: Do not take morning diabetes tablets or insulin while fasting. Bring your medications with you to take after the test.
  • Blood thinners (Anticoagulants): Notify your cardiologist if you take blood thinners (such as Warfarin, Dabigatran, Rivaroxaban, or Apixaban). You will be given specific instructions on whether to take or pause them.

3. Dental Preparation 🦷

  • Please inform the medical staff if you have loose teeth, dental crowns, caps, or bridges.
  • Removable dentures or dental plates must be removed just before the procedure begins.

4. Mandatory Escort & Transport 🚗

  • Because you will receive mild intravenous sedation to keep you relaxed and sleepy, you MUST be accompanied by an adult family member or caregiver who can drive you home.
  • You will NOT be allowed to drive, operate machinery, ride a motorcycle, or travel home alone in public transport/e-hailing services after receiving sedation.

What to Expect During the Procedure

The actual scan takes about 15 to 30 minutes, but preparation and post-procedure recovery take approximately 90 to 120 minutes in total.

  1. Pre-Procedure Setup: An intravenous (IV) cannula will be inserted into a vein in your arm or hand to administer medications. ECG patches and a blood pressure cuff will be attached, and a finger probe will track your blood oxygen levels.
  2. Numbing the Throat: A local anesthetic spray (Lidocaine) will be applied to the back of your throat. It tastes slightly bitter and will make your throat and tongue feel numb and thick, which suppresses your gag reflex.
  3. Mild Sedation: A light sedative will be given through your IV line. You will feel drowsy, deeply relaxed, and comfortable. Most patients do not remember the scan.
  4. Mouth Guard: A small plastic mouth guard (bite block) is placed between your teeth to protect your teeth and keep the probe from being bitten.
  5. Inserting the Probe: You will lie on your left side. The cardiologist will guide the lubricated, flexible probe into your mouth and ask you to swallow to help the probe slide smoothly down your throat. The tube does not interfere with your breathing, as your windpipe remains clear.
  6. Imaging: The cardiologist maneuvers the probe at various depths and angles behind your heart to record detailed ultrasound videos and Doppler measurements.

What Happens After the Test?

  • Recovery Monitoring: You will rest in the NICL observation bay for 30 to 60 minutes while the sedative and throat spray gradually wear off.
  • Fasting After the Procedure: Do not eat or drink anything for at least 1 to 2 hours after the test until your throat numbness has completely resolved. Test your swallowing with a small sip of room-temperature water first. If you swallow normally without coughing, you may resume eating light, cool foods.
  • Throat Care: It is normal to have a mild sore throat, dry mouth, or slight hoarseness for 24 to 48 hours. Warm salt-water gargles or lozenges can help soothe irritation once your swallowing reflex has fully returned.
  • Post-Sedation Precautions: For the remainder of the day (24 hours), rest at home. Do not drive, operate heavy machinery, make important legal decisions, or consume alcohol.
  • Results: The cardiologist will interpret the high-definition recordings. A final diagnostic report will be sent to your primary physician, who will explain the findings and treatment recommendations during your clinic consultation.

Questions or Need to Reschedule?

📍 Location: Non-Invasive Cardiac Laboratory (NICL), Hospital Sultan Idris Shah, Jalan Puchong, 43000 Kajang, Selangor.

📞 Phone: +603-8947 5555

✉️ Email: admin@nicl.my

Versi Bahasa Melayu: Memahami Ujian Ekokardiogram Transesofagus (TEE)

Selamat datang ke Makmal Kardiologi Non-Invasif (NICL), Hospital Sultan Idris Shah.

Ekokardiogram Transesofagus (TEE) ialah prosedur imbasan ultrabunyi jantung beresolusi tinggi yang memberikan gambaran terperinci mengenai struktur dalaman, ruang, dan injap jantung anda. Panduan ini disediakan bagi menerangkan prosedur ujian, persediaan penting yang perlu dipatuhi, serta apa yang berlaku sepanjang proses rawatan.

Apakah itu Ekokardiogram Transesofagus?

Ekokardiogram Transesofagus (TEE) ialah ujian diagnostik khusus di mana sebatang tiub fleksibel yang nipis dengan alat pengimbas (transducer) kecil di hujungnya dimasukkan secara perlahan-lahan melalui mulut ke dalam esofagus (salur pemakanan yang menghubungkan kerongkong ke perut).

Dalam ujian imbasan dada biasa (TTE), gelombang bunyi perlu menembusi kulit, lapisan lemak, tulang rusuk, dan paru-paru, yang kadangkala menghasilkan imej yang kurang jelas. Memandangkan esofagus terletak tepat di belakang jantung, ujian TEE tidak dihalang oleh tulang rusuk atau udara paru-paru. Ini membolehkan Pakar Kardiologi merakam imej dan video beresolusi tinggi bagi struktur jantung yang tidak dapat dilihat dengan jelas dari luar dada.

Mengapa Doktor Menyarankan Ujian Ini?

Pakar kardiologi mungkin mengesyorkan ujian TEE untuk:

  • Mengesan Ketulan Darah Beku (Thrombus): Memeriksa ruang jantung—terutamanya di bahagian left atrial appendage—bagi mengesan ketulan darah beku sebelum prosedur kardioversi (cardioversion) atau ablasi bagi pesakit fibrilasi atrium (AFib).
  • Mencari Punca Strok: Memeriksa sama ada serangan strok atau angin ahmar berpunca daripada bekuan darah yang terlepas daripada ruang jantung atau salur darah aorta.
  • Mengesan Jangkitan Kuman pada Injap (Infective Endocarditis): Mengesan ketumbuhan kuman/bakteria (vegetations) atau nanah pada injap jantung.
  • Menilai Injap Jantung Tiruan (Prosthetic Valve): Memastikan injap gantian mekanikal atau tisu berfungsi dengan baik tanpa kebocoran atau jangkitan.
  • Mengenal Pasti Masalah Kongenital / Lubang Jantung: Memeriksa kecacatan septum seperti Atrial Septal Defect (ASD) atau Patent Foramen Ovale (PFO).
  • Pemeriksaan Salur Darah Aorta: Memeriksa keretakan, pembengkakan, atau koyakan pada dinding salur aorta (aortic dissection).

Persediaan Sebelum Menjalani Ujian

Oleh kerana tiub imbasan perlu dimasukkan melalui tekak di bawah pengaruh ubat penenang, pematuhan arahan ini amat penting demi keselamatan anda.

1. Puasa Ketat (Tidak Makan & Tidak Minum) 🚫🍽️

  • Berpuasa daripada makanan pejal atau gula-gula getah sekurang-kurangnya 6 jam sebelum waktu temujanji.
  • Berpuasa daripada sebarang minuman (termasuk air kosong) sekurang-kurangnya 4 jam sebelum ujian.
  • Tujuan: Perut yang kosong menghalang rasa loya dan mengelakkan sisa makanan daripada tersedut masuk ke dalam saluran pernafasan (aspiration) semasa tekak dikebaskan.

2. Pengambilan Ubat-ubatan 💊

  • Makan ubat harian biasa pada awal pagi dengan seteguk kecil air kosong, kecuali jika diarahkan sebaliknya.
  • Ubat Kencing Manis / Insulin: Jangan ambil ubat kencing manis atau suntikan insulin semasa berpuasa sebelum ujian. Bawa ubat tersebut untuk diambil selepas selesai prosedur.
  • Ubat Pencair Darah (Blood Thinners): Maklumkan kepada doktor sekiranya anda mengambil ubat seperti Warfarin, Dabigatran, Rivaroxaban, atau Apixaban untuk arahan jadual dos yang khusus.

3. Penjagaan Gigi Palsu 🦷

  • Sila maklumkan kepada petugas sekiranya anda mempunyai gigi yang longgar, sarung gigi (crown), atau jambatan gigi (bridge).
  • Gigi palsu yang boleh ditanggalkan mesti dibuka sebelum prosedur dimulakan.

4. Kewajipan Membawa Waris / Pengiring 🚗

  • Oleh kerana anda akan diberikan ubat penenang (sedation) intravena yang membuatkan anda mengantuk, anda WAJIB ditemani oleh seorang ahli keluarga atau waris dewasa untuk memandu anda pulang.
  • Anda dilarang sama sekali memandu kereta, menunggang motosikal, mengendalikan mesin, atau pulang bersendirian menggunakan pengangkutan awam/e-hailing sejurus selepas menerima ubat penenang.

Apa yang Berlaku Semasa Prosedur Dijalankan?

Proses imbasan aktif mengambil masa sekitar 15 hingga 30 minit, namun proses persediaan dan pemulihan mengambil masa keseluruhan sekitar 90 hingga 120 minit.

  1. Penyediaan Awal: Jarum kanula IV akan dimasukkan ke salur darah tangan untuk pemberian ubat. Pelekat ECG, pemantau tekanan darah, dan klip pengukur oksigen pada jari akan dipasang.
  2. Ubat Kebas Tekak: Semburan ubat kebas (Lidocaine) disembur ke bahagian belakang tekak anda. Ia berasa sedikit pahit dan akan membuatkan tekak serta lidah berasa kebas bagi mengurangkan refleks loya/muntah.
  3. Ubat Penenang Ringan: Ubat sedatif ringan diberikan melalui saluran IV agar anda berasa sangat tenang, relaks, dan mengantuk sepanjang ujian.
  4. Pelindung Mulut (Bite Block): Satu alat pelindung plastik kecil diletakkan di antara gigi anda untuk melindungi gigi dan mengelakkan tiub daripada tergigit.
  5. Memasukkan Tiub Imbasan: Anda akan baring mengiring ke sebelah kiri. Doktor akan membimbing tiub lembut yang disapu gel pelincir masuk ke dalam mulut dan meminta anda menelan secara perlahan agar tiub masuk ke esofagus dengan lancar. Tiub ini tidak menghalang pernafasan anda kerana salur pernafasan berada di kedudukan berasingan.
  6. Rakaman Imej: Doktor akan menggerakkan tiub pada sudut dan kedalaman tertentu di belakang jantung untuk merakam video serta aliran darah secara terperinci.

Apa yang Berlaku Selepas Ujian?

  • Fasa Pemerhatian: Anda akan berehat di ruang pemantauan NICL selama 30 hingga 60 minit sehingga kesan ubat penenang dan ubat kebas mula reda.
  • Pantang Makan & Minum Selepas Ujian: Jangan makan atau minum selama 1 hingga 2 jam selepas prosedur sehingga kesan kebas pada tekak hilang sepenuhnya. Selepas tempoh tersebut, uji keupayaan menelan dengan seteguk kecil air kosong. Sekiranya boleh menelan dengan lancar tanpa tersedak, anda boleh mula makan makanan lembut dan sejuk.
  • Kesan Sampingan Ringan: Tekak berasa sedikit perit, kering, atau suara serak adalah perkara biasa bagi tempoh 24 hingga 48 jam. Berkumur dengan air garam suam boleh membantu melegakan kerengsaan tekak setelah refleks menelan pulih sepenuhnya.
  • Langkah Keselamatan 24 Jam: Rehat secukupnya di rumah pada hari tersebut. Dilarang memandu kenderaan, mengendalikan jentera berat, menandatangani dokumen rasmi penting, atau meminum alkohol.
  • Keputusan Ujian: Rakaman imbasan akan dinilai oleh Pakar Kardiologi. Laporan perubatan rasmi akan diserahkan kepada doktor yang merujuk anda untuk dibincangkan semasa temujanji susulan di klinik.

Sebarang Pertanyaan atau Penjadualan Semula?

📍 Lokasi: Makmal Kardiologi Non-Invasif (NICL), Hospital Sultan Idris Shah, Jalan Puchong, 43000 Kajang, Selangor.

📞 Telefon: +603-8947 5555

✉️ Emel: admin@nicl.my

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