Echocardiogram

An echocardiogram is an ultrasound scan of the heart that creates moving pictures of its structure and function in real time.

A small device called a transducer sends harmless sound waves into the chest. Those waves bounce off the heart's walls, valves, and chambers, and the returning echoes are converted into live images on a screen. The cardiologist (heart specialist) uses these images to see how well the heart is pumping, whether the valves open and close properly, and whether any part of the heart muscle is thickened, weakened, or damaged. No radiation is involved.

Doctors order an echocardiogram when they need a detailed picture of how the heart looks and works. It is used both to investigate symptoms and to monitor known heart conditions over time.

• Chest pain or unexplained shortness of breath
• Heart failure (when the heart cannot pump enough blood to meet the body's needs)
• Heart murmur (an unusual sound heard through a stethoscope that may signal a valve problem)
• Valvular heart disease — narrowed or leaking heart valves
• Cardiomyopathy (disease of the heart muscle itself)
• Congenital heart defects (structural problems present from birth)
• Arrhythmia (an irregular heartbeat) that needs further investigation
• Pericardial effusion (fluid collecting around the heart)
• Blood clots or masses suspected inside the heart
• Monitoring the heart before or after heart surgery or certain cancer treatments

A standard echocardiogram is non-invasive and suitable for almost everyone. However, in some situations, doctors may prefer a different type. For example, a transoesophageal echocardiogram — where a small probe is passed down the throat — gives clearer images of certain structures but is not suitable for patients with severe swallowing difficulties or certain throat conditions. Your cardiologist will decide which type is right for your situation.

A standard echocardiogram using sound waves on the chest surface carries virtually no risk and has an excellent safety record across all age groups.

• Mild skin discomfort from the gel used on the chest — it washes off easily
• Slight pressure from the transducer being pressed against the ribs, which may feel uncomfortable for a short time
• In a stress echocardiogram (where the heart is made to work harder, usually with exercise or a medication), there is a small chance of triggering an abnormal heart rhythm or blood pressure change — medical staff are present throughout to respond immediately
• In a transoesophageal echocardiogram (probe passed down the throat), possible risks include mild throat soreness, nausea, or, very rarely, an injury to the throat lining — your doctor will discuss these separately if this type is planned

For a standard echocardiogram done at rest, preparation is minimal. Most patients do not need to fast or stop any medication beforehand. If a stress echocardiogram is planned, however, your care team will usually ask you to avoid eating for a few hours before the test and may ask you to pause certain heart medications on the day — your doctor will give specific guidance based on your personal health profile.

If you smoke, you may be asked to avoid smoking for several hours before a stress test, as nicotine can affect heart rate. Comfortable clothing or a hospital gown will be provided, since electrode stickers (small adhesive pads) need to be placed on the chest.

Before the procedure, the team may review or request the following:

• A recent electrocardiogram — EKG — to record the heart's electrical activity
• Blood pressure measurements
• A brief medical history, including any known allergies
• A list of all current medications and supplements

During the procedure itself, the steps typically go as follows:

• You lie on an examination bed, usually on your left side, with your chest exposed.
• Small electrode stickers are placed on your chest to monitor your heart rhythm throughout.
• Warm gel is applied to your chest to help the transducer make good contact with your skin.
• The sonographer (the technician who performs the scan) gently moves the transducer across different areas of your chest.
• You may be asked to breathe in, breathe out, or hold your breath briefly so the technician can capture clearer images from certain angles.
• The images are recorded and reviewed, usually by a cardiologist who writes a formal report.
• The gel is wiped off and the electrode stickers are removed. The session usually takes between twenty minutes and an hour, though timing varies.

Because a standard echocardiogram is non-invasive and does not involve sedation or any entry into the body, recovery is immediate in most cases. You can dress and leave the facility as soon as the scan is finished. There are no wounds to care for and no physical restrictions afterwards.

• You can eat, drink, and take your regular medications as normal straight after the scan, unless your doctor has given different instructions.
• If you had a stress echocardiogram and were given a medication to raise your heart rate, staff will monitor you for a short period until the medication's effect has passed before you are cleared to leave.
• The results are usually reviewed by a cardiologist and sent to your referring doctor within a few days, though timing varies between facilities.
• Your referring doctor will explain what the images showed and whether any further tests — such as a cardiac MRI or coronary angiography (an X-ray test of the heart's arteries) — are needed.
• If you were being monitored for a known heart condition, follow-up echocardiograms may be scheduled at regular intervals — your cardiologist will advise on the appropriate schedule.
• No special lifestyle changes are required specifically because of the echocardiogram itself, but your doctor may recommend changes based on what the results reveal.