Echocardiogram

Your health expert: Dr Joshua Chai, Consultant Cardiologist
Content editor review by Rachael Mayfield-Blake, Freelance Health Editor, November 2021.
Next review due November 2024.

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. An echocardiogram test can help diagnose problems with your heart, like an injured heart muscle or heart valve disease. It can also monitor how well your heart works over time.

What is an echocardiogram?

During an echocardiogram, sound waves reflect off the muscles and tissues in your heart to create a moving image on a screen.

There are different types of echocardiogram.

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.
A transoesophageal echocardiogram involves your doctor passing a probe down your oesophagus (the pipe that goes from your mouth to your stomach).
A stress echocardiogram checks what happens when your heart has to work harder than normal. For more information on this, see our procedure section below.

This topic is about transthoracic echocardiograms.

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 lying down or while you’re doing exercise (a stress echocardiogram). Sometimes, you may need to have more than one echocardiogram to monitor changes in your heart over time.

You can have an echocardiogram at any age, even newborn babies and unborn babies can have an echocardiogram. For more information, see our FAQ: Why do I need a foetal echocardiogram? below.

What is an echocardiogram used for?

Your doctor may recommend you have an echocardiogram to check your heart valves, heart chambers and large blood vessels. The test will build a detailed picture of your heart. This could be to check for any injuries to your heart muscle or to check for changes that may happen as you get older.

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

an injury to your heart muscle because of 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)
heart failure (when your heart isn’t pumping blood properly)
enlarged heart chambers

If you have any questions about why you need an 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. You can ask to have a friend or family member with you during the procedure if you’d like to. Or you can ask for a healthcare chaperone, although you may need to let your hospital know in advance if you want to do this.

Medicines

You can usually take any of your usual medicines before an echocardiogram. But if you’re having a stress echocardiogram, you’ll usually need 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, you may need to re-arrange to have your echocardiogram another time.

Ask your doctor if you need to stop taking your medicines before your echocardiogram.

Eating and drinking

You can usually eat and drink normally before an echocardiogram, it won’t affect the test. But if you’re having a pharmacological stress echocardiogram, you must stop eating for two hours before your test. For this type of echocardiogram, your doctor gives you medicines to make your heart work harder. You may still drink water. Your doctor or hospital will give you more information.

What happens during an echocardiogram?

Transthoracic echocardiogram

A transthoracic 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 lie on your left-hand side on the bed, with your left arm behind your head. Your doctor or sonographer will put stickers on your chest and connect them to a machine to monitor your heart rate during the test.

Your doctor or sonographer will put a clear gel on your chest. They’ll then 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 different 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, but if you are uncomfortable, let your sonographer or doctor know.

You may be able to hear some sounds during the echocardiogram. This is the sound of the machine recording the blood flowing through your heart valves. It is nothing to worry about.

Stress echocardiogram

A stress echocardiogram is a test that checks what happens when your heart has to work harder than normal. This is described as being under stress. Your doctor or sonographer may ask you to do some exercise or give you some medicines for this test. They’ll monitor your blood pressure and heart rate regularly during the test. It usually lasts for 30 to 45 minutes.

In an exercise stress echocardiogram, your doctor or sonographer may ask you to walk on a treadmill or pedal on a stationary exercise bike. The exercise will be gentle at first but may keep getting harder. They may take pictures of your heart while you exercise and/or immediately afterwards.
In a 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. Your doctor may also inject a contrast medium into your vein. For more information on contrast echocardiogram, see below. Once your heart has been made to work hard enough, your doctor will stop giving you the medicine. Your 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 doctor injects a dye into 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 (sometimes called a bubble study), your doctor will inject a saline contrast agent into your vein during your echocardiogram. This is salt water that contains tiny bubbles, which help to show blood flowing through your heart more clearly. A bubble echocardiogram helps to show if there is a hole in your heart.

Aftercare for echocardiogram

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

If you were given medicines to increase your heart rate in a pharmacological 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 someone to drive you home.

Getting your echocardiogram results

Your sonographer or doctor may talk you through your echocardiogram results straight after your procedure. But they’ll usually send the results to the doctor who sent you for the test, who will go through them with you at your next appointment. Sometimes, you may have an appointment with your doctor straight after your echocardiogram.

Don’t worry if your doctor or sonographer can’t give you the results straight away. Your results may need to be analysed first. Your doctor may also need to consider your medical history and the results of any other tests you’ve had.

Your doctor will let you know if you need any treatment based on the results of your echocardiogram and any other tests you had. Your echocardiogram may rule out a problem with your heart or it may show you need further tests or treatment. Your doctor will talk you through the next steps.

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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 some mild discomfort in your chest or feel breathlessness or dizzy.

During a pharmacological stress echocardiogram, you are given some medicines and you may feel your heart beating harder and faster. You may feel some discomfort in your chest and be a bit breathless. These medicines can also make you feel a bit sick or dizzy. These feelings should go away once your doctor stops giving you the stress medicines.

But if you’re still feeling sick or dizzy after your test, 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 monitor you carefully throughout.

If your doctor or sonographer has used contrast agent or medicines during the echocardiogram, there’s a small chance you may have an allergic reaction.

Alternatives to an echocardiogram

Alternatives to a transthoracic echocardiogram include the following.

Transoesophageal echocardiogram. In this type of echocardiogram, a doctor or sonographer will pass an ultrasound probe into your oesophagus (the pipe that goes from your mouth to your stomach) to take pictures of your heart.
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 alternative is best for you.

An echocardiogram helps your doctor to check the structure of your heart. They’ll check your heart valves, heart chambers and large blood vessels to see if they’re still working well. The test can help your doctor to diagnose heart problems, such as any muscle injury after a heart attack or an infection in your heart.

For more information, see our section on uses of echocardiogram above.

If your routine ultrasound scans show a potential problem with your baby’s heart, you’ll be offered a fetal echocardiogram. Your midwife may also offer you this test if you have a family history of congenital heart disease (congenital means you’re born with a problem). A foetal echocardiogram can show the structure of your baby’s heart and how well the blood is flowing through it. This will help to show if your baby needs any treatment.

An echocardiogram can diagnose a number of heart problems. These range from a blood clot in your heart and severe heart failure (when your heart isn’t pumping blood properly) to pericardial effusion, which is when you have fluid around your heart. An echocardiogram can also check for leaky or narrowed heart valves.

For more information, see our section on uses of echocardiogram above.

An echocardiogram usually takes around 30 to 40 minutes. You’ll be able to go home straight after the test and can drive home. But 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. And you’ll need someone to drive you home.

For more information, see our section on echocardiogram procedure above.

You don’t usually need to do anything before an echocardiogram. But if you’re having a stress echocardiogram (using exercise or medicines), you should stop taking beta-blockers or calcium-channel blockers for two days before your test. And if you’re having a stress echocardiogram where your doctor gives you medicines to make your heart work harder, don’t eat for two hours before your test.

For more information, see our section on preparing for an echocardiogram above.

Yes, an echocardiogram can show heart failure (when your heart isn’t pumping blood properly). An echocardiogram will measure the amount of blood that your heart pumps out each time your heart beats. If this is less than normal, your doctor will use this and other test results to diagnose heart failure.

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