What Is an Echocardiogram?

An echocardiogram (echo), or cardiac ultrasound, is a test that uses high-frequency sound waves to capture moving pictures of the heart. It’s like a sonogram of a developing baby — except it’s of the heart. In an echocardiogram, a small transducer (probe) sends sound waves toward the heart. The sound waves then bounce back and are collected and processed by a computer. The computer generates a series of videos and measurements of the heart structures and movements. This gives information about the health of the heart muscles and valves and how well the heart is pumping (the ejection fraction). A cardiologist (heart specialist) reviews the results.

You may need an echocardiogram if you have symptoms like chest pain, shortness of breath, or swelling in the legs. You may also need an echocardiogram if your healthcare provider hears an abnormal heart noise or “murmur.” That’s the sound that blood makes as it passes through the heart chambers and valves. An echocardiogram can provide you and your healthcare team with valuable information about how well your heart is functioning.

Types Of Echocardiograms

Not all echocardiograms are the same. Depending on your symptoms and the heart problems your provider is looking for, there are a few different types of echocardiogram that can help:

Transthoracic echocardiogram (TTE): A TTE, or surface echocardiogram, is the most common type of echo. A trained professional places a small probe on the front of the chest and moves it around to get pictures of the beating heart.
Transesophageal echocardiogram (TEE): A TEE uses similar ultrasound technology but looks at the heart from the inside of the body (not the outside). The echo probe is on the end of a flexible tube that goes down the throat and into the esophagus, similar to an endoscopy. This lets the probe get closer to the heart and get details about certain parts of the heart that a surface echocardiogram can’t pick up.
Stress echocardiogram: This is a surface echo that looks at how much blood flow the heart muscle receives before and right after someone exercises on a treadmill or bike.

In addition to sound waves generating moving pictures of the heart, there are other techniques that can show details about how the heart is working. For example, a Doppler looks at blood flow through the heart. Depending on what color it shows up as, the person reading the test can see the direction in which blood is moving.

Instead of stressing the heart with exercise, it’s possible to inject medication to stress the heart while taking moving images of the heart under pressure. Finally, your provider can inject contrast into your veins and heart to light up the heart and provide a more detailed look at the structures of the heart during the echo.

Echocardiogram vs. EKG

An echocardiogram is an ultrasound that uses a small device called a transducer to take images of the heart’s functioning and structure. With an EKG, electrodes are placed on the chest to measure the heart’s electrical activity, like rhythm and rate.

Purpose Of The Test

A cardiac echo is used to identify abnormalities in the heart’s structure and function. A handheld device sends out sound waves that bounce off your heart and create a moving image of it on a screen. This allows your healthcare provider to look at the anatomy of your heart from many different angles and to observe your heart rhythm.

If you have symptoms of fatigue, shortness of breath, or fainting, you may need a cardiac echo. This is especially true if a stethoscope or an electrocardiogram (EKG) (a test that charts the electrical activity of your heart) suggests that you have a structural heart problem.

Uses

A cardiac echo allows your healthcare provider to watch your heart as it beats so that specific areas of concern can be identified. Some of the heart functions an echo can detect include:

Problems with the heart valves: For example, mitral valve prolapse can be detected because the test shows how well your heart’s valves are functioning.
The velocity, or speed, of blood flow within the heart: A special microphone called a Doppler can be used during the test to measure this. This is helpful in measuring problems with blood flow in conditions such as aortic stenosis.
Anatomical defects: Congenital heart conditions such as tetralogy of Fallot and atrial septal defect are conditions that are present from birth in which the heart does not develop properly.
Left ventricular ejection fraction: “Ejection fraction” is a term used to describe how strong the heart is and how well it pumps blood. An echo can evaluate how well various cardiac treatments are working in people with conditions such as heart failure.
Cardiac arrhythmia: An echo can assess your heartbeat. This may help in determining the exact cause and best treatment if you do have an arrhythmia, or irregular heart rhythm.

Echocardiograms are also sometimes used along with stress tests to evaluate heart function. An echo test is done while you are at rest and then repeated while you exercise (usually on a treadmill) to look for changes in the function of the heart muscle when you are exerting yourself. Problems with heart muscle function during exercise can be a sign of coronary artery disease.

Limitations

While the echocardiogram provides a lot of information about cardiac anatomy, it does not show the coronary arteries or any blockages in them. Another test called cardiac catheterization is commonly performed if your coronary arteries need to be examined closely.

In people with certain conditions such as a thick chest wall or emphysema, it may be difficult to visualize the heart during an echocardiogram. If you have one of these conditions and need an echo, you might need an invasive ultrasound of your heart known as a transesophageal echocardiogram (TEE). With this, a device is placed in the esophagus in order to view the heart.

Before the Test

You do not need to do anything special to prepare for an echocardiogram and you do not need to have any screening tests before having an echo. Here is what you can expect:

In general, you can expect an echocardiogram to take about an hour. As with all diagnostic tests, you should arrive at least 15 to 30 minutes in advance so that you can sign in and fill out all necessary forms.

Most medical offices will recommend that you have your echo at a cardiac testing center. If you have health insurance, your carrier may require you to go to an approved location.

There are no food and drink restrictions before an echocardiogram. However, depending on the reason for the test, your doctor may ask you to avoid caffeine for six to 10 hours before the test. This is because caffeine can speed up your heart rate.

Your health insurance may require a pre-authorization for a diagnostic echo. You also may be responsible for a copay. You can check with your health insurance provider or with the cardiac testing center—both should be able to answer your questions about these issues.

If you are paying for the test yourself, it is likely to cost you several thousand dollars. This includes facility fees, technical fees, equipment fees, and a professional fee. These costs can range widely and it is highly likely that your healthcare provider and the other healthcare providers taking care of you do not know the cost of the echo. You can ask the facility what the total cost is and for a breakdown of the fees.

During the Test

A technician or a doctor will perform your echo. Often, a technician does some or all of the test, but a doctor, usually a cardiologist, will look at your heart images while you are having your echo. They may want to adjust the transducer—the handheld device used—to visualize additional views, if necessary. Your own doctor may be present at your echo test, or another cardiologist may be there.

As the test begins, you will lie on an examination table and a technician will place some gel on your chest. Then they will place a transducer, or a small device shaped like a microphone, on that area.

The transducer sends sound waves toward your heart. Like the sonar on a submarine, the waves bounce off the structures of the heart and return to the transducer, where they are recorded. They are then processed by a computer and appear on a screen, providing a visual image of your beating heart.

The technician moves the transducer around to visualize your heart from different angles. You may be asked to roll on your side or to hold your breath for a few seconds during the test. An echocardiogram usually takes about 30 to 60 minutes to complete.

Post-Test

After the test is complete, you may be given a small towel or pad to clean up the gel. Then you can change back into your clothes and leave. Typically, results are not ready right away, because the doctor may want to review the test and look at some images more carefully before preparing a report. You do not have to adjust your activities, and there are no side effects after having an echo.

Interpreting Results

The results of your echo will be prepared in a written report by your doctor. The report will describe the heart anatomy, heart movements, and any defects observed during the test.

It may take several days to several weeks for you to receive the report. Often, because the results are so detailed, your doctor may schedule an appointment with you to discuss the results and next steps.

The report should include:

The rate of your heartbeat, with a normal range falling between 60 and 100 beats per minute
An evaluation of the size of your heart and whether there is dilation of chambers, which means that your heart is enlarged
A description of the pericardium, or the protective tissue around your heart, whether the appearance is normal, and any abnormalities
An assessment of the thickness of your heart described in relation to what is expected for your age, size, and gender
A conclusion about the function of your ventricles and details about any abnormalities
An evaluation of the shape and movement of your heart valves including whether regurgitation (leaking of blood flow) was observed
A comment about whether any blood clots were seen in your heart
A description of any anatomical or congenital defects
Any unexpected findings

Your report may also include a comment about the quality of the images. If the images did not come out clearly, that might make the results less reliable.

Follow-Up

A cardiac echo is used to assess many different conditions. As such, follow-up recommendations are highly variable and depend on the findings. You may eventually need to have another echo if you have a chronic heart condition, but regularly scheduled echocardiogram follow-ups are not typical.

In some situations, a TEE may be ordered after echo results are reviewed, particularly if your doctors are concerned that you have a heart problem that was not detected. A TEE looks at the heart by placing an ultrasound device inside your esophagus, instead of outside your chest.

There are pros and cons to both tests, and the most significant difference is that TEE is invasive and requires sedation. A TEE may also be used for surgical planning.

What Happens If Your Echocardiogram Is Abnormal?

There are many cases in which an echocardiogram report describes mild abnormalities, which may have no impact on your overall health or life. If the echo picks up any significant issues, your provider will discuss these with you. They will explain what these could mean and what needs to happen next.

Sometimes, it’s enough just to monitor abnormalities over time, with repeat echocardiograms. In other situations, you may need some follow-up testing, like another type of echo or an MRI scan.

If you’re concerned in any way about your echo results, make sure you have an appointment to discuss these with your provider. It’s important to understand what the information means for you.

The Bottom Line

An echocardiogram is a very safe test that can give you and your providers a wealth of information about your heart muscle, chambers, and valves. The results will be summarized in a very detailed report that contains multiple measurements of your heart’s structure and function.

It’s important to schedule a time to discuss the results of the echocardiogram with your provider. That way, you can fully understand what the report means for you.