An echocardiogram lets your healthcare team watch your heart beating in real time, without any needles or radiation. It is one of the most useful heart tests there is, and for most people it is completely painless.
Imagine being told you have a heart murmur at a routine check, or that your breathlessness might be coming from your heart. You are booked for an “echo”. You lie in a dim room, watching your own heart valves open and close on a screen.
What an echocardiogram is
An echocardiogram, often called an echo, is an ultrasound scan of the heart. It uses high-frequency sound waves to create moving pictures of the heart’s chambers, walls and valves, and Doppler ultrasound to show how blood flows through them.,It is the same basic technology used in pregnancy scans, and it is safe for people of all ages, including babies and pregnant women.
Why it is done
- To investigate breathlessness, swollen ankles or a raised NT-proBNP
- To check a heart murmur
- To assess heart damage after a heart attack
- To look at heart valves before or after surgery
- To check for heart failure and measure how well the heart pumps
- To investigate palpitations, fainting or stroke
- To monitor the heart during some cancer treatments
What happens during a standard echo
A standard echo is called a transthoracic echocardiogram (TTE). You will be asked to undress to the waist and wear a gown that opens at the front. Stickers are placed on your chest to record your heart rhythm.,You lie on your left side while the sonographer moves a small probe covered in cool gel over your chest. They may ask you to breathe in, breathe out or hold your breath to get clearer pictures. You may hear whooshing sounds, which are the blood flow being recorded. The test usually takes 30 to 60 minutes and does not hurt, though firm pressure from the probe can be a little uncomfortable.
Other types of echo
- Transoesophageal echo (TOE): a thin probe is passed down the food pipe, usually with sedation, to get very clear pictures of the valves and back of the heart
- Stress echo: pictures are taken before and after the heart is made to work harder, with exercise or medicine, to look for narrowed arteries
- Bubble echo: a small amount of salt water with tiny bubbles is injected into a vein to look for holes between heart chambers
- Contrast echo: a contrast agent improves the image quality
Understanding ejection fraction
One of the key numbers in an echo report is the left ventricular ejection fraction (LVEF or EF). It is the percentage of blood pumped out of the main pumping chamber with each beat.,A normal EF is roughly 50 to 70%. An EF of 41 to 49% is often described as mildly reduced, and 40% or below as reduced. A low EF can mean heart failure with reduced ejection fraction, which has specific treatments that can improve symptoms and survival. A normal EF does not rule out heart failure, because some people have a stiff heart that pumps normally but fills poorly.
Other things the report may mention
- Valve stenosis: a valve that is narrowed and does not open fully
- Valve regurgitation: a valve that leaks backwards; mild leaks are very common and often harmless
- Left ventricular hypertrophy: thickened heart muscle, often from high blood pressure
- Dilated chambers: enlarged heart chambers
- Pericardial effusion: fluid around the heart
- Diastolic dysfunction: the heart muscle is stiff and relaxes poorly
Do I need to prepare?
For a standard echo, no special preparation is needed. You can eat, drink and take your medicines as usual. Wear clothes that are easy to remove from the waist up. For a TOE, you will need to fast for several hours and arrange for someone to take you home if you have sedation. For a stress echo, follow instructions about medicines such as beta-blockers, which may need to be paused.
After the test
You can go home and continue normal activities straight after a standard echo. The sonographer may not be able to tell you the results on the day, because a cardiologist often reviews and reports the images. Your healthcare provider will discuss the results with you and explain what, if any, treatment you need.
Heart valve disease
Heart valves keep blood flowing in the right direction. With age, the aortic valve can become stiff and narrowed (aortic stenosis), and the mitral valve can become floppy and leak (mitral regurgitation). Mild valve problems often need only monitoring with repeat echocardiograms every few years.
Severe valve disease can cause breathlessness, chest pain, dizziness or fainting. Treatments include valve replacement or repair, which can now often be done through a catheter rather than open-heart surgery, such as TAVI (transcatheter aortic valve implantation).
Questions to ask
- What is my ejection fraction?
- Are my heart valves working normally?
- Do I need any treatment or another echo in future?
- How do these results explain my symptoms?
Frequently asked questions
Is an echo the same as an ECG?
No. An ECG records the heart’s electrical activity. An echo shows the heart’s structure and pumping.
Is the gel cold?
It can be. Some departments warm it.
Can I bring someone with me?
Usually yes, though space may be limited. Ask the department.
Is it safe in pregnancy?
Yes. Echocardiography uses ultrasound, not radiation.
But what if they find something wrong?
Many echo findings are mild and need only monitoring. If treatment is needed, an echo helps your team choose the right one early, which often leads to better outcomes.
Your next step: Before your echo, write down any symptoms you have noticed, such as breathlessness or palpitations, so you can share them with your healthcare provider.
Related: Heart palpitations · BNP test and heart failure
Sources: British Heart Foundation, British Society of Echocardiography, American Society of Echocardiography, European Society of Cardiology heart failure guidelines.
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