Echocardiogram

An echocardiogram (also called an echo) is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen.

  • Doppler echocardiogram. This test is used to look at how blood flows through the heart chambers, heart valves, and blood vessels. The movement of the blood reflects sound waves to a transducer. The ultrasound computer then measures the direction and speed of the blood flowing through your heart and blood vessels. Doppler measurements may be displayed in black and white or in color.

Echo can be used as part of a stress test and with an electrocardiogram (EKG or ECG) to help your doctor learn more about your heart.

Stress echocardiogram

A stress echo may be done to:

  • Identify and monitor reduced blood flow to heart muscle (ischemia). This is usually more apparent after some form of stress, such as exercise or medicine.

Doppler echocardiogram

  • Measure the speed at which blood travels through the heart.
  • Measure the blood pressure and speed of blood flow through the heart valves.

How It Is Done

An echocardiogram may be done in a hospital, clinic, or doctor’s office. It can also be done at your bedside in the hospital.

You will need to remove any jewelry and clothes above your waist (you may be allowed to keep on your underwear if it does not interfere with the test). You may be given a cloth or paper covering to use during the test.

You may receive an IV so you can get medicine during the test. The IV can be used to give you a contrast material, which helps your doctor check your heart function. A contrast material may be used if it is difficult to get good views of your heart. A good view might be hard to get because of certain conditions such as obesity or chronic lung disease.

Doppler echocardiogram

You will lie on your back or on your left side on a bed or table. Small metal discs (electrodes) will be taped to your arms and legs to record your heart rate during the test. To learn more, see Electrocardiogram.

A small amount of gel will be rubbed on the left side of your chest to help pick up the sound waves. A small instrument (transducer) that looks like a microphone is pressed firmly against your chest and moved slowly back and forth. This instrument sends sound waves into the chest and picks up the echoes as they reflect off different parts of the heart. The echoes are sent to a video monitor that records pictures of your heart for later viewing and evaluation. The room is usually darkened to help the technician see the pictures on the monitor.

At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side. The transducer is usually moved to different areas on your chest that provide specific views of your heart.

The test usually takes from 30 to 60 minutes. When the test is over, the gel is wiped off and the electrodes are removed.

Exercise stress echocardiogram

An echo without activity or stress will be done before you start exercising. This is called the baseline, and after it is established you will exercise for a specific amount of time. You will either walk on a treadmill or pedal a stationary bicycle while being monitored by an EKG machine. To learn more, see Exercise Electrocardiogram.

You will then lie on a bed or table, and another echocardiogram will be done. At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side. The transducer is usually moved to different areas on your chest that provide specific views of your heart.

An exercise stress echo takes about 30 to 60 minutes.

Dobutamine stress echocardiogram

Sometimes medicine called dobutamine is used instead of exercise to stress your heart. For this test, you will lie on your back or left side on a bed or exam table, and a baseline echocardiogram will be done. EKG electrodes will be taped to your arms and legs to record your heart rate during the test.

Next, the technician cleans the site on your arm where the medicine will be injected, and an intravenous (IV) line will be placed in a vein in your arm.

After the IV is started, you will be given dobutamine, which increases your heart rate and causes your heart to work harder. Echocardiogram images will be taken while you receive the dobutamine. Your peak heart rate is reached in about 15 minutes. At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side. After your peak heart rate is reached, the medicine will be stopped and your heart rate will return to normal (in about 1 to 3 minutes). More echocardiogram images will be taken when your heart rate returns to normal.

A dobutamine stress echo takes about an hour.

How It Feels

Doppler echocardiogram

You will not have pain from the echocardiogram. Gel is put on your chest for the ultrasound. It may feel cool. The handheld ultrasound device is pressed firmly against your chest, but it does not cause pain. You will not hear or feel the sound waves.
You may feel uncomfortable from lying still or from the transducer pressing on your chest. If you need to take a break, tell the technician.
Most people do not experience any discomfort from ultrasound tests. But if you have severe difficulty breathing or cannot lie flat for a long exam, you may not be able to have an entire echo study. Talk to your doctor or the technician performing your echo about any concerns you have.

Dobutamine stress echocardiogram

  • You may have a brief, sharp pain when the intravenous (IV) needle is placed in a vein in your arm.
  • If medicine to stress your heart is used, you may have symptoms of mild nausea, headache, dizziness, flushing, or chest pain (angina). These symptoms only last a few minutes.

Risks

An echocardiogram is safe, because the test uses only sound waves to evaluate your heart. These high-frequency sound waves have not been shown to have any harmful effects.
If contrast material is used, there is a slight risk of having an allergic reaction. Most reactions can be controlled using medicine.

Stress echocardiogram

A stress echocardiogram can cause dizziness, low blood pressure, shortness of breath, nausea, irregular heartbeats, and heart attack.

Results

An echocardiogram is a type of ultrasound test that uses high-pitched sound waves that are sent through a device called a transducer. The device picks up echoes of the sound waves as they bounce off the different parts of your heart. These echoes are turned into moving pictures of your heart that can be seen on a video screen.

Results are usually available within one day. If the test is done by a cardiologist, the results may be available immediately after the test.

Echocardiogram

Normal:

  • The heart chambers and walls of the heart are of normal size and thickness, and they move normally.
  • Heart valves are working normally, with no leaks or narrowing. There is no sign of infection.
  • The amount of blood pumped from the left ventricle with each heartbeat (ejection fraction) is normal.
  • There is no excess fluid in the sac surrounding the heart, and the lining around the heart is not thickened
  • There are no tumors and blood clots in the heart chambers.

Abnormal:

  • Heart chambers are too big. The walls of the heart are thicker or thinner than normal. A thin heart wall may mean poor blood flow to the heart muscle or an old heart attack. A thin, bulging area of the heart wall may indicate a bulge in the ventricle (ventricular aneurysm). The heart muscle walls do not move normally because of a decreased blood supply from narrowed coronary arteries.
  • One or more heart valves do not open or close properly (are leaking) or do not look normal. Signs of infection are present.
  • The amount of blood pumped from the left ventricle with each heartbeat (ejection fraction) is lower than normal.
  • There is fluid around the heart (pericardial effusion). The lining around the heart is too thick.
  • A tumor or blood clot may be found in the heart.