Needed to read PDF's

Echocardiogram

An echocardiogram is an ultrasound test that checks the structure and function of your heart. An echo can diagnose a range of conditions including cardiomyopathy and valve disease. There are several types of echo tests, including transthoracic and transesophageal. Talk with your provider about the type that’s best for you.
Other names for this test are:

Heart ultrasound.

Heart sonogram.

Overview

What is an echocardiogram?

An echocardiogram (echo) is a graphic outline of your heart’s movement. During an echo test, your healthcare provider uses ultrasound (high-frequency sound waves) from a hand-held wand placed on your chest to take pictures of your heart’s valves and chambers. This helps the provider evaluate the pumping action of your heart.

Providers often combine echo with Doppler ultrasound and color Doppler techniques to evaluate blood flow across your heart’s valves.

Echocardiography uses no radiation. This makes an echo different from other tests like X-rays and CT scans that use small amounts of radiation.

Who performs an echo test?

A technician called a cardiac sonographer performs your echo. They’re trained in performing echo tests and using the most current technology. They’re prepared to work in a variety of settings including hospital rooms and catheterization labs.

What are the different types of echocardiogram?

There are several types of echocardiogram. Each one offers unique benefits in diagnosing and managing heart disease. They include:

Transthoracic echocardiogram.

Transesophageal echocardiogram.

Exercise stress echocardiogram.

Fetal echocardiogram

What techniques are used in echocardiography?

Several techniques can be used to create pictures of your heart. The best technique depends on your specific condition and what your provider needs to see. These techniques include:

Two-dimensional (2D) ultrasound. These images provide pictures of the heart walls and valves and of the large vessels connected to your heart. A standard echocardiogram begins with a 2D study of the heart. A 3D echocardiogram is available in some medical centers and hospitals. It's often done to get more details about the lower left heart chamber. This chamber is the heart's main pumping area.

Three-dimensional (3D) ultrasound. Advances in technology have made 3D imaging more efficient and useful. New 3D techniques show different aspects of your heart, including how well it pumps blood, with greater accuracy. Using 3D also allows your sonographer to see parts of your heart from different angles.

Doppler ultrasound. Sound waves change pitch when they bounce off blood cells moving through the heart and blood vessels. These changes are called Doppler signals. This part of the test measures the speed and direction of blood flow within the heart and vessels. It can help show blocked or leaking valves and check blood pressure in the heart arteries.

Color Doppler ultrasound. This technique also shows your blood flow, but it uses different colors to highlight the different directions of flow. It helps find leaky heart valves and other changes in blood flow.

Strain imaging. This approach shows changes in how your heart muscle moves. It can catch early signs of some heart disease.

Contrast imaging. Your provider injects a substance called a contrast agent into one of your veins. The substance is visible in the images and can help show details of your heart. Some people experience an allergic reaction to the contrast agent, but reactions are usually mild.

How long does an echocardiogram take?

An echocardiogram usually takes 40 to 60 minutes. A transesophageal echo may take up to 90 minutes.

What is an echocardiogram vs. an EKG?

An echocardiogram and an electrocardiogram (called an EKG or ECG) both check your heart. But they check for different things and produce different types of visuals.

An echo checks the overall structure and function of your heart. It produces moving pictures of your heart.

An EKG checks your heart’s electrical activity. It produces a graph, rather than pictures of your heart. The lines on this graph show your heart rate and rhythm.

When would I need an echocardiogram?

Your provider will order an echo for many reasons. You may need an echocardiogram if:

You have symptoms, and your healthcare provider wants to learn more (either by diagnosing a problem or ruling out possible causes).

Your provider thinks you have some form of heart disease. The echo is used to diagnose the specific problem and learn more about it.

Your provider wants to check on a condition you’ve already been diagnosed with. For example, some people with valve disease need echo tests on a regular basis.

You’re preparing for a surgery or procedure.

Your provider wants to check the outcome of a surgery or procedure.

What does an echocardiogram show?

An echocardiogram can detect many different types of heart disease. These include:

Congenital heart disease, which you’re born with.

Cardiomyopathy, which affects your heart muscle.

Infective endocarditis, which is an infection in your heart’s chambers or valves.

Pericardial disease, which affects the two-layered sac that covers the outer surface of your heart.

Valve disease, which affects the “doors” that connect the chambers of your heart.

An echo can also show changes in your heart that could indicate:

Aortic aneurysm.

Blood clots.

A cardiac tumor.

Risks

Echocardiography uses harmless sound waves, called ultrasound. The sound waves pose no known risk to the body. There is no X-ray exposure.

Other risks of an echocardiogram depend on the type of test being done.

If you have a standard transthoracic echocardiogram, you may feel some discomfort when the ultrasound wand pushes against your chest. The firmness is needed to create the best pictures of the heart.

There may be a small risk of a reaction to the contrast dye. Some people get backaches, headaches or rashes. If a reaction occurs, it typically happens right away, while you are still in the test room. Severe allergic reactions are very rare.

If you have a transesophageal echocardiogram, your throat may be sore for a few hours afterward. Rarely, the tube used for this test may scrape the inside of the throat.

Other risks of a TEE include:

Difficulty swallowing.

Weak or scratchy voice.

Spasms of the muscles in the throat or lungs.

Minor bleeding in the throat area.

Injury to teeth, gums or lips.

Hole in the esophagus, called esophageal perforation.

Irregular heartbeats, called arrhythmias.

Nausea from medicines used during the test.

Medicine given during a stress echocardiogram may temporarily cause a fast or irregular heartbeat, a flushing feeling, low blood pressure or an allergic reaction. Serious complications, such as a heart attack, are rare.

Test Details

How is a transthoracic echocardiogram done?

A transthoracic echo is the type most people think of when they hear “heart echo.” It’s also the type most often used. It’s performed outside your body.

A sonographer places a hand-held wand (called a transducer) on the outside of your chest to send sound waves to your heart. These sound waves bounce off the different parts of your heart.

These “echoes” then appear as pictures on the sonographer’s computer screen. These pictures can also be saved for your cardiologist and physician to review later.

Preparing for a transthoracic echo

There’s not much you need to do to prepare for this type of echo. In general:

You don’t need to avoid eating or drinking before a transthoracic echo.

Take your medications as you usually do.

Wear anything you’d like.

Leave anything valuable at home. You’ll be given a storage locker to use during the test.

What to expect during a transthoracic echo

A transthoracic echo includes the following steps:

You’ll be asked to remove your clothing from the waist up. You’ll put on a hospital gown.

Your sonographer will place several electrodes on your chest. These are small, flat, sticky patches. The electrodes are attached to an electrocardiograph (EKG) monitor. The EKG records your heart’s electrical activity during the test.

You’ll lie down on an exam table. Your sonographer will ask you to lie on your left side if possible.

Your sonographer will place a sound-wave transducer (wand) on several areas of your chest. There’s a small amount of gel on the end of the wand, which won’t harm your skin. This gel helps produce clearer pictures.

You may hear swishing sounds throughout the test. This is normal. It means you’re hearing blood flowing through your heart as the wand picks up the sound.

Throughout the test, your sonographer may ask you to hold your breath for several seconds at a time. You may also need to move into a different position.
You should feel no major discomfort during the test. You may feel a coolness on your skin from the gel on the wand. You may also feel a slight pressure of the wand against your chest.

How is a transesophageal echocardiogram done?

A transesophageal echo takes pictures from inside your chest, rather than from the outside. It can show your heart and valves in greater detail than a transthoracic echo. That’s because your body’s bones and tissues aren’t in between the transducer and your heart.

For this test, the sonographer guides a small transducer down your throat and esophagus (food tube) using a long, flexible tube. This minimally invasive procedure may cause mild, temporary discomfort. But it has a low risk of serious problems.

This type of echo may be used:

When your provider needs a detailed look at your aorta or the back of your heart (especially your left atrium or left ventricle).

To check for blood clots.

To evaluate your mitral valve or aortic valve.

If you have Obesity or lung disorders.

If a transthoracic echo isn’t possible for various other reasons.

Preparing for a transesophageal echo

As you prepare for your echo, tell your doctor if you have:

Problems with your esophagus, like a hiatal hernia.

Problems swallowing.

Sleep apnea.

IV drug use.

It’s also important to share if you take medication for:

Sleep issues.

Anxiety.

Pain.

Preparations for the day of your test include:

Find someone to drive you home from your test. This is because you’ll be sedated for the test, and you won’t be able to drive for 24 hours.

Don’t eat or drink anything for at least six hours before your test. Your provider may give you more specific instructions for eating and drinking. It’s essential you follow these closely.

Ask your provider about when to take your usual medications. You may be able to take them at your usual time with a small sip of water.

Ask your provider about when and how to take your diabetes medication, if this is relevant to you.

Plan to leave any valuable personal items at home. You’ll have access to a storage locker for your belongings during the test.

Plan to wear whatever’s most comfortable for you. You’ll change into a hospital gown before the echo begins.

What to expect during a transesophageal echo

A transesophageal echo includes the following steps:

You’ll remove your clothing from the waist up and put on a hospital gown.

Your provider will place electrodes (small stickers) on your chest. The electrodes allow your sonographer to monitor your heart’s electrical activity during the test.

Your provider will place a blood pressure cuff on your arm and a pulse oximeter on your finger.

You’ll gargle with a solution that numbs your throat. Your provider will also spray your throat with pain-relieving medication.

To make you more comfortable, you’ll be hooked up to an IV and sedated. You’ll soon start to feel sleepy.

You may have a tube in your nose that provides oxygen.

You’ll lie on your left side on the exam table.

The provider will insert an endoscope into your mouth. This is a long, thin, flexible tube that has a transducer on the tip. The tube travels into your throat and esophagus. It’s lubricated to help it slide down more easily. While this may feel uncomfortable, it won’t harm you. You may need to swallow to move the transducer into the right spot (just behind your heart).

Your provider will take pictures. You won’t feel anything while this happens.

After your provider has the pictures they need, they’ll remove the tube from your throat. You’ll soon be able to get dressed and get ready to leave.

How is an exercise stress echocardiogram done?

An exercise stress echo, sometimes simply called a stress echo, shows how your heart works when it’s taxed. The test resembles a traditional exercise stress test. A technician will monitor your heart rate and rhythm as well as your blood pressure (this is standard during a stress test). But they’ll also use echo imaging (which isn’t normally used during a stress test).

This test shows how well your heart can withstand activity. Your sonographer takes pictures before you start exercising and then right after you’re done.

In some cases, you won’t exercise. Instead, your provider will give you medication to make your heart work harder as if you were exercising. The goal is to force your heart to need more oxygen.

When your heart is under stress, your sonographer can see details they might not be able to see if you were lying on the exam table. These include problems with your coronary arteries or the lining of your heart.

Preparing for an exercise stress echo

Your provider will give you detailed instructions on how to prepare for your test. An exercise stress echo needs more preparation than other types of echo testing. These include:

Not eating or drinking anything except water for at least four hours before your test.

Not smoking on the day of your test.

Avoiding caffeine for 24 hours before your test. This includes caffeine in any form (coffee, tea, decaf drinks and some over-the-counter pain medicines).

Ask your provider when and how to take your usual medications. You may need to avoid taking certain heart medications on the day of your test. You may also need to change your dose of diabetes medication. Closely follow your provider’s guidance.

You won’t be sedated, but you still may want to ask someone to drive you to and from the appointment. You may feel tired after the test.

Plan to wear comfortable clothes and shoes. You’ll need to walk or ride a stationary bike during the test, so wear what feels good for you.

What to expect during an exercise stress echo

The exercise stress echo will include the following steps:

Your sonographer will place electrodes (small stickers) on your chest. These stickers are hooked up to an EKG monitor to check your heart rate and rhythm during the test.

Your provider will measure your heart rate, heart rhythm and blood pressure before you start moving.

You’ll lie on an exam table so your sonographer can take pictures of your heart. They’ll place a hand-held wand (the kind usually used for echo tests) on the outside of your chest in various spots.

Then, it’s time to start moving. You’ll walk on a treadmill or pedal on a stationary bike. The intensity will gradually increase. You’ll keep going until you’re exhausted. This usually takes seven to 12 minutes.

As you’re exercising, a technician will ask how you’re feeling. Tell them any and all symptoms you notice. They’ll also watch your heart on the EKG monitor.

You’ll stop moving, and you’ll have another echo test done.

You’ll then do a short cool-down (slow walking or cycling), and your provider will monitor your vitals until they’re back to normal.
If you were given medication to stress your heart, the process will be a bit different. You won’t be on a treadmill or bike. Talk to your provider to learn what to expect and how you might feel during this type of test.

After the procedure

Most echocardiograms take less than an hour. If you have a transesophageal echocardiogram, you may be watched for a few hours after the test.

After imaging is done, the images will be reviewed by a healthcare professional. You may be asked to wait in case more imaging is needed.

Most people can go back to their usual daily activities after an echocardiogram.

If your echocardiogram looks OK, no further testing may be needed. If the results are concerning, you may need more tests. If you aren't already seeing a heart doctor, you may be referred to one. This type of healthcare professional is called a cardiologist.

Results and Follow-Up

How do I get the results of my test?

After your cardiologist reviews your test, they’ll enter the results into your electronic medical record. Your primary care provider will have access to the results, too. You’ll discuss the results with one or both of these providers.

Ask any questions you’d like about the pictures and what they mean. Your provider will explain what the pictures show and whether you need follow-up tests or treatment.
Information from an echocardiogram may show:

Changes in heart size. Weakened or damaged heart valves, high blood pressure or other diseases can cause thickened heart walls or enlarged heart chambers.

Pumping strength. An echocardiogram can show how much blood pumps out of a filled heart chamber with each heartbeat. This is called the ejection fraction. The test also shows how much blood the heart pumps in one minute. This is called cardiac output. If the heart doesn't pump enough blood for the body's needs, heart failure symptoms occur.

Heart muscle damage. The test can show how the heart wall helps the heart pump blood. Areas of heart wall that move weakly may be damaged. Such damage might be due to a lack of oxygen or a heart attack.

Heart valve disease. An echocardiogram can show how the heart valves open and close. The test is often used to check for leaky heart valves. It can help diagnose valve disease such as heart valve regurgitation and valve stenosis.

Heart problems present at birth, called congenital heart defects. An echocardiogram can show changes in the structure of the heart and heart valves. The test also is used to look for changes in the connections between the heart and major blood vessels.

Additional Echocardiogram FAQs

What should you not do before an echocardiogram?

It depends on which type of echo you’re having done. Check with your provider to learn exactly what you should avoid. Things you may need to avoid before your echo include:

Eating or drinking.

Smoking or using any nicotine products.

Drinking coffee or anything with caffeine in it. This includes decaf drinks, which still contain a small amount of caffeine. It also includes over-the-counter medications that contain caffeine.

You may need to adjust your medication schedule before your echo. Don’t stop taking any medications or make any changes until you talk with your provider.
What 5 abnormalities can be found on an echocardiogram?

An echocardiogram can reveal:

An enlarged heart or thick ventricles

Weakened heart muscles

Problems with heart valves

Heart defects present since birth

Blood clots or tumors

Do you have to take your bra off for an echocardiogram?

For some echocardiograms, you'll need to take off all your clothes from the waist up and put on a hospital gown.

What should you not do before an echocardiogram?

Before an echocardiogram, you shouldn't eat or drink anything for a certain period of time, depending on the type of test. You may also need to avoid caffeine, smoking, and certain medications on the day of the test. Your health care team will tell you how to prepare.

Takeaways

An echocardiogram is a test that uses sound waves to create pictures of your heart. You might need one if your doctor suspects you or your baby has problems like an enlarged heart, weak heart muscles, issues with heart valves, and even birth defects in the heart. There are different types of echocardiograms, depending on what your doctor needs to see. It's a safe way to diagnose and keep an eye on heart conditions.

Find me on Social Media

Don't forget to bookmark me to see updates..