Echocardiogram

What is an echocardiogram?

An echocardiogram (echo) is a graphic outline of your heart’s movement. During an echo test, your healthcare provider uses ultrasound (high-frequency sound waves) from a hand-held wand placed on your chest to take pictures of your heart’s valves and chambers. This helps the provider evaluate the pumping action of your heart.

Providers often combine echo with Doppler ultrasound and color Doppler techniques to evaluate blood flow across your heart’s valves.

Echocardiography uses no radiation. This makes an echo different from other tests like X-rays and CT scans that use small amounts of radiation.

Who performs an echo test?

A technician called a cardiac sonographer performs your echo. They’re trained in performing echo tests and using the most current technology. They’re prepared to work in a variety of settings including hospital rooms and catheterization labs.

What are the different types of echocardiogram?

There are several types of echocardiogram. Each one offers unique benefits in diagnosing and managing heart disease. They include:

• Transthoracic echocardiogram.
• Transesophageal echocardiogram.
• Exercise stress echocardiogram.

What techniques are used in echocardiography?

Several techniques can be used to create pictures of your heart. The best technique depends on your specific condition and what your provider needs to see. These techniques include:

• Two-dimensional (2D) ultrasound. This approach is used most often. It produces 2D images that appear as “slices” on the computer screen. Traditionally, these slices could be “stacked” to build a 3D structure.
• Three-dimensional (3D) ultrasound. Advances in technology have made 3D imaging more efficient and useful. New 3D techniques show different aspects of your heart, including how well it pumps blood, with greater accuracy. Using 3D also allows your sonographer to see parts of your heart from different angles.
• Doppler ultrasound. This technique shows how fast your blood flows, and also in what direction.
• Color Doppler ultrasound. This technique also shows your blood flow, but it uses different colors to highlight the different directions of flow.
• Strain imaging. This approach shows changes in how your heart muscle moves. It can catch early signs of some heart disease.
• Contrast imaging. Your provider injects a substance called a contrast agent into one of your veins. The substance is visible in the images and can help show details of your heart. Some people experience an allergic reaction to the contrast agent, but reactions are usually mild.

How long does an echocardiogram take?

An echocardiogram usually takes 40 to 60 minutes. A transesophageal echo may take up to 90 minutes.

What is an echocardiogram vs. an EKG?

An echocardiogram and an electrocardiogram (called an EKG or ECG) both check your heart. But they check for different things and produce different types of visuals.

An echo checks the overall structure and function of your heart. It produces moving pictures of your heart.

An EKG checks your heart’s electrical activity. It produces a graph, rather than pictures of your heart. The lines on this graph show your heart rate and rhythm.

When would I need an echocardiogram?

Your provider will order an echo for many reasons. You may need an echocardiogram if:

• You have symptoms, and your healthcare provider wants to learn more (either by diagnosing a problem or ruling out possible causes).
• Your provider thinks you have some form of heart disease. The echo is used to diagnose the specific problem and learn more about it.
• Your provider wants to check on a condition you’ve already been diagnosed with. For example, some people with valve disease need echo tests on a regular basis.
• You’re preparing for a surgery or procedure.
• Your provider wants to check the outcome of a surgery or procedure.

What does an echocardiogram show?

An echocardiogram can detect many different types of heart disease. These include:

• Congenital heart disease, which you’re born with.
• Cardiomyopathy, which affects your heart muscle.
• Infective endocarditis, which is an infection in your heart’s chambers or valves.
• Pericardial disease, which affects the two-layered sac that covers the outer surface of your heart.
• Valve disease, which affects the “doors” that connect the chambers of your heart.

An echo can also show changes in your heart that could indicate:

• Aortic aneurysm.
• Blood clots.
• A cardiac tumor.

How is a transthoracic echocardiogram done?

A transthoracic echo is the type most people think of when they hear “heart echo.” It’s also the type most often used. It’s performed outside your body.

A sonographer places a hand-held wand (called a transducer) on the outside of your chest to send sound waves to your heart. These sound waves bounce off the different parts of your heart.

These “echoes” then appear as pictures on the sonographer’s computer screen. These pictures can also be saved for your cardiologist and physician to review later.

Preparing for a transthoracic echo

There’s not much you need to do to prepare for this type of echo. In general:

• You don’t need to avoid eating or drinking before a transthoracic echo.
• Take your medications as you usually do.
• Wear anything you’d like.
• Leave anything valuable at home. You’ll be given a storage locker to use during the test.

What to expect during a transthoracic echo

A transthoracic echo includes the following steps:

1. You’ll be asked to remove your clothing from the waist up. You’ll put on a hospital gown.
2. Your sonographer will place several electrodes on your chest. These are small, flat, sticky patches. The electrodes are attached to an electrocardiograph (EKG) monitor. The EKG records your heart’s electrical activity during the test.
3. You’ll lie down on an exam table. Your sonographer will ask you to lie on your left side if possible.
4. Your sonographer will place a sound-wave transducer (wand) on several areas of your chest. There’s a small amount of gel on the end of the wand, which won’t harm your skin. This gel helps produce clearer pictures.
5. You may hear swishing sounds throughout the test. This is normal. It means you’re hearing blood flowing through your heart as the wand picks up the sound.
6. Throughout the test, your sonographer may ask you to hold your breath for several seconds at a time. You may also need to move into a different position.

You should feel no major discomfort during the test. You may feel a coolness on your skin from the gel on the wand. You may also feel a slight pressure of the wand against your chest.

How is a transesophageal echocardiogram done?

A transesophageal echo takes pictures from inside your chest, rather than from the outside. It can show your heart and valves in greater detail than a transthoracic echo. That’s because your body’s bones and tissues aren’t in between the transducer and your heart.

For this test, the sonographer guides a small transducer down your throat and esophagus (food tube) using a long, flexible tube. This minimally invasive procedure may cause mild, temporary discomfort. But it has a low risk of serious problems.

This type of echo may be used:

• When your provider needs a detailed look at your aorta or the back of your heart (especially your left atrium or left ventricle).
• To check for blood clots.
• To evaluate your mitral valve or aortic valve.
• If you have obesity or lung disorders.
• If a transthoracic echo isn’t possible for various other reasons.

Preparing for a transesophageal echo

As you prepare for your echo, tell your doctor if you have:

• Problems with your esophagus, like a hiatal hernia.
• Problems swallowing.
• Sleep apnea.
• IV drug use.

It’s also important to share if you take medication for:

• Sleep issues.
• Anxiety.
• Pain.

Preparations for the day of your test include:

• Find someone to drive you home from your test. This is because you’ll be sedated for the test, and you won’t be able to drive for 24 hours.
• Don’t eat or drink anything for at least six hours before your test. Your provider may give you more specific instructions for eating and drinking. It’s essential you follow these closely.
• Ask your provider about when to take your usual medications. You may be able to take them at your usual time with a small sip of water.
• Ask your provider about when and how to take your diabetes medication, if this is relevant to you.
• Plan to leave any valuable personal items at home. You’ll have access to a storage locker for your belongings during the test.
• Plan to wear whatever’s most comfortable for you. You’ll change into a hospital gown before the echo begins.

What to expect during a transesophageal echo

A transesophageal echo includes the following steps:

1. You’ll remove your clothing from the waist up and put on a hospital gown.
2. Your provider will place electrodes (small stickers) on your chest. The electrodes allow your sonographer to monitor your heart’s electrical activity during the test.
3. Your provider will place a blood pressure cuff on your arm and a pulse oximeter on your finger.
4. You’ll gargle with a solution that numbs your throat. Your provider will also spray your throat with pain-relieving medication.
5. To make you more comfortable, you’ll be hooked up to an IV and sedated. You’ll soon start to feel sleepy.
6. You may have a tube in your nose that provides oxygen.
7. You’ll lie on your left side on the exam table.
8. The provider will insert an endoscope into your mouth. This is a long, thin, flexible tube that has a transducer on the tip. The tube travels into your throat and esophagus. It’s lubricated to help it slide down more easily. While this may feel uncomfortable, it won’t harm you. You may need to swallow to move the transducer into the right spot (just behind your heart).
9. Your provider will take pictures. You won’t feel anything while this happens.
10. After your provider has the pictures they need, they’ll remove the tube from your throat. You’ll soon be able to get dressed and get ready to leave.

How is an exercise stress echocardiogram done?

An exercise stress echo, sometimes simply called a stress echo, shows how your heart works when it’s taxed. The test resembles a traditional exercise stress test. A technician will monitor your heart rate and rhythm as well as your blood pressure (this is standard during a stress test). But they’ll also use echo imaging (which isn’t normally used during a stress test).

This test shows how well your heart can withstand activity. Your sonographer takes pictures before you start exercising and then right after you’re done.

In some cases, you won’t exercise. Instead, your provider will give you medication to make your heart work harder as if you were exercising. The goal is to force your heart to need more oxygen.

When your heart is under stress, your sonographer can see details they might not be able to see if you were lying on the exam table. These include problems with your coronary arteries or the lining of your heart.

Preparing for an exercise stress echo

Your provider will give you detailed instructions on how to prepare for your test. An exercise stress echo needs more preparation than other types of echo testing. These include:

• Not eating or drinking anything except water for at least four hours before your test.
• Not smoking on the day of your test.
• Avoiding caffeine for 24 hours before your test. This includes caffeine in any form (coffee, tea, decaf drinks and some over-the-counter pain medicines).

Ask your provider when and how to take your usual medications. You may need to avoid taking certain heart medications on the day of your test. You may also need to change your dose of diabetes medication. Closely follow your provider’s guidance.

You won’t be sedated, but you still may want to ask someone to drive you to and from the appointment. You may feel tired after the test.

Plan to wear comfortable clothes and shoes. You’ll need to walk or ride a stationary bike during the test, so wear what feels good for you.

What to expect during an exercise stress echo

The exercise stress echo will include the following steps:

1. Your sonographer will place electrodes (small stickers) on your chest. These stickers are hooked up to an EKG monitor to check your heart rate and rhythm during the test.
2. Your provider will measure your heart rate, heart rhythm and blood pressure before you start moving.
3. You’ll lie on an exam table so your sonographer can take pictures of your heart. They’ll place a hand-held wand (the kind usually used for echo tests) on the outside of your chest in various spots.
4. Then, it’s time to start moving. You’ll walk on a treadmill or pedal on a stationary bike. The intensity will gradually increase. You’ll keep going until you’re exhausted. This usually takes seven to 12 minutes.
5. As you’re exercising, a technician will ask how you’re feeling. Tell them any and all symptoms you notice. They’ll also watch your heart on the EKG monitor.
6. You’ll stop moving, and you’ll have another echo test done.
7. You’ll then do a short cool-down (slow walking or cycling), and your provider will monitor your vitals until they’re back to normal.

If you were given medication to stress your heart, the process will be a bit different. You won’t be on a treadmill or bike. Talk to your provider to learn what to expect and how you might feel during this type of test.

How do I get the results of my test?

After your cardiologist reviews your test, they’ll enter the results into your electronic medical record. Your primary care provider will have access to the results, too. You’ll discuss the results with one or both of these providers.

Ask any questions you’d like about the pictures and what they mean. Your provider will explain what the pictures show and whether you need follow-up tests or treatment.

What should you not do before an echocardiogram?

It depends on which type of echo you’re having done. Check with your provider to learn exactly what you should avoid. Things you may need to avoid before your echo include:

• Eating or drinking.
• Smoking or using any nicotine products.
• Drinking coffee or anything with caffeine in it. This includes decaf drinks, which still contain a small amount of caffeine. It also includes over-the-counter medications that contain caffeine.

You may need to adjust your medication schedule before your echo. Don’t stop taking any medications or make any changes until you talk with your provider.

A note from Cleveland Clinic

An echocardiogram is an important test that can reveal a lot about your heart’s structure and function. If your provider recommends an echo for you, ask about what type you’ll be receiving and what you can expect. You may need more than one echo, or multiple tests with different techniques, so your provider can get enough details about your heart.

Ask your provider to explain the pictures to you and help you understand what they mean. Taking an active role in your diagnosis and care can help you feel comfortable with each step of the process.