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Echocardiogram


Expert reviewer, Dr Susie Lewis, Consultant Cardiologist
Next review due July 2022

An echocardiogram is a test that checks the structure of your heart and how well it’s working. It uses sound waves (ultrasound) to create moving images. This test can be used to diagnose and monitor heart problems.

Patient talking with a doctor

What is an echocardiogram?

An echocardiogram uses ultrasound to create a moving image on a screen. During the test, the sound waves are reflected off the muscles and tissues in your heart. A transthoracic echocardiogram is the most common type of echocardiogram. It involves moving an ultrasound probe over your chest to get pictures of your heart.

People of all ages can have an echocardiogram, even newborn babies and unborn babies. For more information about echocardiograms on unborn babies, see our FAQ: Why do I need a fetal echocardiogram?

Your echocardiogram will usually be done by a sonographer (who is trained to do ultrasounds) or a cardiologist (a specialist heart doctor). You may have an echocardiogram while you’re resting or while you’re doing exercise (a stress echocardiogram). A stress echocardiogram checks what happens when your heart has to work harder than normal (see our section: What happens during an echocardiogram?).

This topic is about transthoracic echocardiograms. We have a separate topic on transoesophageal echocardiograms, which take pictures of your heart from a probe passed down your oesophagus.

Why do I need an echocardiogram?

Your doctor may recommend you have an echocardiogram to check your heart valves, heart chambers and large blood vessels. The test builds a detailed picture of your heart to check there’s no damage and that it’s still working well.

An echocardiogram can check for lots of heart problems, including:

  • damage after a heart attack
  • a blood clot in your heart
  • damaged heart valves
  • congenital heart disease (an abnormality you were born with)
  • endocarditis (an infection in your heart)
  • pericardial effusion (fluid around your heart)
  • severe heart failure (when your heart isn’t pumping blood properly)
  • enlarged heart chambers
  • problems with your heart muscles

If you have any questions about your echocardiogram, ask your doctor.

Preparing for an echocardiogram

You usually have an echocardiogram as an outpatient at the hospital. This means you have the test and go home on the same day.

Your doctor or sonographer will explain how to prepare for your procedure in advance. You can arrange to bring a friend or relative with you.

Medicines

You don’t usually need to stop taking any of your usual medicines before an echocardiogram. But if you’re having a stress echocardiogram, you’ll be advised to stop taking beta-blockers or calcium-channel blockers for two days before your test. This is because these medicines change how your heart works. If you don’t stop taking them, your echocardiogram may need to be re-arranged. Check with your doctor whether or not you need to stop taking your medicines before your echocardiogram.

Eating and drinking

You don’t usually need to stop eating or drinking before an echocardiogram. But check with your doctor if you’re having a stress echocardiogram. You may be given medicines for a stress echocardiogram, and in this case, you must stop eating for two hours before your test. You should still be able to drink water. Your doctor or hospital will let you know how to prepare before you have the procedure.

What are the alternatives to an echocardiogram?

Alternatives to a transthoracic echocardiogram include the following.

  • Transoesophageal echocardiogram. This involves passing an ultrasound probe 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 create detailed images of your heart.
  • Cardiac computer tomography (CT) scan. This uses X-rays to create a three-dimensional image of your heart and is useful for checking for narrowed coronary arteries.
  • 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’s working.

Ask your doctor to talk through the options with you and discuss which one is best for you.

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What happens during an echocardiogram?

An echocardiogram usually takes around 30 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. Stickers will be put on your chest and connected to a machine so your heart rate can be monitored during the test.

Your doctor or sonographer will put a clear gel on your chest. They’ll press the probe firmly against your chest and move it around. As they move the sensor, it will send out sound waves and pick up the returning echoes reflected from the various parts of your heart. Pictures of your heart will be displayed on a screen. These pictures are constantly updated, so the scan can show movement.

Most people don’t find an echocardiogram uncomfortable at all, but let your sonographer or doctor know if it is.

You may be able to hear some sounds during the echocardiogram. This is the sound the machine makes when it is recording the blood flowing through your heart valve and is nothing to worry about.

Stress echocardiogram

A stress echocardiogram usually lasts for 30 to 45 minutes. It shows how your heart copes with working harder than usual. This is described as being under stress. You may be asked to do some exercise or given some medicines to take.

Your blood pressure and heart rate will be monitored regularly during the test.

Exercise stress echocardiogram

You may be asked to walk on a treadmill or pedal on a stationary exercise bike. The exercise will be gentle at first but may keep getting harder. Your sonographer may take pictures of your heart while you’re exercising and/or immediately afterwards.

Pharmacological stress echocardiogram

Your doctor will give you some medicines that mimic the effects of stress. These medicines make your heart beat faster and harder. You’ll usually have these medicines through a drip into a vein in your arm. You may also have a contrast medium injected into your vein (see our section: Contrast echocardiogram).

Once your heart has been made to work hard enough, your doctor will stop giving you the medicine. The sonographer will keep taking pictures of your heart until the effects of the stress medicine have worn off.

Contrast echocardiogram

A contrast echocardiogram is when a special dye is injected in to a vein in your arm. The dye helps to show your heart more clearly. You might have this if you had an echocardiogram, but the images weren’t very clear.

Bubble echocardiogram

In a bubble echocardiogram (sometime called a bubble study), your doctor will inject a saline contrast agent into your vein during your echocardiogram. The saline contains tiny bubbles, which help to show blood flowing through your heart more clearly.

What to expect afterwards

If you have an echocardiogram as an out-patient procedure, you’ll be able to go home straight after the test. You should be able to carry on with your usual day-to-day activities, including driving home.

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 make sure the effects of the medicines have completely worn off before you leave the hospital. It’s best not to drive that day – ask a friend or relative to drive you home.

Getting your results

Your sonographer may be able to talk you through the results of your echocardiogram straight after your procedure. But they’ll usually send the results to your doctor, who will go through them with you at your next appointment. Sometimes, you may have an appointment with your doctor straight after your echocardiogram on the same day.

It’s important not to worry if your sonographer can’t give you the results straight away. Your results may need to be analysed first. Your doctor may also need to take into account your medical history and any other recent test results.

For further information, see our FAQ: What is my doctor looking for in an echocardiogram?

Side-effects of an echocardiogram

Echocardiograms don’t usually cause any side-effects.

Having an exercise stress echocardiogram is the same as doing some vigorous exercise at home.

You may feel your heart beating harder and faster if you’ve been given medicines during a stress echocardiogram. These medicines can also make you feel a bit sick or dizzy. These feelings should go away once the stress medicines are stopped. If you’re feeling any sickness or dizziness, let your doctor or sonographer know.

Complications of an echocardiogram

A standard echocardiogram is a safe procedure and doesn’t cause any complications.

A stress echocardiogram can sometimes cause heart rhythm problems and chest pains. Your doctor or sonographer will be monitoring you carefully throughout.

If your doctor or sonographer has used contrast agent or medicines during the echocardiogram, there is a small chance of you having an allergic reaction.

Frequently asked questions

  • An echocardiogram creates detailed pictures your heart. It helps your doctor (or sonographer) to check the structure of your heart and whether or not there are any problems. Your doctor will look at:

    • your four heart chambers
    • your valves
    • the thickness of your heart walls
    • how well your heart muscle contracts
    • your blood flow

    Your left ventricle is one of the lower chambers of your heart. Its size and how well it’s working can reveal if there’s a problem with your heart’s ability to pump blood. If there’s a problem, it could be a sign of lots of things, including pericarditis (inflammation of your heart) or a problem with your heart muscle. Your left ventricle muscle can also be bigger than normal if you have high blood pressure.

    To check for heart valve disease, your doctor will look at the shape of your valves and how well they’re moving. They’ll also look for signs of calcium deposits. Calcium deposits are the most common cause of narrowed valves. This can restrict the blood flowing through the heart. Sometimes the valves don’t close properly so that blood flows back in the wrong direction. Your doctor can measure how fast your blood is flowing through your valves and heart., This will help them to check if your valves are narrowed.

  • 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.

    Your echocardiogram may rule out a problem with your heart or it may show you need further tests before your doctor can make a diagnosis. An echocardiogram is just one test that doctors use to look at how your heart is working. Other tests may include an electrocardiogram (ECG), a chest X-ray, and blood and urine tests.

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

  • It’s very important to go to all of your routine ultrasound scans when you’re pregnant. If there’s a problem with your baby’s heart, this 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 give a very detailed picture of your baby’s heart before they’re born. It can show the structure of their heart and how well the blood is flowing through it.

    When a baby is born with a heart problem, this is called congenital heart disease. Some heart problems in babies are very minor and don’t cause any symptoms. But others need to be treated, either with medicines or an operation.


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Related information

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  • Reviewed by Natalie Heaton, Specialist Health Editor, Bupa Health Content Team, July 2019
    Expert reviewer, Dr Susie Lewis, Consultant Cardiologist
    Next review due July 2022



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