What Is an Echocardiogram?

An echocardiogram is a medical test that uses sound waves (ultrasound) to produce images of your heart. It allows healthcare providers to see the heart's structures like the chambers, valves, and walls, as well as blood flow.

The test can help healthcare providers examine heart function and diagnose cardiac conditions, such as heart murmurs, heart valve problems, congenital heart defects, and abnormalities in heart function.

There are different types of echocardiogram tests and several reasons for why healthcare providers use them. 

Why Does a Healthcare Provider Order an Echocardiogram?

An echocardiogram—also known as an echo, cardiac echo, or cardiac ultrasound—allows healthcare providers to see the heart's structure and blood flow. Providers can observe the rhythm of a heart and measure the size and function of the heart’s chambers and valves.

Healthcare providers may order an echocardiogram for several reasons, including to:

• Investigate a heart murmur that was detected with a stethoscope during a routine physical examination 
• Determine the cause of symptoms such as chest pain, shortness of breath, palpitations, or lightheadedness
• Assess the effects of a heart attack or monitor the progression of heart disease
• Monitor the heart's response to physical activity or stress
• Evaluate the effectiveness of heart condition treatments, such as medications, devices, or procedures

Based on the images and observations made during an echocardiogram, your healthcare provider can determine the presence and severity of certain conditions. They can use this information to recommend effective treatment. 

Types of Echocardiograms

There are different types of echocardiograms. The specific type your healthcare provider orders will depend on the condition or the area of your heart that needs attention. Echocardiogram types include:

• Transthoracic echocardiogram (TTE): The most common type of echocardiogram, a TTE consists of placing a handheld device called a transducer over different parts of your chest. The transducer will emit sound waves and then pick back up the sound waves' echos to produce images of the heart. 
• Stress echocardiogram: This test combines an echocardiogram with exercise or medication to evaluate the heart's response to stress. The ultrasound machine creates pictures of the heart before and after exercise for healthcare providers to evaluate how the heart responds to stress. 
• Transesophageal echocardiogram (TEE): A special ultrasound probe (a flexible, but firm tube) is placed into the mouth and down the esophagus to provide clear pictures of the heart. A TEE typically provides clearer pictures than a TTE and is often used in conditions that require higher-quality images.
• Doppler echocardiogram: This is used to evaluate the blood flow through the heart's chambers, blood vessels, and valves. A doppler echo can help diagnose blood flow and heart valve problems and may be performed during a TTE, TEE, or stress echocardiogram. 
• Three-dimensional echocardiogram: This echo uses multiple images to produce a three-dimensional view of the heart, allowing for a more detailed evaluation of its structure and function.

How to Prepare

Most echocardiogram tests do not require much preparation. However, there are a few steps you can take to prepare for the test:

• Wear comfortable, loose-fitting clothing. You may need to remove some clothing, such as your shirt, so the provider can access your chest with the transducer. For a stress echo, you may want to wear fitness clothes for the exercise portion of the test.
• Inform your healthcare provider of any medications you take, especially blood thinners such as aspirin, warfarin, or heparin. In some cases, you may need to stop taking certain medications before the test.
• If you have a transesophageal echocardiogram, your provider may ask you to avoid eating and drinking approximately eight hours before the test.  

Follow the instructions provided by your healthcare provider to ensure the accuracy and safety of your echocardiogram.

What to Expect 

An echocardiogram is typically performed in a hospital or your healthcare provider’s office. A trained and certified echocardiography technician or a physician, such as a cardiologist will perform the test. The procedure typically takes 30-60 minutes.

Before the procedure, you will be asked to remove any clothing or jewelry that may interfere with the procedure. You may be asked to change into an examination gown. 

You will then lie on a table, either on your back or left side, depending on the type of echocardiogram being performed. As you lie there, you will remain still and hold your breath for short periods as the technician takes the images. 

During the most commonly performed echocardiogram, the transthoracic echocardiogram, the technician will:

• Place a small handheld transducer on your chest, using a special gel to ensure good contact
• Move the transducer to different positions on the chest to produce images of the heart from different angles
• Use a Doppler ultrasound to evaluate the blood flow through the heart's chambers and valves

The procedure is generally painless and non-invasive, but you may feel pressure when the transducer is placed on your chest.

For a stress echocardiogram, you will first undergo a regular echo test while your heart is at a resting rate. Then to increase your heart rate, you will be asked to walk on a treadmill or pedal on an exercise bike. The speed and incline of the treadmill or bike will increase every few minutes until you reach the target heart rate, or until you are too tired. The exercise portion should take about 5-15 minutes.

Echocardiogram images will be taken as your heart rate increases and reaches the target rate during exercise. The healthcare provider will also monitor your heart rhythm and blood pressure during the test.

For a transesophageal echocardiogram, a gel or spray will numb the back of your mouth and throat, and you will be given supplemental oxygen through a tube in your nose. You may also be given a medication to help you relax or go to sleep. During the procedure, the healthcare provider will place a tube down your throat and position it behind your heart, where the transducer will take pictures of your heart’s structures.

After the Test

There is generally no recovery time needed after an echocardiogram. If you have a transesophageal echocardiogram, you may experience some soreness in your throat for a few hours after the test.

Most people can return to their normal activities immediately after the test. If you have any concerns or issues after the echocardiogram, talk to your healthcare provider. They can guide you on what steps to take and answer your questions. 

What Will the Results Show?

After the test, your healthcare provider will interpret the echocardiogram results. Once they have evaluated the results, they will go over the report with you.

Echocardiogram reports may include the following:

• The reason the test was performed 
• Measurements of the upper and lower heart chambers and walls 
• The thickness of the heart muscle 
• Left and right ventricle function, including ejection fraction, which measures how the heart pumps blood with each heartbeat 
• Description of the heart shape, function, movement, and valves 
• Description of the heart arteries, veins, and lining 
• Abnormalities detected, such as blood clots and heart defects

The results of an echocardiogram can either be normal or abnormal. A normal echocardiogram means the heart's structure and function are within normal limits and there are no signs of significant problems such as heart disease, heart valve abnormalities, or congenital heart defects.

An abnormal echocardiogram means that the test has revealed an issue with the heart's structure or function that needs further evaluation or treatment. Some abnormalities that may be detected on an echocardiogram include:

• Damage from a heart attack: An echo may be used after a heart attack to determine where the heart has sustained damage and where the blood supply to the heart was blocked. 
• Heart disease: Coronary artery disease, cardiomyopathy, or heart failure can be detected on an echo test.
• Heart valve problems: An echocardiogram can detect if the heart valves are not working properly, such as if they are too narrow (stenosis) or not closing properly (regurgitation).
• Congenital heart defects: These are heart defects that are present at birth and can be detected on an echocardiogram. 
• Endocarditis: The presence of an infection in the heart’s lining, which can damage heart valves. 

If your echocardiogram results are abnormal, your healthcare provider will discuss the results with you and develop a treatment plan, which may include further testing, medication, or surgery. 

Risks

A standard transthoracic echocardiogram is generally considered a safe and non-invasive procedure with no known risks. Some people may feel mild discomfort from the cold gel placed on the chest or from the pressure of the transducer on their chest during the procedure. 

A transesophageal echocardiogram is considered an invasive procedure and may include some risks. Since a transesophageal echocardiogram involves moving an ultrasound probe down the esophagus, there is potential for damage to the esophagus. This is more likely for people who already have a problem with their esophagus. Some people might also experience a reaction to the sedative medicines used to put you to sleep during the procedure.

Talk to your healthcare provider about any risks or concerns related to the type of echo test you will be taking.

A Quick Review

An echocardiogram is a test that uses sound waves to produce images of the heart and assess its structure and function. It can help diagnose heart disease, heart valve problems, and congenital heart defects. Echocardiogram types include a transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), Doppler echocardiogram, three-dimensional echocardiogram, and stress echocardiogram.

A trained technician in a healthcare facility will perform the procedure, and most types of echo tests do not require special preparations. Your healthcare provider will interpret the test results and discuss the findings with you. Depending on the results, they may provide a diagnosis and treatment plan or recommend further testing if necessary. 

A TTE echocardiogram is considered safe with no known risks. However, other types of echo tests may have some risks. Talk to your healthcare provider for more information about echocardiograms.