Echocardiography

What is echocardiography?

Echocardiography (also called an electrocardiogram or “echo”) is an ultrasound exam of the heart. An ultrasound is an imaging test that uses sound waves to create pictures of organs and other structures inside your body. An echocardiograph uses a specific type of ultrasound (sometimes called a transthoracic ultrasound) that can show a moving image of the heart.

An echocardiogram uses sound waves to check:

• Your heart's size and structure
• Your heart's valves
• The strength of your heart's walls
• How well your heart pumps blood
• The pericardium (the sac that surrounds the heart)

There are several types of echocardiography. The most common type is called a transthoracic echocardiogram (or TTE). For this type, a health care professional applies gel to a transducer (a wand-like device) and moves it across your chest. The transducer sends ultrasound waves into your chest, and the waves bounce (or echo) back. When they echo back, the transducer sends the echoes to a computer which then changes them into pictures.

In some cases, however, your health care provider may need to perform a transesophageal echocardiogram (or TEE) test. This test lets your provider get a more detailed look at the blood flow in your heart. To do this test, they will have to attach the transducer to a tube that they'll insert down your esophagus (the muscular tube that carries food and liquids from your mouth to the stomach). You'll be given medicine to relax you and numb the back of your throat before the scope is guided into your esophagus.

Other names: transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), stress echocardiography, point-of-care ultrasound (POCUS), contrast echocardiography, strain imaging, 3-D echocardiography, echo, heart echo, heart/cardiac ultrasound, heart sonogram

What is it used for?

Your provider can use an echocardiogram to screen for and help diagnose certain conditions such as:

• Cardiomyopathy, a disease that makes it harder for your heart to pump blood the way it should
• Aortic aneurysm, a bulge that occurs in the wall of the aorta (the body's main artery that carries blood out of the heart)
• Heart failure, which happens when your heart can't pump blood the way it should
• Heart valve disease, which happens when your heart valves narrow or start leaking, causing problems with blood flow
• Pericardial effusion, which is when the sac around the heart fills up with fluid
• Pericarditis, an infection in the sac around the heart
• Cardiac tumors, which can form on the outside of the heart
• Blood clots, which can block blood flow in the heart
• Congenital heart disease, which is a heart condition present since birth

This test can also be used to monitor your heart:

• Before and after surgery
• During treatment for a heart condition
• After a heart attack or stroke, which can damage your heart's walls
• If you have any congenital heart defects

Most echocardiograms present real-time, two-dimensional (2D) images of your heart in motion (also called cardiac 2D echo panels). These images (often called “slices”) show your heart's structure and how well the heart's valves and chambers work. However, your provider may use different ultrasound techniques to look at your heart. These can include:

• Three-dimensional (3D) ultrasounds, which displays your heart as a 3D image on the computer screen. Your provider can use this approach to better see the heart from different angles. It can also be used when a provider wants to get a clearer look at the heart's lower left chamber.
• Doppler imaging, which uses sound waves that change in pitch to see how fast your blood flows and in what direction. Your provider can use this approach to see if you have any blocked or leaking valves.
• Strain imaging, which takes images of your heart and measures its length when it contracts (or tightens) and relaxes. This is a newer method, and your provider can use it to help find certain heart problems, such as cardiomyopathy (a type of condition that affects your heart's ability to pump blood).

Why do I need an echocardiogram?

Your provider may order an echo if you have:

• A heart murmur
• Damaged heart valves
• Shortness of breath
• Edema (swelling in the legs)
• Unexplained chest pains
• Rheumatic fever, which can cause swelling and injury to your heart
• Any congenital heart defects (heart problems present since birth)
• Had a heart attack or stroke
• Had heart surgery

You may need a transesophageal echocardiogram (TEE) if:

• A transthoracic echocardiogram (TTE) didn't show enough detail
• You have very low blood pressure or oxygen levels
• You suddenly develop heart problems, such as a tear in your aorta
• You're having a procedure to treat arrhythmia (an irregular heart rhythm)
• You're having heart surgery

Your provider may also order regular echocardiograms to monitor chronic (long-term) or congenital heart conditions.

These conditions can look different depending on your sex. For example, women are more likely to experience nausea, extreme fatigue, and pain in the neck or back during a heart attack. Certain health conditions can also raise the risk for heart disease in women more than they do in men. These include:

• Menopause
• Pregnancy complications
• Smoking
• Stress and depression
• Diabetes

So, if you're a woman with any of these risk factors, your provider may order echos more frequently.

What happens during an echocardiogram?

There are several types of echocardiograms, each with differing procedures. What you experience will depend on which type of echocardiogram you get.

For a TTE (transthoracic echocardiogram):

• You may need to remove some or all of your clothing. If so, you will be given a hospital gown.
• You'll lie on a bed on your left side or back.
• A health care professional will put a special gel on your chest.
• The health care professional will then move a transducer over several places on your chest.
• Sound waves will travel down the transducer and into your chest. When they bounce (or echo) off your heart and return to the transducer, they will then be sent to a computer.
• The computer will translate these waves into images and videos of your heart.
• This usually takes 30-60 minutes.

For a TEE (transesophageal echocardiogram):

• You may need to remove some or all of your clothing. If so, you will be given a hospital gown.
• You may also need to remove dentures and any removable dental appliances.
• You will lie on a bed or table with your head raised.
• You may get medicine (sedative) to help you relax. The medicine will be injected into a vein or given through an IV (intravenous) line placed in your arm or hand.
• Your provider will spray a numbing medicine in the back of your mouth and throat so you won't feel any pain during the procedure.
• Your provider will insert a tube down your throat. A transducer will be attached to the end of the tube.
• Sound waves will travel down the transducer and into your heart. When they bounce (or echo) off your heart and return to the transducer, they will then be sent to a computer.
• The computer will translate these waves into images and videos of your heart.
• When the test is finished, your provider will gently pull the probe out. You may feel a need to cough.
• This procedure may take up to 90 minutes.

Will I need to do anything to prepare for the test?

For a TTE, no special preparation is usually needed.

For a TEE, your provider may ask you not to eat or drink for several hours before the test. You will need someone to take you home after the test. The sedatives needed for a TEE test may make you drowsy for several hours.

Are there any risks to the test?

There are no risks to a TTE.

For a TEE, there is a slight risk of:

• Allergic reactions to medicines
• Aspiration pneumonia, an infection caused by inhaling anything that isn't air, such as food or fluid
• Blood pressure or heart rhythm problems
• Minor bleeding in your esophagus

What do the results mean?

Your results will likely include measurements and descriptions of your heart. This can include information about:

• Any changes in your heart's size
• Your heart's pumping strength (for example, how much blood your heart pumps with every heartbeat)
• Any heart muscle damage
• Heart valve disease

Your provider may use these results along with your medical history and the results of other tests to diagnose a heart condition or decide on a treatment plan.

To understand your results, talk to your provider.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about an echocardiogram?

In some cases, your provider may order a stress test echocardiogram. This test lets your provider see how well your heart works when under stress. To do this, your provider can either:

• Examine your heart before and after you exercise. This often means running on a treadmill.
• Give you medicine that increases your heart rate.

Your provider can use this test to help diagnose coronary artery disease. This condition happens when the blood vessels that carry blood to your heart become blocked.

You may need this test if you have symptoms of heart disease that get worse with activity.