Echocardiography (ECHO)

Echocardiography is a painless test that uses sound waves to create pictures of your heart.

The test gives your doctor information about the size and shape of your heart and how well your heart's chambers and valves are working. ECHO also can be done to detect heart problems in infants and children.

The test also can identify areas of heart muscle that aren't contracting normally due to poor blood flow or injury from a previous heart attack. In addition, a type of ECHO called Doppler ultrasound shows how well blood flows through the chambers and valves of your heart.

ECHO can detect possible blood clots inside the heart, fluid buildup in the pericardium (the sac around the heart), and problems with the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body.

Echocardiography (ECHO)

The illustration shows a patient having an echocardiography. The patient lies on his left side. A sonographer moves the transducer on the patient’s chest, while viewing the pictures from the echocardiography on a computer.

Who Needs Echocardiography?

Your doctor may recommend echocardiography if you have signs and symptoms of heart problems. For example, shortness of breath and swelling in the legs can be due to weakness of the heart (heart failure), which can be seen on an echocardiogram.

Your doctor also may use ECHO to learn about:

  • The size of your heart. An enlarged heart can be the result of high blood pressure, leaky heart valves, or heart failure.
  • Heart muscles that are weak and aren't moving (pumping) properly. Weakened areas of heart muscle can be due to damage from a heart attack. Weakening also can mean that the area isn't getting enough blood supply, which may be due to coronary heart disease (also called coronary artery disease).
  • Problems with your heart valves. ECHO can show whether any of your heart valves don't open normally or don't form a complete seal when closed.
  • Problems with your heart's structure. ECHO can detect many structural problems, such as a hole in the septum and other congenital heart defects. The septum is the wall that separates the two chambers on the left side of the heart from the two chambers on the right side. Congenital heart defects are structural problems present at birth. Infants and children may have echo to detect these heart defects.

Your doctor also may use echo to see how well your heart responds to certain heart treatments, such as those used for heart failure.

Types of Echocardiography

There are several types of echocardiography (ECHO)—all use sound waves to create pictures of your heart. This is the same technology that allows doctors to see an unborn baby inside a pregnant woman.

Unlike x rays and some other tests, echo doesn't involve radiation.

Transthoracic Echocardiography

Transthoracic ECHO is the most common type of echocardiogram test. It's painless and noninvasive. "Noninvasive" means that no surgery is done and no instruments are inserted into your body.

This type of echo involves placing a device called a transducer on your chest. The device sends special sound waves, called ultrasound, through your chest wall to your heart. The human ear can't hear ultrasound waves.

As the ultrasound waves bounce off the structures of your heart, a computer in the echo machine converts them into pictures on a screen.

Stress Echocardiography

Stress ECHO is done as part of a stress test. During a stress test, you exercise or take medicine (given by your doctor) to make your heart work hard and beat fast. A technician will take pictures of your heart using echo before you exercise and as soon as you finish.

Some heart problems, such as coronary heart disease, are easier to diagnose when the heart is working hard and beating fast.

Transesophageal Echocardiography

With standard transthoracic ECHO, it can be hard to see the aorta and other parts of your heart. If your doctor needs a better look at these areas, he or she may recommend transesophageal echocardiography (TEE).

During this test, the transducer is attached to the end of a flexible tube. The tube is guided down your throat and into your esophagus (the passage leading from your mouth to your stomach). This allows your doctor to get more detailed pictures of your heart.

Fetal Echocardiography

Fetal ECHO is used to look at an unborn baby's heart. A doctor may recommend this test to check a baby for heart problems. Fetal echo is commonly done during pregnancy at about 18 to 22 weeks. For this test, the transducer is moved over the pregnant woman's belly.

3-D Echocardiography

A three-dimensional (3D) ECHO creates 3D images of your heart. These images provide more information about how your heart looks and works.

During transthoracic ECHO or TEE, 3D images can be taken as part of the process used to do these types of echo.

3D echo may be used to diagnose heart problems in children. This method also may be used for planning and monitoring heart valve surgery.

What To Expect Before Echocardiography

Echocardiography is done in a doctor's office or a hospital. No special preparations are needed for most types of ECHO. Usually you can eat, drink, and take any medicines as you normally would.

The exception is if you're having a transesophageal echo. This test usually requires that you don't eat or drink for 8 hours prior to the test.

If you're having a stress ECHO, there may be special preparations. Your doctor will let you know how to prepare for your echo test.

What To Expect During Echocardiography

Echocardiography (ECHO) is painless and usually takes less than an hour to do. For some types of echo, your doctor will need to inject saline or a special dye into one of your veins to make your heart show up more clearly on the test images. This special dye is different from the dye used during angiography (a test used to examine the body's blood vessels).

For most types of ECHO, you'll be asked to remove your clothing from the waist up. Women will be given a gown to wear during the test. You'll lay on your back or left side on an exam table or stretcher.

Soft, sticky patches called electrodes will be attached to your chest to allow an EKG (electrocardiogram) to be done. An EKG is a test that records the heart's electrical activity.

A doctor or sonographer (a person specially trained to do ultrasounds) will apply gel to your chest. The gel helps the sound waves reach your heart. A wand-like device called a transducer will then be moved around on your chest.

The transducer transmits ultrasound waves into your chest. Echoes from the sound waves will be converted into pictures of your heart on a computer screen. During the test, the lights in the room will be dimmed so the computer screen is easier to see.

The sonographer will make several recordings of the pictures to show various locations in your heart. The recordings will be put on a computer disc or videotape for the cardiologist (heart specialist) to review.

During the test, you may be asked to change positions or hold your breath for a short time so that the sonographer can get good pictures of your heart. At times, the sonographer may apply a bit of pressure to your chest with the transducer. This pressure can be a little uncomfortable, but it helps get the best picture of your heart. You should let the sonographer know if you feel too uncomfortable.

Stress Echocardiography

Stress ECHO is a transthoracic echo combined with either an exercise or pharmacological stress test.

For an exercise stress test, you'll walk or run on a treadmill or pedal a stationary bike to make your heart work hard and beat fast. For a pharmacological stress test, you'll be given medicine to make your heart work hard and beat fast.

What Are the Risks of Echocardiography?

Transthoracic and fetal echocardiography (ECHO) have no risks. These tests are safe in adults, children, and infants.

If you have a transesophageal echo (TEE), some risks are associated with the medicine given to help you relax. These include a bad reaction to the medicine, problems breathing, or nausea (feeling sick to your stomach). Your throat also might be sore for a few hours after the test. Rarely, the tube used during TEE can cause minor throat injuries.

Stress echo has some risks, but they're related to the exercise or medicine used to raise your heart rate, not to the echo. Serious complications from stress tests are very uncommon. Go to the Diseases and Conditions Index Stress Testing article for more information about the risks of that test.

Reference: The National Heart, Blood and Lung Institute

Last updated April 27, 2017

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

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