An echocardiogram is usually done as a day-case procedure in hospital.
Your doctor or sonographer will explain how to prepare for your procedure. If you’re having a stress (exercise) echocardiogram (see The procedure), you may need to stop taking beta-blockers or calcium-channel blockers for two days before the procedure.
Alternatives to an echocardiogram include the following.
- Transoesophageal echocardiogram. This involves passing an ultrasound sensor into your oesophagus (the pipe that goes from your mouth to your stomach).
- Cardiac MRI scan. MRI is a technique that uses powerful magnets, radio waves and computers to produce detailed images of the inside of your heart.
- Radionuclide test. In this test, your doctor will inject a harmless, radioactive substance into your body. They will then use a camera to take pictures of your heart. The radioactive substance shows up as it travels through your heart – your doctor can see how well your heart is functioning and your blood flowing.
Talk to your doctor which procedure is most suitable for you.
An echocardiogram usually takes 30 to 40 minutes.
You will be asked to undress to your waist and put on a hospital gown that opens at the front. You will need to lie on your left-hand side. Your doctor or technician will place a clear gel over the left side of your chest. This helps to make sure there is good, airtight contact between your skin and the sensor.
Your doctor or sonographer will place the sensor firmly against your skin. As it moves across your chest, it will send out sound waves and pick up the returning echoes. Pictures of the inside of your heart will be displayed on a monitor. These pictures are constantly updated, so the scan can show movement. The test isn’t usually painful but may feel uncomfortable when the sensor is moved over your skin. Sometimes your doctor or sonographer may need to press quite hard – be sure to tell them if it’s painful.
During the echocardiogram, you may be able to hear some sounds. This is the noise of your blood flow and you will hear it whether or not there are any abnormalities in your heart.
Your heart rhythm will be monitored throughout your echocardiogram.
Stress (exercise) echocardiogram
This type of echocardiogram is done while your heart is working harder – this is described as being under stress. You may be asked to do some exercise, such as walk on a treadmill or ride an exercise bike. Alternatively, your doctor may ask you to take medicines to make your heart beat faster and harder.
If you have a stress echocardiogram, the exercise will be gentle at first but get progressively more strenuous. Your doctor may take pictures of your heart while you’re exercising or immediately afterwards.
This is when a dye (contrast agent) is injected into your vein during the echocardiogram. The dye helps show your heart more clearly. A contrast echocardiogram can help diagnose if you have a hole in your heart.
Your doctor or sonographer may discuss the results of your echocardiogram with you immediately after the procedure. Alternatively, your results may be sent to your doctor who will go through them with you at your next appointment.
If medicines are used to increase your heart rate, you may be asked to rest for up to an hour after the test. This will ensure the effects of the medicines have completely worn off before you leave.
If you have an echocardiogram as an out-patient procedure, you will be able to go home straight after the test. And you should be fine to carry on with your usual day-to-day activities.
As with every procedure, there are some risks associated with an echocardiogram. We haven’t included the chance of these happening as they are specific to you and your condition. Ask your doctor or sonographer for more information about how you’re likely to be affected by any risks.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.
Medicines for stress echocardiograms can sometimes make you feel sick or dizzy.
Complications are when problems occur during or after the procedure.
- A standard echocardiogram is a safe procedure. There are no known complications associated with having it.
- A stress echocardiogram can occasionally cause heart rhythm problems, a headache or chest pains.
- If contrast agent or medicines are used during the echo, there is a small risk of having an allergic reaction.
How will the doctor know if there is a problem with my heart?
An echocardiogram produces detailed pictures of the structures inside your heart, which can help your doctor to identify any problems.
To check how well your heart is pumping blood, for example, your doctor will look at the size, thickness and function of your left ventricle. This is one of the lower chambers of your heart, which pumps blood that contains oxygen around your body. The size of your left ventricle and how well it’s working can show your doctor if there is a problem with your heart’s pumping ability.
To check for heart valve disease, your doctor will look at the shape of your valves, how they’re moving and for signs of calcium deposits. Calcium deposits are a common cause of narrowed valves. Measuring how fast your blood is flowing will help your doctor assess if your valves have become narrowed or are leaking.
What will happen after I get the results of my echocardiogram?
Your doctor will help you to choose the best course of action or treatment. This will be based on the results of your echocardiogram, together with any other tests you have.
An echocardiogram is just one test that doctors use to look at how your heart is working. You may have other tests such as an electrocardiogram (ECG), a chest X-ray and blood and urine tests.
Your doctor may diagnose a problem with your heart using the results of all these tests. However, your echocardiogram may also rule out a problem with your heart, or show that you need further tests before a diagnosis can be made.
If tests do show up a problem with your heart, your doctor will discuss your treatment options with you. This might be taking medicines or having surgery.
Why do I need a fetal echocardiogram?
A fetal echocardiogram can give a very detailed picture of your developing baby’s heart, before he or she is born. It’s used to check whether they have a heart problem.
In the UK, around six in 1,000 babies are born with congenital heart disease (heart disease from birth). Some babies who have major heart disease will need surgery or other medical treatment in the first year of their life.
It’s very important that you go to all your routine ultrasound scans during pregnancy. If there’s a problem with your baby’s heart, it’s often first picked up when you have your scan at 18 to 21 weeks. If a possible problem is detected, you’ll be asked to have a fetal echocardiogram. You’ll also be offered this test if you have a family history of congenital heart disease.
A fetal echocardiogram can show up abnormalities in the structure or function of the heart and problems with heart rhythm. The scan is often done by a sonographer (a technician trained in ultrasounds) or a specialist obstetrician (a doctor who specialises in pregnancy and childbirth). Alternatively, the test will be done by a specialist cardiologist (a doctor who specialises in conditions that affect the heart).
- Echocardiography. PatientPlus. www.patient.co.uk/patientplus, reviewed 20 February 2012
- Patient information leaflet: transthoracic echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 22 July 2014
- Patient information leaflet: contrast echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 23 July 2014
- American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of fetal echocardiography. J Ultrasound Med 2013; 32:1067–82. doi:10.7863/ultra.32.6.1067
- Echocardiography. Medscape. www.emedicine.medscape.com, published 30 January 2014
- A minimum dataset for a standard transthoracic echocardiogram. British Society of Echocardiography. www.bsecho.org, published September 2012
- Patient information leaflet: trans-oesophageal echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 22 July 2014
- Cardiac imaging tests. The Merck Manuals. www.merckmanuals.com, published December 2012
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- Radionuclide imaging. The Merck Manuals. www.merckmanuals.com, published December 2012
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- Ultrasound – general. Radiological Society of North America. www.radiologyinfo.org, published 23 June 2014
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- Pharmacologic stress testing. Medscape. www.emedicine.medscape.com, published 5 February 2014
- Cardiac tests. Medscape. www.emedicine.medscape.com, published 9 December 2013
- Ultrasound – carotid. Radiological Society of North America. www.radiologyinfo.org, published 27 August 2013
- Heart anatomy. Medscape. www.emedicine.medscape.com, published 19 March 2013
- Indications for echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 23 July 2014
- Aortic stenosis. Medscape. www.emedicine.medscape.com, published 23 June 2014
- Aortic stenosis. PatientPlus. www.patient.co.uk/patientplus, reviewed 30 October 2012
- Aortic regurgitation. PatientPlus. www.patient.co.uk/patientplus, reviewed 6 November 2012
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