(TEE) Transesophageal echocardiography provides a superior view of cardiac anatomy compared with transthoracic echocardiography. TEE is performed by the introduction of a probe attached to a fiberoptic endoscope into the esophagus. Caused by the position close to the heart e.g., clot finding and the view of the mitral valve are improved.

Indications:
The piezoelectric crystal creating the acoustic power is mounted on the gastroscope that must be swallowed by the patient. This endoscopic transducer is miniaturized to approximately the size of a fingernail. Usually the probe is in place for an average of 15 minutes, to numb the surface a topical anesthetic is sprayed into the throat, in addition a conscious sedation is recommended.

See also Myocardial Contrast Echocardiography, Stress Echocardiogram, M-Mode Echocardiography, Contrast Enhanced Ultrasound and Vascular Ultrasound Contrast Agents.

Dobutamine stress echocardiography is a variation of exercise echocardiography to unmask coronary artery blockages. During this test, the heart is stressed by infusing dobutamine. Dobutamine is commonly used to treat patients with low blood pressure, to improve circulation and as a diagnostic testing agent. Dobutamine increases the heart rate and blood pressure and the degree to which the heart contracts. It therefore mimics the effects of exercise for patients who are unable to exercise to a sufficient degree.
The examination starts with the resting transthoracic echocardiogram. After that, dobutamine is infused at a low dose. Following, the dose is increased every three minutes to increase the heart rate and cardiac contractions. At each of these three-minute stages, the heart is scanned using transthoracic echocardiography. An electrocardiogram has to be continuously recorded and blood pressure automatically checked every three minutes.
Disconcerting and stress-related sensations of the patient is to expect during infusion of dobutamine and does not represent any harmful effect. As soon as the infusion is completed, it is discontinued and usually within five to ten minutes the heart rate and blood pressure will return to the levels before starting the exam. Only qualified staff with specific training should perform this test. As for all types of cardiovascular stress testing, all of the necessary equipment and medicines to treat complications must be available in the stress testing room.

(MCE) Myocardial contrast echocardiography is a contrast enhanced ultrasound method that utilizes intravenous injected microbubbles as red blood cell tracers. MCE can assess myocardial perfusion both at rest and stress to evaluate viable myocardium after acute infarction.
MCE perfusion imaging improves the blood echoes during the microbubble passage and the imaging system suppresses the clutter represented by non-contrast-bearing tissue.

See also Injection Rate, Stress Echocardiogram, and Myomap.

Anatomic structures respond with characteristic features on ultrasound scanning.
There are some ultrasound terms, referring to the echo appearance, that describes tissue appearance in a uniform manner:

Tendons characteristically are hyperechoic on ultrasound because of the fibrillar pattern. Ligaments appear hyperechoic when the beam is perpendicular to the tissue. Peripheral nerves are hyperechoic relative to muscle.
Muscle appears relatively hypoechoic to tendon fibers. Close observation reveals hypoechoic muscle fibers separated by hyperechoic septae that converge on a hyperechoic aponeurosis. Articular hyaline cartilage appears hypoechoic. The presence of fluid within the joint outlining the cartilage produces a thin bright echo at this interface.
Sound beams do not penetrate the bone cortex. The very bright echo produced at the interface allows both recognition of the bone cortex but also can demonstrate fracture, spurring and bone callus bridging. Abnormal soft tissue calcification and ossification also produces bright reflective echoes.
Cysts or fluid filled areas are without internal echoes and are called echo free or anechoic and may demonstrate enhanced soft tissue echoes posterior to the fluid collection. Inflamed metatarsal bursae and calcaneal bursae clearly depict fluid swelling.

See also Beam Pattern and Zero Offset.

Cardiac ultrasound, also known as echocardiography or echocardiogram, is used to provide several different levels and types of heart testing. Cardiac ultrasound utilizes the same ultrasound principles as used for obstetric and gynecologic evaluations of pregnant women, gallbladder ultrasound and other abdominal structures.
The ultrasound is directed out of a hand held probe which can be moved to image the heart from different positions. Additionally, so that heart events can be timed, ECG leads are placed on the chest. The reflected wave is converted into an actual image of the heart and displayed in a real-time mode or M-mode ultrasound format. M-mode recordings permit measurement of cardiac dimensions and detailed analysis of complex motion patterns depending on transducer angulations. Also the time relationships with other physiological variables such as ECG, heart sounds, and pulse tracings, can be recorded simultaneously. A stress echocardiogram provides information about the cardiac performance.
Two-dimensional tomographic images of selected cardiac sections give more information than M-mode about the shape of the heart and also show the spatial relationships of its structures during the cardiac cycle (diastole to systole).

See also M-Mode Echocardiography, and Myocardial Contrast Echocardiography.