An echocardiogram is a test that uses ultrasound to show how your heart muscle and valves are working. The sound waves make moving pictures of your heart so your doctor can get a good look at its size and shape. You might hear them call it “echo” for short.
Why Do I Need an Echocardiogram?
Your doctor may order an echocardiogram to:
- Look for heart disease
- Monitor heart valve disease over time
- See how well medical or surgical treatments are working
What Are the Types of Echocardiograms?
There are several types of these tests. Your doctor will tell you more about which is best for you.
Transthoracic echocardiogram
This is the standard test. It’s like an X-ray but without the radiation. Specialists use the same technology to check a baby's health before birth.
A technician will put a hand-held device called a transducer on your chest. It sends high-frequency sound waves (ultrasound) that bounce off your heart, creating images and sounds.
On the day of the test, eat and drink as you usually would. Take all of your medications at the regular times.
You’ll take off your clothing from the waist up and put on a hospital gown. A specialist called a cardiac sonographer will put three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an electrocardiograph monitor (EKG or ECG) that tracks your heart's electrical activity.
You’ll lie on your left side on an exam table. The sonographer will run a wand (called a sound-wave transducer) across several areas of your chest. There will be a small amount of gel on the end to help create clearer pictures.
Changes in the sound waves, called Doppler signals, can show the direction and speed of blood moving through your heart.
You may or may not hear the sounds during the test. The sonographer might ask you to move around so they can take pictures of different areas of your heart. They might also ask you to hold your breath sometimes.
You won’t feel anything during the test except coolness from the gel and slight pressure from the transducer.
The test will take about 40 minutes. Afterward, you can get dressed and go back to your routine.
Transesophageal echocardiogram (TEE)
For this test, the transducer goes down your throat and into your esophagus (the swallowing tube that connects your mouth to your stomach). Because it’s closer to your heart, it can get a clearer picture.
Tell your doctor beforehand if you have any problems with your esophagus, such as a hiatal hernia, swallowing problems, or cancer.
Don’t eat or drink anything for 6 hours before the test. Take all of your medications at the usual times, with a small sip of water if necessary. If you use medicine or insulin for diabetes, ask your doctor or the testing center about it.
Before the transesophageal echocardiogram, a nurse will put an intravenous line (IV) into a vein in your arm or hand so they can give you medications. A technician will stick EKG electrodes on your chest. They’ll also put a blood pressure monitor on your arm and a pulse oximeter clip on your finger to watch your vital signs.
You’ll get a mild sedative to help you relax.
A member of the medical team will pass the ultrasound probe into your mouth, down your throat, and into your esophagus. It won't affect your breathing. They might ask you to swallow to help the probe along. This takes a few seconds and may be uncomfortable. Once the probe is in place, it will take pictures of your heart. You won’t feel it.
The test takes about 10 to 30 minutes. Then, someone will take out the probe. Nurses will monitor you for 20 to 30 minutes afterward.
Don’t eat or drink until the sedative wears off, which takes an hour after the test. You might still be drowsy or dizzy, so someone else should drive you home.
Stress echocardiogram
You have this test while exercising on a treadmill or stationary bicycle. It shows the motion of your heart's walls and pumping action when it’s working hard. It can also show a lack of blood flow that might not appear on other heart tests.
Don’t eat or drink anything but water for 4 hours before the test. Don’t drink or eat anything with caffeine (such as cola, chocolate, coffee, tea, or medications) for 24 hours before. Don’t smoke the day of the test. Caffeine and nicotine might affect the results.
Your doctor may tell you to stop taking certain heart medications on the day of your test. Ask what you should do if you take one of these drugs:
- Beta-blockers such as atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol XL), and propranolol (Inderal LA, Inderal XL, InnoPran XL)
- Isosorbide dinitrate (Dilatrate SR, Isordil)
- Isosorbide mononitrate (Monoket)
- Nitroglycerin (Minitran patch, Nitrostat, Nitro-Dur patch)
Talk to them if you have questions.
For the procedure, a cardiac sonographer will stick EKG electrodes to your chest. They’ll chart your heart activity and take your pulse and blood pressure.
The sonographer will first do a transthoracic echocardiogram.
Then, you’ll get on a treadmill or a stationary bicycle and start exercising. The medical team will slowly raise the intensity. In the meantime, they’ll watch the EKG monitor for changes and ask about any symptoms.
You’ll exercise until you can’t do it anymore. The sonographer will quickly do another echocardiogram.
After the tests, you’ll exercise slowly to cool down. The team will monitor your vital signs until they’re back to normal.
The appointment takes about an hour, but the test itself usually takes less than 15 minutes.
Dobutamine stress echocardiogram
This is another form of stress echocardiogram. But instead of exercising, you get a drug called dobutamine that makes your heart feel like it’s working hard.
This test checks your heart and valves when you can’t exercise on a treadmill or stationary bike. It can tell your doctor how well your heart handles activity. It also helps them figure out your risk of coronary artery disease (blocked arteries) and how well any cardiac treatments are working.
A technician will attach EKG electrodes to your chest. A nurse will put an intravenous line (IV) into a vein in your arm in order to give you the dobutamine.
The team will do a transthoracic echocardiogram, measure your resting heart rate, and take your blood pressure. Then, you’ll get the dobutamine, which will make your heart react as if you were working out. Your heart will begin beating faster and stronger. You might have a warm, flushed feeling and a mild headache.
Lab personnel will ask how you’re feeling. They’ll watch for changes on the EKG monitor and take out the IV once you’ve gotten all the dobutamine.
The appointment will take about an hour, but the IV usually lasts about 15 minutes. Plan to stay in the waiting room until any symptoms have gone away.
Intravascular ultrasound
During this test, your doctor threads the transducer into your heart blood vessels through a catheter in your groin. It gives more detailed information about atherosclerosis (blockage) inside your blood vessels.
Your doctor will tell you what medications to take and what to eat or drink before the test.
You’ll put on a hospital gown and lie on a special table. A nurse will attach EKG electrodes to your chest. They’ll put an IV line into your arm and give you a mild sedative so you can relax.
Your doctor will use a medication to numb your groin. They’ll put a plastic introducer sheath (a short tube) through a small cut and run a catheter (a long, narrow tube) through it and into the arteries of your heart. The catheter has a wire with an ultrasound tip inside. It will make pictures of your artery.
The test takes about an hour. After your doctor removes the catheter and sheath, a nurse will put a tight bandage on your groin to prevent bleeding. You’ll lie flat with your leg straight for 3 to 6 hours. You might have to stay in the hospital overnight.
What Do Echocardiogram Results Show?
An echocardiogram can help your doctor diagnose several kinds of heart problems, including:
- An enlarged heart or thick ventricles (the lower chambers)
- Weakened heart muscles
- Problems with your heart valves
- Heart defects that you’ve had since birth
- Blood clots or tumors