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Echocardiogram

An echocardiogram is a test that uses ultrasound (sound waves) to produce moving, real-time images of your heart. It helps to check the structure of your heart, and how well it’s working.

Your echocardiogram will be done by a cardiologist (a doctor who specialises in heart conditions) or a technician trained to do ultrasounds). They’ll adapt your care depending on your individual needs so it might not be exactly as we describe here.

This topic is about a type of echocardiogram called a transthoracic echocardiogram. We have a separate topic on transoesophageal echocardiogram.

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Details

  • About About echocardiograms

    The medical name for an echocardiogram is a transthoracic echocardiogram. It involves moving an ultrasound sensor over your chest to get pictures of your heart. Echocardiograms can be used on adults, young children, newborn babies and unborn babies. For more information about echocardiograms on unborn babies, see our FAQ: Fetal echocardiogram below.

    An echocardiogram can check for lots of different things to do with your heart. If you’re unsure why you’re having one, or have any other questions, ask your doctor.

  • Preparation Preparing for an echocardiogram

    An echocardiogram is usually done as a day-case procedure in hospital so you have it and go home the same day.

    Your doctor or sonographer will explain how to prepare for your procedure.

    If you’re having a stress echocardiogram, you might need to stop taking beta-blockers or calcium-channel blockers for two days before it. And you might need to stop eating a couple of hours before your procedure (if you’re taking medicines instead of doing exercise). Your doctor or hospital will let you know before you have the procedure.

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  • Alternatives What are the alternatives to an echocardiogram?

    Alternatives to a transthoracic 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 magnetic resonance imaging (MRI) scan. MRI uses powerful magnets, radio waves and computers to produce detailed images of the inside of your heart.
    • Cardiac computer tomography (CT) scan. This uses X-rays to create a three-dimensional image of your heart.
    • Radionuclide test. In this test, your doctor will inject a harmless, radioactive substance into your body and then take pictures of your heart. The radioactive substance shows up as it travels through your heart so your doctor can see your blood flowing and how well your heart is working.

    Ask your doctor to talk you through the options and which procedure is most suitable for you.

  • The procedure What happens during an echocardiogram?

    An echocardiogram usually takes about half an hour to 40 minutes.

    You’ll need to undress to your waist and put on a hospital gown that opens at the front. When you’re in the procedure room, you’ll need to lie on your left-hand side on the bed, with your left arm behind your head. Your doctor or sonographer will then put a clear gel over the left side of your chest. This will help make sure there’s a good, airtight seal between your skin and the sensor. 

    Your doctor or sonographer will put the sensor firmly against your chest. As they move it 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 it might feel uncomfortable when your doctor or sonographer moves the sensor over your skin. Let them know if it’s too uncomfortable.

    You might be able to hear some sounds during the echocardiogram. This will be the noise of your blood flow and is nothing to worry about. 

    Your doctor or sonographer will monitor your heart rhythm throughout your echocardiogram.

    Stress (exercise) echocardiogram

    This type of echocardiogram is done while your heart is working harder, which is described as being under stress. You might need to do some exercise, such as walk on a treadmill or ride on a stationary exercise bike. The exercise will be gentle at first but may get progressively more strenuous. Your doctor or sonographer may take pictures of your heart while you’re exercising or immediately afterwards.

    Another way to do this test is to take medicines to make your heart beat faster and harder.

    Contrast echocardiogram

    In this procedure, your doctor will inject a saline contrast agent into your vein during the echocardiogram. This helps show blood flowing through your heart more clearly.

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  • Aftercare What to expect afterwards

    Your doctor or sonographer might be able to talk you through the results of your echocardiogram straight away after the procedure. Or they’ll send them to your doctor who will go through them with you at your next appointment.

    If you have an echocardiogram as an out-patient procedure, you’ll be able to go home straight after the test. And you should be fine to carry on with your usual day-to-day activities – you can drive home, for example.

    If you took medicines to increase your heart rate in a stress echocardiogram, you may need to rest for about 20 minutes after the test. This will ensure the effects of the medicines have completely worn off before you leave. It’s best not to drive that day – ask a friend or relative to drive you home.

  • Complications Complications of an echocardiogram

    Complications are when problems occur during or after the procedure.

    • A standard echocardiogram is a safe procedure. There aren’t any known complications from 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 echocardiogram, there’s a small risk of having an allergic reaction.
  • Side-effects Side-effects of an echocardiogram

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. The only side-effects of an echocardiogram are that the medicines used for stress echocardiograms can sometimes make you feel sick or dizzy.

  • FAQ: Finding heart problems How will the doctor know if there’s a problem?

    An echocardiogram produces detailed pictures of the structures inside your heart, which can help your doctor (or sonographer) to identify any problems.

    They’ll look at the size, thickness and function of your left ventricle, for example, to check how well your heart is pumping blood. Your left ventricle is one of the lower chambers of your heart, which pumps oxygen-rich blood around your body. The size of your left ventricle and how well it’s working can reveal if there’s a problem with your heart’s ability to pump blood.

    To check for heart valve disease, they’ll look at the shape of your valves, how they’re moving and for signs of calcium deposits. Calcium deposits are the most common cause of narrowed valves. Measuring how fast your blood is flowing will help your doctor assess if your valves are narrowed or leaking.

    What will happen after I get the results of my echocardiogram?

    Answer

    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.

    Explanation

    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?

    Answer

    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.

    Explanation

    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).

  • FAQ: Results What will happen after I get the results?

    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. Others may include an electrocardiogram (ECG), a chest X-ray and blood and urine tests.

    Your doctor might diagnose a problem with your heart using the results of all these tests. But your echocardiogram may also rule out a problem with your heart, or show that you need further tests before they can make a diagnosis.

    If tests do show up a problem with your heart, your doctor will talk you through your next steps and treatment options.

  • FAQ: Fetal echocardiogram Why do I need a fetal echocardiogram?

    A fetal echocardiogram can give a very detailed picture of your baby’s heart, before they’re born. It’s used to check if they might have a heart problem.

    More information

    Congenital heart disease means a baby is born with heart disease. It affects between four and 13 babies in 1,000. Some babies who have major heart disease need to have an operation or be treated with medicines.

    It’s very important to go to all your routine ultrasound scans when you’re pregnant. If there’s a problem with your baby’s heart, it will often be first picked up when you have your scan at 18 to 21 weeks. You’ll then be asked to have a fetal echocardiogram. You may 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 your baby’s heart and problems with heart rhythm. The scan is usually done by a specialist who is familiar with diagnosing heart problems in babies. This might be a technician trained in ultrasounds or a specialist cardiologist (a doctor who specialises in conditions that affect the heart).

     

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Cardiovascular medicine. Oxford handbook of clinical medicine (online). Oxford Medicine Online. oxfordmedicine.com, published January 2014
    • Echocardiography. Medscape. emedicine.medscape.com, updated 30 January 2014
    • Picard MH, Adams D, Bierig SM, et al. American Society of Echocardiography recommendations for quality echocardiography laboratory operations. J Am Soc Echocardiogr 2011; 24(1):1–10. doi: 10.1016/j.echo.2010.11.006
    • Porter TR, Abdelmoneim S, Belcik JT, et al. Guidelines for the cardiac sonographer in the performance of contrast echocardiography: a focused update from the American Society of Echocardiography. J Am Soc Echocardiogr; 27(8):797–810. doi: 10.1016/j.echo.2014.05.011
    • Spencer KT, Kimura BJ, Korcarz CE, et al. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26(6):567–81. doi: 10.1016/j.echo.2013.04.001
    • Echocardiography. The MSD Manuals. www.msdmanuals.com, last full review/revision, February 2016
    • Patient information leaflet: transthoracic echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 21 February 2017
    • Patient information leaflet: exercise stress echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 21 February 2017
    • Patient information leaflet: stress echocardiography. British Society of Echocardiography. www.bsecho.org, accessed 21 February 2017
    • Cardiac imaging tests The MSD Manuals. www.msdmanuals.com, last full review/revision February 2016
    • Cardiac tests. Medscape. emedicine.medscape.com, updated 18 December 2016
    • Radionuclide imaging. The MSD Manuals. www.msdmanuals.com, last full review/revision February 2016
    • Echocardiography. PatientPlus. patient.info/patientplus, last checked 27 November 2015
    • General ultrasound. American College of Radiology. www.radiologyinfo.org, reviewed 30 May 2016
    • Echocardiography technique. Medscape. emedicine.medscape.com, updated 30 January 2014
    • Heart anatomy. Medscape. emedicine.medscape.com, updated 21 July 2015
    • Aortic stenosis. Medscape. emedicine.medscape.com, updated 11 December 2016
    • Aortic stenosis. BMJ Best Practice. bestpractice.bmj.com, last updated 22 August 2016
    • Carvalho JS, Allan LD, Chaoui R, et al. ISUOG practice guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol 2013; 41(3):349–59. doi: 10.1002/uog.12403
    • Prenatal diagnosis for congenital malformations and genetic disorders. Medscape. emedicine.medscape.com, updated 15 January 2015
    • Congenital heart disease in children. PatientPlus. patient.info/patientplus, last checked 25 May 2016
    • Antenatal examinations. PatientPlus. patient.info/patientplus, last checked 1 December 2015
    • Cardiac disease in pregnancy. PatientPlus. patient.info/patientplus, last checked 23 October 2015
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  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, March 2017
    Expert reviewer Mr Mark Yeatman, Consultant Cardiothoracic Surgeon
    Next review due March 2020

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