Echocardiogram

What is an echocardiogram?

An echocardiogram is an ultrasound test for your heart. It uses high-frequency sound waves to create moving pictures of your heart as it beats. This test can help your healthcare provider diagnose and treat many different heart conditions, including those you’re born with and those you develop later in life. Other names for this test include echo, heart echo and heart/cardiac ultrasound.

An echocardiogram shows your heart’s structure and pumping ability. It also shows blood flow through your heart, including through each of its valves.

Cardiologists order echocardiograms for many reasons, including to:

• Find the cause of your symptoms
• Confirm a diagnosis
• Assess your heart’s function
• Monitor a condition, like valve disease
• Prepare you for heart surgery
• Check the outcome of surgery

Your provider will tell you why you need this test and how it can help you. Most echocardiograms are noninvasive, meaning nothing goes into your body. In some cases, you may need a more invasive type where a small device takes pictures from inside your body.

What are the different types of echocardiograms?

There are several types of echo tests:

• Transthoracic echocardiogram (TTE): This is the most common type and what most people mean when they say they’re getting an echo. A provider places a small device on the surface of your chest to take pictures of your heart. It’s quick and painless.
• Transesophageal echocardiogram (TEE): This type takes pictures of your heart from within your body. A provider guides a small device down your throat while you’re sedated. This test makes higher-quality pictures than a TTE and shows the back of your heart better.
• Exercise stress echocardiogram: This type shows how your heart functions when it’s working hard. You use a treadmill or a stationary bike to get your heart rate up. This test helps diagnose the cause of symptoms you have while you’re active.
• Dobutamine stress echocardiogram: This test also checks how your heart works when it’s under stress. But instead of using exercise to elevate your heart rate, your provider gives you medicine to do it. This is useful if you can’t exercise on a treadmill or bike.

How does echocardiography work?

An echocardiogram uses ultrasound technology to create images of your heart in motion. A device called a transducer sends sound waves through your chest. These waves bounce off your heart tissue, making echoes. The transducer captures these echoes and sends them back to a computer.

Computer software uses these echoes to make pictures of your heart. The pictures move, allowing your healthcare provider to see how your heart beats. The pictures are easily saved for your provider to review and keep as part of your medical record.

This same basic technology is the same for all echocardiograms. But providers may use certain techniques to get extra details or check a specific aspect of your heart, like blood flow through your valves. Examples of such techniques include:

• Two-dimensional (2D) ultrasound: This approach is common. It produces 2D images that appear as “slices” on the computer screen. These slices are “stacked” to build a 3D structure.
• Three-dimensional (3D) ultrasound: Advances in technology have made 3D imaging more efficient and useful. New 3D techniques can improve accuracy and show parts of your heart from different angles. 
• Doppler ultrasound: This technique shows how fast your blood flows and in what direction. It can also track the velocity of your heart muscle, which may be helpful for your provider to understand your heart’s function.
• Strain imaging: This approach shows changes in how your heart muscle squeezes and relaxes. It can catch early signs of some heart issues.
• Contrast imaging: Your provider injects a substance called a contrast dye into one of your veins. The substance shows up in the images and highlights details of your heart.

An echo doesn’t use radiation, which many people see as a benefit. This is different from tests like X-rays and CT scans, which use small amounts of radiation.

How do I prepare for the test?

Prep depends on the type of echo you’re getting. Your provider will give you specific instructions. You may need to:

• Avoid caffeine, alcohol, tobacco or food for a certain amount of time leading up to the test
• Stop taking some of your medicines (never do this unless your provider tells you to)
• Wear comfortable clothes and shoes if you’ll be exercising
• Find someone to drive you home from the test if you’ll be sedated

For most types of echo tests, you’ll need to undress from the waist up and put on a hospital gown.

What happens during the test?

A cardiac sonographer performs your echo. The test usually takes 40 to 60 minutes. A TEE may take up to 90 minutes. The exact details vary by type. In general, your provider will:

1. Help you get comfortable: For a TTE, that just means lying on an exam table. For a TEE, you’ll gargle with a numbing solution and receive sedation. If you’re exercising, you’ll get onto a bike or treadmill. Your provider may put a gel on your chest to help transmit sound.
2. Connect you to an EKG monitor: This device tracks your heart rate and rhythm during your echo. Your provider will place several small stickers (electrodes) on your chest.
3. Take pictures of your heart: Your provider will use a wand-like device called a transducer to send sound waves to your heart. They typically place this device on your chest. For a TEE, a tiny transducer is inside your esophagus, but otherwise, it works the same.
4. Ask you to move or breathe in certain ways: You may need to stay still or hold your breath at certain moments. This helps get the best possible pictures.

Once your provider has enough pictures, they’ll wrap up the test. If you were in a gown, you’ll change back into your clothes. You may need to stay for around 30 minutes so your provider can monitor you after the test.

What are the risks of an echo test?

Echocardiography is typically safe and painless. A TTE has no known risks. Other types, like TEE and those that stress your heart, come with some risks. For example, an exercise stress test may make you feel symptoms like chest pain or shortness of breath. A TEE may cause a mild sore throat for a few days. The contrast dye used in some echo tests may cause an allergic reaction.

Your provider will explain the risks before your test and answer all your questions.

What can I expect after the test?

For most echo tests, you can drive yourself home. But you need someone to drive you after a TEE because you’re sedated during this test. It’s not safe for you to drive for 24 hours.

Your provider who ordered the test (likely your heart doctor) will let you know when the results are ready. You may have a follow-up visit or phone call to discuss them.

You might see results pop up on your electronic medical record. But it’s a good idea to wait for your provider to review them with you. Certain things may sound scary when you read the results on your own. Your provider will help you understand what the results mean and whether you need treatment for any issues.

What type of results do you get?

An echo makes moving pictures of your heart that your provider can review. They may show you these pictures when you come in to discuss the results. A normal echocardiogram means there aren’t any concerns about your heart’s structure or function. An echo can also find problems that need treatment either right now or down the road.

An echocardiogram can diagnose:

• Blood clots: Gel-like clumps that can form in your heart’s chambers
• Congenital heart disease: Heart problems that you’re born with
• Cardiomyopathy: Conditions affecting your heart muscle
• Heart tumors: Growths in your heart that may be cancerous or benign
• Infective endocarditis: A dangerous infection of your heart valves
• Pericarditis: Inflammation of the sac that protects your heart
• Thoracic aortic aneurysm: A bulge in the part of your aorta that’s in your chest
• Valve disease: Problems with how your heart valves open or close to let blood through

When should I call my doctor?

Call the doctor who ordered your echo if you have:

1. Questions about prep
2. Reactions or side effects after the test
3. Questions or concerns about the results or what comes next