What Is an Echocardiogram?

What to expect when undergoing this test

echocardiogram
Echocardiogram Test. BSIP/UIG/Getty Images

An echocardiogram, often called a cardiac echo test or a transthoracic echo (TTE), is a non-invasive ultrasound imaging test used to observe the heart in motion. In particular, an echo is considered the best way to visualize the movement and function of the heart muscle and heart valves. You may need a cardiac echo if you have heart valve disease, heart rhythm irregularities, or cardiac muscle diseases such as dilated cardiomyopathy or hypertrophic cardiomyopathy.

Purpose of the Test

A cardiac echo is used to identify abnormalities in the heart's structure and function. Sound waves are emitted during the test, which bounce off your heart and create a moving image of it on a screen. This allows your doctor to look at the anatomy of your heart from many different angles and to watch your heart rhythm.

If you have symptoms of fatigue, shortness of breath, or fainting, you may need a cardiac echo, especially if your heart sounds 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 doctor to watch your heart as it beats so that specific areas of concern can be identified. For example:

  • Problems with the heart valves such as mitral valve prolapse can be detected because the test can visualize the movement of your heart valves.
  • A special microphone called a Doppler can be used during the test to measure the velocity (speed) of blood flow in various areas within the heart. This is helpful in measuring impaired blood flow in conditions such as aortic stenosis
  • An echo is also helpful in evaluating congenital heart disease. For example, tetralogy of Fallot and atrial septal defect are congenital conditions in which the heart does not develop the proper anatomic structure.
  • An echo is often used to measure the left ventricular ejection fraction to evaluate the effectiveness of various cardiac treatments in conditions such as heart failure.
  • If you have a cardiac arrhythmia, which is an irregular rhythm, and echo can assess your heart movement, which may help in determining the exact cause and best treatment.

Echocardiograms are also sometimes used in conjunction with stress tests for cardiac evaluations. An echo test is done at rest and then repeated during exercise to look for changes in the function of the heart muscle during periods of exertion. Deterioration in 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 visualize the coronary arteries or blockages in your coronary arteries. If imaging the coronary arteries is necessary, a cardiac catheterization is commonly performed.

Certain physical variations, such as a thick chest wall or emphysema, can interfere with visualization of your 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).

Risks and Contraindications

Regardless of your health, you can safely have a transthoracic echo. You may be asked to hold your breath for a few seconds during the test, and there are no expected adverse events related to the test.

Before the Test

If you will have an echo, you do not need to do anything special to prepare for it, and you do not need to have any screening tests prior to having an echo.

Timing

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

Location

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

What to Wear

You will need to wear an examination gown for the test itself, so there is nothing special that you need to wear to the test.

Food and Drink

Before a transthoracic echo, there are no food and drink restrictions. However, depending on the reason for the test, your doctor may ask you to avoid caffeine for six to 10 hours before the test because it can speed up your heart rate.

Cost and Health Insurance

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 suite—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, which includes facility fees, technical fees, equipment fees, and a professional fee. These costs can range dramatically, and it is highly likely that your doctor 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.

What to Bring

You should bring your test order form (if not already sent electronically), your insurance card, a form of identification, and a method of payment.

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 and may adjust the transducer to visualize additional views, if necessary. Your own doctor may be present at your echo test or another cardiologist may be there.

Pre-Test

You will be asked to change into an examination gown for the test.

During the Test

As the test begins, you will lie on an examination table and a technician will place some gel on your chest, followed by a transducer—a small device shaped like a microphone.

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 collected. They are then processed by a computer and appear on a screen, providing a visual of your beating heart.

The technician moves the transducer 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. Overall, a transthoracic echo usually takes 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, and 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 you should not expect side effects after having an echo.

Interpreting Results

The results of your echo will be prepared in a report in which your doctor 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 the next steps.

The report should include:

  • The rate of your heartbeat: Normal range is between 60 and 100 beats per minute.
  • An evaluation of the size of your heart: Dilation of chambers means that your heart is enlarged.
  • A description of the pericardium, which is the protective tissue around your heart, including whether the appearance is normal and a description of any abnormalities
  • An assessment of the thickness of your heart in relation to what is expected for your age, size, and gender
  • A conclusion about the function of your ventricles with details about any abnormalities
  • An evaluation about the shape and movement of your heart valves and 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, or unexpected findings

Your report may also include a comment about the quality of the images, in case there was any difficulty ensuring clarity that would 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 general, follow-up after an echo is focused on the treatment of your heart condition. For example, if the test is used for diagnosis of a congenital heart condition, the next steps may include a surgical repair. If it is used for assessment of heart failure, medication adjustments may be needed. If it is used for evaluation of an arrhythmia, then medication, surgery, or a pacemaker may be needed.

In some situations, a TEE may be ordered after transthoracic 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.

A Word From Verywell

If you or a loved one needs a cardiac echo, you can rest assured that this is a safe and uncomplicated test. There are many different reasons for having the test, as well as a variety of possible outcomes. Most of the time, problems identified with an echo can be treated with medication. Sometimes heart surgery, which has a very good success rate, is needed to repair the problem. If you are unclear about what all the facets of your results mean, speak with your doctor.

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