What Is an Echocardiogram and Why Doctors Order It
An echocardiogram is an ultrasound test of your heart. The word "echo" comes from the ultrasound sound waves that bounce off your heart to create pictures. These images let doctors see how your heart is structured and how well it pumps blood through your body. Unlike some imaging tests, echocardiograms use no radiation and pose no known risks to patients.
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Doctors order echocardiograms for several reasons. They may want to check the size and thickness of your heart chambers, look at how well your heart valves open and close, or measure how much blood your heart pumps with each beat. The test can reveal problems like heart valve disease, heart failure, irregular heartbeat patterns, fluid around the heart, or damage from a previous heart attack. According to data from the American Heart Association, millions of echocardiograms are performed in the United States each year, making it one of the most common heart imaging tests.
Your primary care doctor or a cardiologist might order an echocardiogram if you have symptoms like shortness of breath, chest pain, unusual fatigue, or swelling in your legs. The test may also be ordered if you have a heart murmur detected during a physical exam, high blood pressure that has been difficult to control, or a family history of heart disease. Sometimes doctors use echocardiograms to monitor patients who are already known to have heart conditions, checking whether their condition is getting better, worse, or staying the same.
Practical takeaway: Understanding why your doctor ordered an echocardiogram can help you prepare mentally for the test and know what information the doctor is trying to gather. Write down any symptoms or concerns you have before your appointment so you can discuss them with the technician or doctor.
Types of Echocardiogram Procedures Available
There are several types of echocardiograms, and your doctor will determine which one is right for your situation. The most common type is the transthoracic echocardiogram, performed from outside your chest. A technician places a small handheld device called a transducer against your skin, moving it around to get images of your heart from different angles. This procedure takes about 30 to 60 minutes and requires no needles or invasive steps. You remain awake and can watch your heart on the monitor if you wish.
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Another type is the transesophageal echocardiogram, or TEE. During this procedure, a long, thin tube with a transducer at the end is gently passed down your throat into your esophagus, which sits directly behind your heart. This position allows the technician to get clearer, more detailed images because there are fewer layers of tissue between the transducer and your heart. The TEE procedure typically takes 30 to 45 minutes. Because the tube passes down your throat, your doctor will give you medication to help you relax, and your throat will be numbed. You will not remember the procedure afterward.
A stress echocardiogram combines heart imaging with exercise or medication. You either walk on a treadmill or ride a stationary bike to elevate your heart rate, then lie down for immediate ultrasound imaging while your heart is still working hard. This shows how your heart functions under stress. If you cannot exercise, the technician may inject medication through an IV line to simulate the effects of exercise on your heart. A stress echo typically lasts 45 minutes to an hour. Some patients also receive a bubble study, where a special contrast material is injected into your bloodstream to make certain heart structures more visible on the ultrasound images.
Practical takeaway: Ask your doctor which type of echocardiogram you are scheduled for and why that particular type is appropriate for your situation. Each type provides different information, and knowing which one you are having helps you prepare correctly.
Step-by-Step What Happens During a Transthoracic Echocardiogram
When you arrive for a transthoracic echocardiogram, you will check in at the imaging department and may complete some paperwork if you are a new patient. A technician will call you back and ask you to change into a hospital gown that opens in the front, allowing easy access to your chest. You will lie on your left side on an examination table in a dimly lit room. The room is kept dark so the technician can see the ultrasound images more clearly on the monitor.
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The technician will apply a clear, warm gel to your chest. This gel helps the ultrasound transducer make good contact with your skin and allows the sound waves to travel through to your heart. The gel may feel slightly cold at first, but many patients find it soothing. The technician then places the transducer against your chest and gently moves it around, angling it to capture images from different positions. You may feel mild pressure as they work, but the procedure should not be painful. The technician may ask you to take a deep breath, hold your breath, or turn slightly to help get better pictures.
Throughout the procedure, you will see images of your heart appear on the monitor next to the examination table. The technician may explain what they are looking at, though some facilities prefer to let the doctor interpret the images later. The images show your heart's chambers, valves, and the movement of blood flow through your heart. The technician captures still images and video clips of different heartbeats from various angles. If you have questions during the procedure, feel free to ask. The entire process typically takes 30 to 60 minutes, depending on how easily the technician can obtain clear images and whether additional views are needed.
Practical takeaway: Wear clothing that is easy to remove and put back on, since you will need to change into a gown. Bring a list of your current medications and any allergies you have. If you feel anxious about the procedure, let the technician know beforehand so they can help you relax.
Preparation Steps and What You Should Know Beforehand
Preparation for a transthoracic echocardiogram is minimal compared to many other medical tests. In most cases, you do not need to fast or avoid eating and drinking beforehand. You can take your regular medications unless your doctor instructs otherwise. However, you should wear comfortable, loose-fitting clothing that allows easy access to your chest. Avoid wearing tight clothing or multiple layers, since you will need to change into a gown.
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If you are scheduled for a transesophageal echocardiogram, preparation is more involved. You will typically be told to fast for at least six hours before the procedure, meaning no food or drink except water. This precaution reduces the risk of complications if you vomit during the procedure. You may be asked to stop taking certain medications before the test, particularly blood thinners. Someone will need to drive you home after a TEE because of the sedating medication used during the procedure.
For a stress echocardiogram, wear comfortable athletic shoes and loose clothing suitable for exercise. You should eat a light meal a few hours before the test but not eat a heavy meal right before your appointment. Avoid caffeine for at least 24 hours before the test, as it can affect your heart rate during the stress portion. If you are taking certain heart medications, your doctor may instruct you to skip a dose before the stress echo. During the stress portion, you will need to exercise until your heart reaches a target heart rate, typically 85 percent of the maximum heart rate for your age.
Before any echocardiogram appointment, arrive 10 to 15 minutes early to allow time for check-in. Bring your insurance card and photo identification. If you have previous imaging results from other facilities, bring those records so your doctor can compare. Write down any questions you have about the procedure and bring a list of all medications and supplements you are currently taking, including over-the-counter products and herbal supplements.
Practical takeaway: Call your doctor's office the day before your appointment to confirm the time and ask about any specific preparation instructions for your type of echocardiogram. Different facilities may have slightly different requirements, and confirming beforehand prevents misunderstandings.
Understanding Your Echocardiogram Results
After your echocardiogram, a cardiologist will review all the images and measurements taken during your test. This analysis typically takes a few days, and your doctor will discuss the results with you at a follow-up appointment.