What to Expect During an Echocardiogram

An echocardiogram is an ultrasound imaging test used to observe the heart. It is also called a cardiac echo. Your healthcare provider may order this test to help diagnose a heart condition.

A cardiac echo is considered the best way to see the movement and function of the heart muscle and 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.

This article explains why an echocardiogram may be used and what kinds of heart problems it can detect. It will also describe in detail how to prepare for the test, what happens during the test, and what the results may mean for you.

Why Is an Echocardiogram Done?

A cardiac echo is used to identify abnormalities in the heart's structure and function. A handheld device sends out sound waves that bounce off your heart and create a moving image of it on a screen. This allows your healthcare provider to look at the anatomy of your heart from many different angles and to observe your heart rhythm.

If you have symptoms of fatigue, shortness of breath, or fainting, you may need a cardiac echo. This is especially true if a stethoscope or an electrocardiogram (EKG) (a test that charts the electrical activity of your heart) suggests that you have a structural heart problem.

A cardiac echo allows your healthcare provider to watch your heart as it beats so that specific areas of concern can be identified. Some of the heart functions and conditions an echo can detect include:

• Problems with the heart valves: For example, mitral valve prolapse, a heart valve that is less rigid than it should be, can be detected because the test shows how well your heart's valves are functioning.
• The velocity, or speed, of blood flow within the heart: A special microphone called a Doppler can be used during the test to measure this. This is helpful in measuring problems with blood flow in conditions such as aortic stenosis. 
• Anatomical defects: Congenital heart conditions such as tetralogy of Fallot and atrial septal defect are conditions that are present from birth in which the heart does not develop properly.
• Problem with the way the heart pumps: "Ejection fraction" is a term used to describe how strong the heart is and how well it pumps blood. An echo can evaluate how well various cardiac treatments are working in people with conditions such as heart failure.
• Cardiac arrhythmia: An echo can assess your heartbeat. This may help in determining the exact cause and best treatment if you do have an arrhythmia or irregular heart rhythm.
• Coronary artery disease (CAD): This type of echocardiogram done while your heart is under stress can help identify narrow or clogged arteries.
• Pericardium problems: The pericardium is the sac that surrounds the heart. An echocardiogram can identify problems such as inflammation (pericarditis) or fluid (pericardial effusion).
• Pressure: An echocardiogram can also be used to measure the pressure in your heart, which can help identify pulmonary hypertension, when there is too much pressure in the pulmonary artery.
• Heart size and structure: This test can evaluate the size of your heart as well as the thickness of the heart walls and other problems that can make it difficult for your heart to pump blood (cardiomyopathy). It can also help identify weak or thickened heart muscles, which are signs of heart failure.
• Problems with the aorta: The aorta is the large artery that carries blood from your heart to the rest of your body. An echocardiogram can help identify weakness in this artery as well as thickening of the valve flaps and blood clots. 
• Heart attack: Impaired blood supply in the heart and abnormalities in the wall of the heart can indicate a heart attack. 
• Blood clots: Echocardiogram could be used to find blood clots in the heart (thrombosis).
• Masses: Tumors in the heart are uncommon, but this test could be used to find a mass and help rule out malignancies (cancer).
  

Limitations

While the echocardiogram provides a lot of information about cardiac anatomy, it does not show the coronary arteries or any blockages in them. Another test called cardiac catheterization is commonly performed if your coronary arteries need to be examined closely.

Risks and Contraindications

An echocardiogram is considered a safe procedure with no known risks.

Types of Echocardiograms

There are a few different types of echocardiograms. The type that will work best for you depends on a number of factors such as medical conditions you might have and whether or not you can exercise.

Transthoracic Echocardiogram

This is the standard echocardiogram test. It is similar to the ultrasound tests that are used during pregnancy to view a fetus. This test uses high-frequency sound waves to create a picture of your heart. 

Transesophageal Echocardiogram

In people with certain conditions such as a thick chest wall or emphysema, it may be difficult to visualize the 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). With this, a device is placed in the esophagus in order to view the heart.

Stress Echocardiogram

A stress test measures your heart's function while it is under stress. It is done while you are at rest and then repeated while you exercise (usually on a treadmill) to look for changes in the function of the heart muscle when you are exerting yourself.

A stress test can also be done using a medication that makes your heart beat faster. A medication stress test is usually only done if you have difficulty exercising.

A stress echocardiogram uses sound waves to create a picture of your heart while it is under stress. There are a few different types of stress echocardiograms, including:

• M-mode: This type produces a simple picture of the heart and is used for obtaining measurements of heart structures.  
• Doppler: This test can measure how blood flows through the structures in your heart. This can help your healthcare provider assess how well your heart is working.
  
• 2-D: This test can give your healthcare provider a picture of the motion and structures in your heart.
  
• 3-D: This test creates a picture in three dimensions.
  
• Nuclear: Also called a contrast stress test, this test uses a small amount of radioactive dye to create a picture of how blood moves through your arteries. 
  

How to Prepare

You do not need to do anything special to prepare for an echocardiogram and you do not need to have any screening tests before having one.

Here is what you can expect:

Timing

In general, expect a transthoracic echocardiogram to take about an hour. A transesophageal echo takes between 20 and 40 minutes and a stress echo takes between 45 and 90 minutes.

As with all diagnostic tests, 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 cardiac testing center. If you have health insurance, your carrier may require you to go to an approved location.

What to Wear

You will need to wear an examination gown for the test itself. Once it is over, you can change back into your clothes.

Food and Drink

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

If you are having a transesophageal echocardiogram you will need to avoid food and water for four to six hours before the test. For a stress echocardiogram, you will need to avoid caffeine and tobacco for 24 hours and stop eating or drinking for four to six hours before the test.

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 center—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. This includes facility fees, technical fees, equipment fees, and a professional fee. These costs can range widely and it is highly likely that your healthcare provider 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

Bring your referral form (if it wasn't already sent electronically), your insurance card, a form of identification, and a method of payment.

Echocardiogram Procedure

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. They may want to adjust the transducer (the handheld device used) 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 a Transthoracic Echo

The test will proceed differently depending on which type you are having. For a transthoracic echo, you will lie on an examination table and a technician will place some gel on your chest. Then they will place a transducer, or a small device shaped like a microphone, on that area.

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

The technician moves the transducer around 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.

During a Transesophageal Echo

Because a transesophageal echo is an invasive test, you may be given a sedative and oxygen during the test. Your throat will be numbed and your provider will insert a flexible tube down your throat. The sound waves that create the picture of your heart are released from a transducer at the end of the tube.

During a Stress Echo

A stress echo combines a resting echocardiogram with an echo done while you are exercising on a treadmill. 

Post-Test

After the test is complete, you may be given a small towel or pad to clean up the gel. Then 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 there are no side effects after having an echo.

What Results Will I Receive?

The results of your echo will be prepared in a written report by your doctor. The report 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 next steps.

The report should include:

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

Your report may also include a comment about the quality of the images. If the images did not come out clearly, that might 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 was used to diagnose a congenital heart condition, the next steps may include surgical repair.
• If it detected heart failure, medication adjustments may be needed.
• If it is used for evaluation of an arrhythmia, medication, surgery, or a pacemaker may be needed.
  

In some situations, a TEE may be ordered after 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.

Summary

An echocardiogram uses sound waves to create a picture of your heart. It is used to diagnose a variety of heart conditions, including congenital defects, mitral valve prolapse, and heart failure.

Depending on what your healthcare provider is looking for and any physical limitations you may have, you may undergo one of several different types of echocardiogram. These tests are generally done in a cardiac testing center and may take up to 90 minutes, depending on the type of test.

After the test, your doctor will write a detailed report of the results. A treatment plan will be put in place depending on the findings.