Echocardiogram

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who are having an echocardiogram, or who would like information about it.

An echocardiogram is a procedure that uses ultrasound to produce a moving real-time image of the inside of the heart. This is similar to the procedure carried out to check a growing baby during pregnancy. It's sometimes called an echo.

To meet your individual needs, your care may differ from what's described here. It's important that you discuss your echocardiogram with your doctor.

About echocardiogram

An echocardiogram is used to check the structure of your heart and how well it's functioning. The procedure uses an ultrasound probe, which is moved over your chest to get a moving picture of your heart.

Echocardiograms can be done on babies, children and adults.

The test can also be carried out when your heart is under stress, for example after you have been exercising. This is called a stress echocardiogram and is used to see how your heart copes with stress.

Reasons for having an echocardiogram include:

• to see how well your heart is pumping (for example, after a heart attack)
• to look for damage to your heart valves
• to check for heart defects in newborn babies and young children
• to look for heart defects in unborn babies (fetal echocardiogram)

What are the alternatives?

There are a number of alternatives to having an echocardiogram. Some of these are listed below.

• Electrocardiogram (ECG). This test measures the electrical activity of your heart to see how well it's working, but doesn't give any information about how your heart valves are working.
  
• Transoesophageal echocardiogram (TOE).This is another type of echocardiogram used to get clear pictures of your heart valves. Images are taken from a probe placed inside your oesophagus (the pipe that goes from your mouth to your stomach). This is good if you have artificial heart valves (because they shown up less well with a conventional echocardiogram) and for detecting any blood clot (thrombus) in your heart.
  
• Radionuclide test. During this test you're injected with a harmless, radioactive substance when you're resting and when your heart is under stress. The radioactive substance is seen with a special camera as it travels through your heart.
  
• Cardiac MRI (magnetic resonance imaging) test. An MRI scan uses magnets and radiowaves to produce images of the inside of the body.

Radionuclide tests and MRI scans aren't often used and are only available at a few specialist hospitals. Your doctor will advise you which procedure is most suitable for you.

Preparing for an echocardiogram

Echocardiograms are carried out in hospital by a cardiologist (a doctor specialising in conditions of the heart) or a technician trained in the procedure (a sonographer).

Echocardiogram equipment is portable, so the machine can be wheeled to your bedside if you're in hospital and unwell. If you aren't already in hospital, you will be asked to attend as an out-patient.

Before your echocardiogram, you can eat and drink as usual and take any medication you would normally have. If you're having a stress echocardiogram, you may be asked not to eat for four hours before the test and to stop taking certain medicines before the procedure.

What happens during an echocardiogram

The test normally takes around 40 minutes. At the hospital, you will be asked to undress to the waist. The doctor or technician will then ask you to lie on your left-hand side and will rub a clear gel over the left side of your chest. This is to make sure there will be a good, airtight contact between your skin and the probe. As the probe is moved across your chest, ultrasound waves will pass into your body and bounce off the different structures in your heart, and back into the probe. The test shouldn't hurt but it may feel uncomfortable when the probe is being moved over your skin.

The echocardiogram machine creates a moving image of your heart on a screen. If a doctor is doing the test, he or she may be able to tell you straight away how your heart is functioning and whether everything looks normal.

                                                          Echocardiogram

Stress echocardiogram

This is carried out in exactly the same way as a standard echocardiogram, except that your heart will be examined while it's under stress. This is achieved by:

• asking you to take exercise, such as walking on a treadmill, and then doing the echocardiogram afterwards
  
• injecting increasing amounts of medicine into your vein, which makes your heart work harder while the echocardiogram is carried out

A stress echocardiogram takes about an hour. Your blood pressure and heart will be monitored throughout the test.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What to expect afterwards

The results of your echocardiogram may be discussed with you immediately after the examination. Alternatively, your results may be sent to the doctor who requested you have the test (for example, your GP), who will discuss them with you at your next appointment.

What are the risks?

Echocardiogram is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

An echocardiogram is a safe test. There are no known risks associated with having it. Stress echocardiograms that use a drug to increase your heart rate can occasionally cause rhythm problems, headache or chest pains. The staff at the hospital will be fully trained to deal with problems such as this. There is also a small risk of bruising in the area where you have the injection, and a very small chance that you may be allergic to the medicines used during the test.

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your doctor to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.