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Echocardiogram

By

Catherine Spader, RN

What is an echocardiogram (echo)?

An echocardiogram, or echo, is a type of ultrasound or sonogram imaging test. It uses a transducing device that translates sound wave echoes into moving images of the heart. Your doctor uses an echocardiogram to look at the heart’s size and structure, and to see how well it pumps blood. 

An echocardiogram evaluates many heart problems, including heart murmurs, heart failure, and heart valve disease.

An echocardiogram is only one method used to monitor and diagnose heart conditions. Discuss all of your diagnostic options with your doctor to understand which options are right for you.    

Types of echocardiogram

The types of echocardiogram include:

  • Standard transthoracic echocardiogram (TTE) makes moving pictures of your heart while you are at rest. It uses a painless, wand-like instrument, called a transducer, on your chest. It is the most common type of echocardiogram. Your doctor may also perform an EKG (electrocardiogram) during your echocardiogram to evaluate your heart’s electrical activity during the test.

  • Stress echocardiogram involves performing an echocardiogram during a cardiac stress test. A cardiac stress test shows how exercising on a treadmill affects your heart. If you cannot tolerate walking on a treadmill, the doctor will give you a medication called dobutamine to mimic the effect of exercise on the heart.

  • Transesophageal echocardiogram (TEE) involves passing a special, much smaller transducer down your throat to take moving pictures of your heart. A transesophageal echocardiogram produces clearer pictures than other types of echocardiograms.

  • Doppler echocardiogram records the flow of blood through the heart.

Why is an echocardiogram (echo) performed? 

Your doctor may recommend an echocardiogram to evaluate your heart health. An echocardiogram by itself cannot diagnose all types of heart conditions or predict future heart problems. It provides important information about your heart health in relation to your age, physical exam, medical history, and other tests.

Doctors use echocardiograms to help diagnose, determine the severity of, or monitor treatment of the following conditions:

  • Cardiac arrhythmias, a heartbeat that is too fast, too slow, or irregular

  • Cardiomyopathy, thickened or enlarged heart muscle

  • Congenital heart defects, birth defects of the heart

  • Coronary artery disease (CAD), a buildup of plaque on the walls of the coronary arteries that supply blood to the heart

  • Heart attack, death of a portion of the heart muscle usually due to coronary artery disease and a blood clot that blocks blood flow to the heart

  • Heart failure, an inability of a weakened heart to pump enough blood to the body

  • Heart murmurs, unusual or abnormal heart sounds heard with a stethoscope

  • Heart valve disease including narrowed valves, leaky valves, and infectious endocarditis (an infection of the heart valves)

  • Pericarditis, inflammation of the sac that surrounds the heart

  • Pulmonary hypertension, increased blood pressure in the blood vessels that carry blood from the heart to the lungs

Your doctor may also use an echocardiogram to look for blood clots inside the heart that could travel to the brain and cause a stroke or transient ischemic attack (TIA). 

An echocardiogram can also help your doctor determine if certain symptoms are related to a heart problem. This commonly includes an irregular heartbeat or fluttering sensation in your chest. Other symptoms include chest pain, dizziness, shortness of breath, fatigue, weakness, palpitations, or passing out.

Who performs an echocardiogram (echo)?

A specially trained radiologic technologist, called a sonographer, generally performs an echocardiogram. Radiologic technologists are trained in medical imaging and the care of patients during imaging procedures. A radiologic technologist is supervised by a radiologist or other doctor. 

The following specialists order echocardiograms:

  • Cardiologists are internists or pediatricians who specialize in treating heart conditions. A cardiologist will also evaluate the echocardiogram images and provide your primary doctor with the results.

  • Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.

  • Primary care providers including internists, family practitioners (family medicine doctors), pediatricians, geriatricians, physician assistants (PAs), and nurse practitioners (NPs). Primary care providers offer comprehensive healthcare services and treat a wide range of illnesses and conditions.

  • Pulmonologists are internists or pediatricians with specialized training in treating diseases and conditions of the chest.

  • Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.

How is an echocardiogram (echo) performed?

The procedure takes 15 minutes to two hours, depending on the type of echocardiogram.

An echocardiogram generally includes these steps:

  1. You will undress from the waist up, put on a patient gown, and relax on a table. The room will be dark so the images are easier to see on the ultrasound screen.

  2. Your provider will attach sticky, painless EKG patches, or electrodes, to your chest if you have an EKG (electrocardiogram) with your echocardiogram.

  3. Your technologist will apply a water-based jelly to your chest. The gel helps the transducer slide across your skin. The transducer is shaped like a microphone. It sends and receives sound waves to produce the images.

  4. Your technologist will move the transducer to different places on your chest and ribs to take pictures of different areas of the heart. You may have to shift your position, breathe slowly, and hold your breath for short periods to help make clearer pictures.

  5. Your technologist watches the echocardiogram screen during the procedure. This ensures that the right type and amount of images is captured.

  6. The technologist will wipe off the gel after the test is complete. The gel is water-based and washes away easily.

  7. You may wait a short period of time while the sonographer or cardiologist verifies that the imaging is complete. Patients usually go home right after the test.

  8. Your cardiologist will evaluate your echocardiogram and discuss the results with you.

The procedure varies somewhat for other types of echocardiograms:

  • Transesophageal echocardiogram involves numbing your throat with an anesthetic and giving you medication to help you relax. The cardiologist gently passes a specialized, much smaller transducer down your throat into your esophagus to make clearer moving images of the heart.

  • Stress echocardiogram involves performing an echocardiogram before and during a cardiac stress test. A stress test involves walking on a treadmill.

Will I feel pain?

Your comfort and relaxation is important to you and your care team. A regular or standard transthoracic echocardiogram is a painless, noninvasive procedure. 

A transesophageal echocardiogram can be uncomfortable, but you will have medication to keep you relaxed and comfortable. A stress echocardiogram can cause chest pain or shortness of breath, although this is uncommon. Tell your care team right away if you have any pain, discomfort, or other symptoms.  

What are the risks and potential complications of an echocardiogram (echo)?  

There are no known risks or complications of a regular, standard transthoracic echocardiogram. An echocardiogram is a type of ultrasound, which uses sound waves to produce images. Unlike X-rays, echocardiograms do not use radiation.

Transesophageal echocardiogram is generally safe, but it is invasive. It involves passing a special instrument into the throat and esophagus. Rarely, it can cause:

  • Breathing problems

  • Reaction to sedative or anesthetic medications

  • Slow heart rate

Stress echocardiogram forces the heart to work harder and carries a small risk of complications including:

  • Abnormal heartbeats, also called cardiac arrhythmia

  • Breathing problems such as wheezing and shortness of breath

  • Chest pain, also called angina

  • Heart attack (rare)

  • Low blood pressure and fainting

Reducing your risk of complications

You can reduce the risk or the seriousness of some complications by following your treatment plan and: 

  • Notifying your care team immediately of any concerns such as chest pain, palpitations, dizziness, or difficulty breathing

  • Telling your care team about your complete medical history including a history of allergies and heart problems

How do I prepare for my echocardiogram (echo)?

You are an important member of your own healthcare team. The steps you take before your echocardiogram helps produce the most accurate test results.

You can prepare for an echocardiogram by:

  • Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Not eating, drinking, or using caffeine before your test as directed by your doctor. These restrictions generally do not apply to a regular transthoracic echocardiogram.

Questions to ask your doctor

Having an echocardiogram can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before an echocardiogram and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Questions can include:

  • Why do I need an echocardiogram?

  • Will I have a regular echocardiogram or a more complex procedure, such as a stress echocardiogram or transesophageal echocardiogram?

  • How long will the procedure take? Will I need a ride home?

  • How should I take my medications?

  • When and how will I receive my test results?

  • What other tests or treatments might I need?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my echocardiogram (echo)?

Knowing what to expect after an echocardiogram can help you get back to your everyday life as soon as possible.

How will I feel after my echocardiogram?

Patients can usually return to normal activities and eat and drink as usual after an echocardiogram. Follow your doctor’s dietary and activity advice. 

You should not feel any ill effects or have any symptoms after your echocardiogram. Tell your doctor right away about any symptoms, such as dizziness, vomiting, chest pain, trouble swallowing, or shortness of breath. 

When can I go home?

You will likely go home right after an outpatient echocardiogram. Your doctor will discuss the results with you at a later time. Sometimes, patients stay to discuss the results with the doctor or cardiologist and to get more tests. If you are hospitalized, you will likely stay in the hospital for further evaluation and treatment.

When should I call my doctor?

It is important to keep your follow-up appointments after an echocardiogram. Contact your doctor for questions and concerns between appointments. Seek immediate medical care if you have chest pain or shortness of breath.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 4, 2016

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Echocardiogram. HeartSite.com. http://www.heartsite.com/html/echocardiogram.html
  2. Echocardiogram. American College of Cardiology. http://cardiosmart.org/HeartDisease/CTT.aspx?id=176
  3. Stress Echocardiography. Texas Heart Institute. http://www.texasheartinstitute.org/HIC/Topics/Diag/disecho.cfm

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