An echocardiogram, often called an echo, is an ultrasound of the heart. A handheld probe placed on your chest sends out sound waves that bounce off the heart and return as moving pictures. Those images show how well the heart pumps, how the valves open and close, how thick the heart walls are, how large the chambers are, and whether fluid has collected around the heart.
The standard test, a transthoracic echocardiogram, is safe and painless. It uses no radiation, needs no preparation, and you can eat, drink and take your medications as usual beforehand. It usually takes 30 to 60 minutes, and you can go straight back to your normal day afterward.
NYMD Center does not perform echocardiograms in the office. When you need one, we arrange it by referral, and your physician here reviews the results with you. It is one of the most informative heart tests we order, because it shows the heart's structure and function directly rather than inferring them.
What an echocardiogram shows and who needs one
An echo answers several questions at once. It measures pumping function, usually expressed as the ejection fraction, which Mayo Clinic describes as the percentage of blood the left ventricle pumps out with each contraction. It shows whether each valve opens fully and closes without leaking. It shows wall thickness and chamber size, which change with long-standing high blood pressure, valve disease and cardiomyopathy. It can show areas of heart muscle that move poorly after a heart attack, and it shows fluid in the sac around the heart (pericardial effusion). With Doppler, the same study measures the speed and direction of blood flow through the heart.
We commonly order an echocardiogram for:
- A new heart murmur heard on examination.
- Shortness of breath, reduced exercise tolerance, or swelling of the legs or ankles.
- An abnormal ECG, such as signs of thickened heart muscle or a prior heart attack.
- Checking the effects of high blood pressure on the heart.
- Palpitations or a newly found irregular rhythm such as atrial fibrillation.
- Part of the workup after a stroke or mini-stroke.
- Follow-up of known valve disease, heart failure or cardiomyopathy.
The test also plays a role in evaluating chest pain and before some surgeries, and it can be repeated over time to track a valve leak or pumping strength without any cumulative risk.
How the test works
At the facility where the test is done, you change into a gown and lie on an exam table, usually turned partly onto your left side. A few ECG electrodes are placed on your chest to track your heart rhythm during the study. The sonographer applies a water-based gel and moves the probe to several positions on the chest and just below the ribs, pressing gently to get clear pictures. You may be asked to breathe out and hold your breath briefly. You will hear whooshing sounds when the Doppler is used; that is the sound of blood flow. Occasionally a contrast agent is given through an IV to sharpen the images, and it involves nothing more than a brief needle pinch.
The standard test has no known risks. Some people find the pressure of the probe mildly uncomfortable, and the electrodes can irritate the skin slightly when removed.
Related tests arranged when needed
A stress echocardiogram combines ultrasound with exercise, or with medication for people who cannot exercise, to show how the heart muscle responds to effort. It helps detect reduced blood flow from narrowed arteries and is discussed further on our exercise or stress test page. A transesophageal echocardiogram (TEE) uses a thin probe passed down the throat under sedation to get close-up images of the valves and the back of the heart, and is sometimes needed to look for a clot or to examine a valve in detail. Unlike the standard echo, TEE requires fasting for several hours and someone to take you home. We arrange these tests when your situation calls for them.
How to prepare
When we order the test, we send the referral and your records and tell you how to prepare. For a standard transthoracic echo there is no special preparation. Eat, drink and take your usual medications. Wear a two-piece outfit so you only need to change your top, and bring a list of medications and any previous echo reports so the new study can be compared with the old one.
What results mean
The images are interpreted by a cardiologist, and the results are reviewed with you by your physician. A normal study shows normal pumping function, normal valves, normal wall thickness and chamber sizes, and no significant fluid around the heart. Common findings include a mildly leaky valve, which is often harmless and simply watched; thickened walls from high blood pressure, which strengthens the case for tighter blood pressure control; a reduced ejection fraction, which points toward heart failure or cardiomyopathy and leads to treatment and further evaluation; and a narrowed or significantly leaking valve, which may need regular monitoring and cardiology referral. As MedlinePlus notes, results are used together with your history and other tests to reach a diagnosis and plan.
What to expect at your visit
At your visit with us, we explain why the echo is needed and arrange it. At the testing facility, plan on 30 to 60 minutes for the study itself. There is no recovery time, and you can drive yourself home and return to work the same day. When the report comes back, your physician will go over the findings with you, explain what they mean for your symptoms and risk factors, and recommend the next step, whether that is reassurance, a change in medication, a repeat study in the future, or further testing through cardiology.
When to seek care urgently
An echocardiogram is a scheduled test, not an emergency one. If you have severe chest pain, sudden or worsening shortness of breath, fainting, or new weakness, numbness, facial droop or trouble speaking, call 911 rather than waiting for an appointment.
Questions patients ask
Does an echocardiogram use radiation?
No. An echocardiogram uses ultrasound, the same kind of sound-wave imaging used in pregnancy, so there is no radiation exposure. That makes it safe to repeat over time to follow a valve problem or pumping strength. The standard transthoracic test has no known risks beyond mild discomfort from the pressure of the probe.
How long does an echocardiogram take?
A standard transthoracic echocardiogram usually takes 30 to 60 minutes. You need no preparation, can eat and take your medications as usual, and can return to normal activities right afterward. A stress echo or a transesophageal echo takes longer and has its own preparation instructions, which we give you if one is needed.
What is ejection fraction?
Ejection fraction is the percentage of blood the left ventricle, the heart's main pumping chamber, pushes out with each beat. It is one of the key measurements on an echocardiogram. A reduced ejection fraction suggests the heart muscle is weakened, which can point toward heart failure or cardiomyopathy. Your physician will explain your number and what it means for you.
Why would I need an echocardiogram if my ECG was normal?
An ECG records the heart's electrical activity, while an echocardiogram shows its structure and pumping. A normal ECG does not rule out a leaky or narrowed valve, a weakened heart muscle or thickened walls. If you have a murmur, shortness of breath, swelling or long-standing high blood pressure, an echo answers questions the ECG cannot.
Who reads my echocardiogram?
The images are interpreted by a cardiologist, and your physician reviews the results with you. We explain what the findings mean in the context of your symptoms, blood pressure and other tests, and we arrange follow-up testing or a cardiology referral when the results call for it.