Echocardiogram

Echocardiography (EK-o-kar-de-OG-ra-fee), or ECHO, is a painless test that uses sound waves to create pictures of your heart.

The test gives your doctor information about the size and shape of your heart and how well your heart's chambers and valves are working. ECHO also can be done to detect heart problems in infants and children.

The test also can identify areas of heart muscle that aren't contracting normally due to poor blood flow or injury from a previous heart attack. In addition, a type of ECHO called Doppler ultrasound shows how well blood flows through the chambers and valves of your heart. It can be used to detect any narrowing of the heart valves or leaking valves.

ECHO can detect possible blood clots inside the heart, fluid buildup in the pericardium (the sac around the heart), and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to the organs of the body.

Other Names for Echocardiography

  • ECHO
  • Surface ECHO
  • Ultrasound of the heart

Types of Echocardiography

There are several types of echocardiography (ECHO)—all use sound waves to create pictures of your heart. This is the same technology that allows doctors to see an unborn baby inside a pregnant woman.

Unlike x rays and some other tests, echo doesn't involve radiation.

Transthoracic Echocardiography

Transthoracic (tranz-thor-AS-ik) ECHO is the most common type of echocardiogram test. It's painless and noninvasive. "Noninvasive" means that no surgery is done and no instruments are inserted into your body.

This type of echo involves placing a device called a transducer on your chest. The device sends special sound waves, called ultrasound, through your chest wall to your heart. The human ear can't hear ultrasound waves.

As the ultrasound waves bounce off the structures of your heart, a computer in the ECHO machine converts them into pictures on a screen.

Stress Echocardiography

Stress echo is done as part of a stress test. During a stress test, you exercise or take medicine (given by your doctor) to make your heart work hard and beat fast. A technician will take pictures of your heart using echo before you exercise and as soon as you finish.

Some heart problems, such as coronary heart disease, are easier to diagnose when the heart is working hard and beating fast.

Adding ECHO to the stress test increases the sensitivity of the stress test in detecting coronary artery disease, or narrowing of the coronary vessels.

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Transesophageal Echocardiography

With standard transthoracic echo, it can be hard to see the aorta and other parts of your heart. If your doctor needs a better look at these areas, he or she may recommend transesophageal (tranz-ih-sof-uh-JEE-ul) echo (TEE). TEE is especially useful in detecting clots in the left atrium and may be recommended before cardioversion or catheter ablation procedures for atrial fibrillation.

During this test, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus (the passage leading from your mouth to your stomach). You will be given a topical anesthetic to the throat, to minimize discomfort, and also a sedative through your vein for this procedure. Images of the heart are obtained with the ultrasound transducer in the esophagus looking forward into the heart. This closer view allows more detailed information to be obtained about the heart and valves, including detection of blood clots that may have formed in the left upper chamber, or atrium, of the heart and infections or structural abnormalities of the heart valves.

Three-Dimensional Echocardiography

A three-dimensional (3D) echo creates 3D images of your heart. These images provide more information about how your heart looks and works.

During transthoracic echo or TEE, 3D images can be taken as part of the process used to do these types of echo. (See above for more information on how transthoracic echo and TEE are done.)

3D echo may be used to diagnose heart problems in children. This method also may be used for planning and monitoring heart valve surgery.

Researchers continue to study new ways to use 3D echo.

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What To Expect Before Echocardiography

Echocardiography (ECHO) is done in a doctor's office or a hospital. No special preparations are needed for most types of echo. Usually you can eat, drink, and take any medicines as you normally would.

The exception is if you're having a transesophageal ECHO. This test usually requires that you don't eat or drink for 8 hours prior to the test.

If you're having a stress ECHO, there may be special preparations. Your doctor will let you know how to prepare for your echo test.

What To Expect During Echocardiography

Echocardiography (ECHO) is painless and usually takes less than an hour to do. For some types of ECHO, your doctor will need to inject saline or a special dye into one of your veins to make your heart show up more clearly on the test images. This special dye is different from the dye used during angiography (a test used to examine the body's blood vessels).

For most types of ECHO, you'll be asked to remove your clothing from the waist up. Women will be given a gown to wear during the test. You'll lay on your back or left side on an exam table or stretcher.

Soft, sticky patches called electrodes will be attached to your chest to allow an EKG (electrocardiogram) to be done. An EKG is a test that records the heart's electrical activity.

A doctor or sonographer (a person specially trained to do ultrasounds) will apply gel to your chest. The gel helps the sound waves reach your heart. A wand-like device called a transducer will then be moved around on your chest.

The transducer transmits ultrasound waves into your chest. Echoes from the sound waves will be converted into pictures of your heart on a computer screen. During the test, the lights in the room will be dimmed so the computer screen is easier to see.

The illustration shows a patient having an echocardiography. The patient lies on his left side. A sonographer moves the transducer on the patient’s chest, while viewing the pictures from the echocardiography on a computer.

The sonographer will make several recordings of the pictures to show various locations in your heart. The recordings will be put on a computer disc or videotape for the cardiologist (heart specialist) to review.

During the test, you may be asked to change positions or hold your breath for a short time so that the sonographer can get good pictures of your heart.

At times, the sonographer may apply a bit of pressure to your chest with the transducer. This pressure can be a little uncomfortable, but it helps get the best picture of your heart. You should let the sonographer know if you feel too uncomfortable.

Transesophageal Echocardiography

Transesophageal echo (TEE) is used when your doctor needs a more detailed view of your heart. For example, TEE may be used to look for blood clots in your heart. A doctor, not a sonographer, performs this type of echo.

The test uses the same technology as transthoracic echo, but the transducer is attached to the end of a flexible tube. The tube will be guided down your throat and into your esophagus (the passage leading from your mouth to your stomach). From this angle, your doctor can get a more detailed image of the heart and major blood vessels leading to and from the heart.

For TEE, you'll likely be given medicine to help you relax during the test. The medicine will be injected into one of your veins. Your blood pressure, the oxygen content of your blood, and other vital signs will be checked during the test. You'll be given oxygen through a tube in your nose. If you wear dentures or partials, you'll have to remove them.

The back of your mouth will be numbed with a gel or a spray so that you don't gag when the transducer is put down your throat. The tube with the transducer on the end will be gently placed in your throat and guided down until it's in place behind the heart.

The pictures of your heart are then recorded as your doctor moves the transducer around in your esophagus and stomach. You shouldn't feel any discomfort as this happens.

Although the imaging usually takes less than an hour, you may be watched for a few hours at the doctor's office or hospital after the test.

Stress Echocardiography

Stress echo is a transthoracic echo combined with either an exercise or pharmacological (FAR-ma-ko-LOJ-i-kal) stress test.

For an exercise stress test, you'll walk or run on a treadmill or pedal a stationary bike to make your heart work hard and beat fast. For a pharmacological stress test, you'll be given medicine to make your heart work hard and beat fast.

A technician will take pictures of your heart using echo before you exercise and as soon as you finish. The Diseases and Conditions Index Stress Testing article provides more information about what to expect during a stress test.

What You May See and Hear During Echocardiography

As the doctor or sonographer moves the transducer around, different views of your heart can be seen on the screen of the echo machine. The structures of the heart will appear as white objects, while any fluid or blood will appear black on the screen.

Doppler ultrasound techniques often are used during echo tests. Doppler ultrasound is a special ultrasound that shows how blood is flowing through the blood vessels.

This test allows the sonographer to see blood flowing at different speeds and in different directions. The speeds and directions appear as different colors moving within the black and white images.

The human ear is unable to hear the sound waves used in echo. If Doppler ultrasound is used, you may be able to hear "whooshing" sounds. Your doctor can use these sounds to learn about blood flow through your heart.

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What To Expect After Echocardiography

You usually can go back to your normal activities right after having echocardiography (echo).

If you have a transesophageal echo (TEE), you may be watched for a few hours at the doctor's office or hospital after the test. Your throat might be sore for a few hours after the test.

You also may not be able to drive right after a TEE. Your doctor will let you know whether you need to arrange for someone to take you home.

What Does Echocardiography Show?

Echocardiography (echo) shows the size, structure, and movement of the various parts of your heart. This includes the valves, the septum (the wall separating the right and left heart chambers), and the walls of the heart chambers. Doppler ultrasound shows the movement of blood through the heart.

Echo can be used to:

  • Diagnose heart problems
  • Guide or determine next steps for treatment
  • Monitor changes and improvement
  • Determine the need for more tests
Echo can detect many heart problems. Some may be minor and pose no risk to you. Others can be signs of serious heart disease or other heart conditions. Your doctor may use echo to learn about:
  • The size of your heart. An enlarged heart can be the result of high blood pressure, leaky heart valves, or heart failure.
  • Heart muscles that are weak and aren't moving (pumping) properly. Weakened areas of heart muscle can be due to damage from a heart attack. Weakening also could mean that the area isn't getting enough blood supply, which may be due to coronary heart disease.
  • Problems with your heart's valves. Echo can show whether any of the valves of your heart don't open normally or don't form a complete seal when closed.
  • Problems with your heart's structure. Echo can detect many structural problems, such as a hole in the septum and other congenital heart defects. Congenital heart defects are structural problems present at birth.
  • Blood clots or tumors. If you've had a stroke, echo might be done to check for blood clots or tumors that may have caused it.

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Information provided by National Heart, Lung and Blood Institute

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