Echocardiogram

What is an Echocardiogram?

An echocardiogram, often shortened to an echo, is a painless ultrasound scan of the heart. A small handheld probe called a transducer is pressed against the chest. It sends high frequency sound waves into the body. Then it listens for the echoes that bounce back from the heart's walls, valves, and moving blood. A computer turns those echoes into a live moving picture. The scan shows the size and thickness of each chamber and how strongly the heart squeezes. It also shows whether the valves open and close properly, whether blood is leaking backward, and whether fluid has collected in the sac around the heart. It measures the ejection fraction too, the percentage of blood pumped out with each beat. There is no radiation, no needles in a standard study, and no recovery time. We perform a routine echocardiogram in our office, and it takes about 30 to 60 minutes. Dr. Vimal Nanavati reviews the images and explains what they show.

Why Dr. Nanavati may recommend this

An echocardiogram answers structural questions that an electrocardiogram cannot. One measures electricity, the other measures anatomy and movement.

Dr. Nanavati may recommend an echocardiogram if you have:

• Shortness of breath, swelling in the legs, or reduced exercise tolerance.
• A heart murmur, which is an extra sound made by turbulent blood flow across a valve.
• Chest pain or pressure that needs a structural explanation.
• Suspected heart failure, or a known weak heart muscle that needs periodic follow-up.
• A previous heart attack, to see how much muscle was affected.
• Suspected valve disease, including narrowing or leaking. The American Heart Association explains heart valve problems and disease.
• Heart palpitations or an arrhythmia that may have a structural cause.
• A congenital heart difference, or a family history of an inherited heart muscle condition.
• Monitoring during chemotherapy that can affect the heart muscle.

There are several forms of the test. A transthoracic echocardiogram is the standard scan through the chest wall. A stress echocardiogram compares images at rest and immediately after exercise. A transesophageal echocardiogram uses a probe passed into the esophagus. It gives a closer view when the standard scan is not detailed enough.

How to prepare

For a standard echocardiogram, preparation is minimal.

• Eat and drink normally. No fasting is needed for a routine transthoracic study.
• Take all of your medications as usual unless you are specifically told otherwise.
• Wear a two piece outfit. You will undress from the waist up and wear a gown. A bra will need to be removed.
• Skip lotion, oil, or powder on the chest that morning. These interfere with the gel and the probe.
• Leave necklaces at home or plan to remove them.
• Bring previous echocardiogram reports so changes over time can be compared.
• Allow about an hour for the appointment.
• A stress echocardiogram or a transesophageal study has different, stricter instructions, and they typically include fasting. Follow the specific directions you are given.

What happens during the procedure

You change into a gown and lie on an exam table. Usually you lie on your left side, with your left arm tucked under your head. That position brings the heart closer to the chest wall and improves the images. A wedge or pillow supports your back.

Three small sticky electrodes are placed on your chest. They record your heart rhythm alongside the images. The room lights are dimmed so the sonographer can see the screen clearly.

Warm water-based gel is applied to your chest. The probe is then moved across several positions, below the collarbone, between the ribs, under the breastbone, and sometimes at the base of the neck. Firm pressure is used at times to get past the ribs and lungs. That can feel uncomfortable, but it should not be painful.

You will be asked to breathe in, breathe out, hold your breath briefly, or roll further onto your side. You will hear whooshing and pulsing sounds from the speakers. That is Doppler recording of blood flow, and it is expected.

Sometimes the images are unclear. A contrast agent made of tiny gas-filled microbubbles may then be given through a small intravenous line to outline the heart chambers more sharply. When the study is finished, the gel is wiped off and the electrodes removed.

Recovery and results

There is no recovery. You dress and leave. You can drive, work, and exercise immediately. If contrast was used, the intravenous line is removed before you go. No special precautions are needed.

The images are measured and interpreted by a physician. Reports usually reach Dr. Nanavati within a few days. He then reviews the results with you and explains them in context.

A normal echocardiogram shows normal chamber sizes and normal wall thickness. The valves open and close cleanly, and the ejection fraction is normal, generally in the range of about 55 to 70 percent. The National Heart, Lung, and Blood Institute overview of heart tests explains what each measurement means.

Abnormal findings guide the next step. A reduced ejection fraction leads to heart failure medication and close follow-up. A thickened wall or an abnormal valve may lead to repeat imaging at set intervals, a transesophageal study, or a referral. Wall motion abnormalities suggesting reduced blood supply may prompt advanced stress testing or coronary CT angiography.

Risks and safety

A standard echocardiogram is one of the safest tests in medicine. Diagnostic ultrasound has been used for decades with no evidence of tissue harm at the energy levels used. There is no ionizing radiation. The test can be repeated as often as needed, and it is safe during pregnancy.

The discomforts are minor. The gel feels cool, and the probe pressure can be tender over the ribs. The electrode stickers may leave temporary redness or briefly pull the skin when removed.

Ultrasound contrast, when used, is generally well tolerated. Allergic reactions are rare, and the agent clears from the body within minutes. Tell the team if you have had a reaction to it before or have a known right-to-left heart shunt.

The main limitation is image quality rather than risk. Lung disease, obesity, chest wall shape, and previous chest surgery can make the heart harder to see. Sometimes the pictures are inadequate. Another approach such as a transesophageal echocardiogram or cardiac MRI may then be recommended.

Related services and conditions

• Electrocardiogram (ECG / EKG), the electrical companion test.
• Heart murmur and heart anatomy.
• Advanced stress testing when blood flow is the question.
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