An Echocardiogram Uses Ultrasound to Check Heart Function

What an Echocardiogram Shows and Why It Is Ordered

An echocardiogram is an ultrasound exam of the heart that uses sound waves to make moving pictures of its size, valves, wall strength and pumping; a provider may order it to screen for or help diagnose heart conditions or to monitor a known one.

An ultrasound is an imaging test that uses sound waves to create pictures of organs and structures inside the body. An echo uses a type of ultrasound that can show a moving image of the heart. The sound waves check the size and structure of the heart, the heart valves, the strength of the heart walls, how well the heart pumps blood, and the pericardium, which is the sac around the heart.

A provider can use an echo to screen for and help diagnose several heart conditions. These conditions include cardiomyopathy, aortic aneurysm, heart failure, and heart valve disease where valves narrow or leak. The test can also help diagnose pericardial effusion, which is fluid in the sac around the heart. In addition, an echo can help diagnose pericarditis, cardiac tumors, blood clots in the heart, and congenital heart disease.

An echo can also be used to monitor the heart in specific clinical situations. A provider may use it to monitor the heart before and after surgery, during treatment for a heart condition, after a heart attack or stroke, and for congenital heart defects. A heart attack or stroke can damage the heart walls.

Types of Echocardiograms and Imaging Methods

The most common type is the transthoracic echocardiogram (TTE). During a TTE, a health care professional applies gel to a transducer, which is a wand-like device, and moves it across the chest. The transducer sends ultrasound waves into the chest, the waves bounce back as echoes, and a computer turns the echoes into pictures.

A transesophageal echocardiogram (TEE) gives a more detailed look at blood flow in the heart. The transducer is attached to a tube inserted down the esophagus, which is the tube that carries food and liquids from the mouth to the stomach. Medicine is given to relax the person and numb the back of the throat first.

A stress echocardiogram lets a provider see how well the heart works under stress. It examines the heart before and after exercise, often on a treadmill, or after medicine that increases the heart rate. A stress echo can help diagnose coronary artery disease, which involves blocked vessels that carry blood to the heart. A provider may order this test if you have symptoms of heart disease that get worse with activity.

Most echocardiograms show real-time two-dimensional (2D) images of the heart in motion, showing structure and how well the valves and chambers work. Providers may also use 3-D ultrasound to see the heart from different angles and get a clearer look at the lower left chamber. Doppler imaging uses sound waves that change in pitch to show how fast blood flows and in what direction, which can show blocked or leaking valves. Strain imaging measures the heart length as it contracts and relaxes, which is a newer method that helps find problems such as cardiomyopathy. Other names for an echo include heart echo, cardiac ultrasound, heart sonogram, contrast echocardiography, and point-of-care ultrasound (POCUS).

Reasons a Provider May Order an Echocardiogram

A provider may order an echo if you have certain symptoms or conditions. These reasons include a heart murmur, damaged heart valves, shortness of breath, edema (swelling in the legs), unexplained chest pains, rheumatic fever, congenital heart defects, a prior heart attack or stroke, or prior heart surgery.

A TEE may be needed when a standard TTE does not provide enough detail. A provider may order a TEE if there is very low blood pressure or oxygen level, or if heart problems develop suddenly, such as a tear in the aorta. A TEE may also be ordered if a procedure to treat arrhythmia is planned, or if heart surgery is planned.

Regular echocardiograms may be ordered to monitor chronic or congenital heart conditions. For women with risk factors that raise heart disease risk more than in men, such as menopause, pregnancy complications, smoking, stress and depression, or diabetes, a provider may order echos more frequently.

What Happens During the Test

During a TTE, you may remove some or all clothing and get a hospital gown. You lie on a bed on your left side or back. A health care professional puts gel on your chest and moves the transducer over several places. The computer turns the waves into images and videos of your heart. A TTE usually takes 30 to 60 minutes.

During a TEE, you may remove clothing, put on a gown, and remove any dentures or removable dental appliances. You lie on a bed or table with your head raised. You may get a sedative through an intravenous (IV) line in your arm or hand. A numbing medicine is sprayed in the back of the mouth and throat. The provider inserts a tube down the throat with the transducer on the end. When finished, the probe is gently pulled out, and you may feel a need to cough. A TEE may take up to 90 minutes.

Preparation Requirements and Safety Risks

For a TTE, no special preparation is usually needed. For a TEE, the provider may ask you not to eat or drink for several hours before the exam. You need someone to take you home because the sedative may make you drowsy for several hours.

There are no risks to a TTE. For a TEE, there is a slight risk of allergic reactions to medicines. Other slight risks for a TEE include aspiration pneumonia, which is an infection from inhaling something that is not air, such as food or fluid. There is also a slight risk of blood pressure or heart rhythm problems, and minor bleeding in the esophagus.

Understanding Your Echocardiogram Results

Results likely include measurements and descriptions of your heart. These descriptions can include changes in the heart size, the heart pumping strength, such as how much blood it pumps with every heartbeat, heart muscle damage, and heart valve disease.

A provider may use the results along with your medical history and other tests to diagnose a heart condition or decide on a treatment plan. A BNP test is a separate blood test. To understand your results, talk to your provider.