Echocardiogram

Why is it performed?

Your doctor may order an echocardiogram for several reasons. For example, they may have discovered something unusual in other tests or while listening to your heartbeat through a stethoscope.

If you have an irregular heartbeat, your doctor may want to inspect the heart valves or chambers or check your heart’s ability to pump. They may also order one if you’re showing signs of heart problems, such as chest pain or shortness of breath or if you have an abnormal EKG (electrocardiogram).

Types

There are several different types of echocardiograms.

Transthoracic echocardiography

This is the most common type of echocardiography.

A device called a transducer will be placed on your chest over your heart. The transducer sends ultrasound waves through your chest toward your heart. A computer interprets the sound waves as they bounce back to the transducer. This produces the live images that are shown on a monitor.

A health specialist will follow guidelines for collecting different types of images and information.

What to expect

Transthoracic echocardiography is painless and noninvasive. There is no need to do any special preparation before having this test, and no recovery time will be needed.

At the test center, the following will most likely happen:

• You will need to remove your clothes from the waist up and put on a gown.
• If the doctor is using a contrast dye or saline solution, they will inject or infuse the solution.
• You will lie on your back or side on a table or stretcher.
• The technician will apply gel to the chest and move a wand across the chest to collect images.
• They may ask you to change position or hold your breath for a short time at specific intervals.

Transesophageal echocardiography

For more detailed images, your doctor may recommend a transesophageal echocardiogram.

In this procedure, the doctor guides a much smaller transducer down your throat through your mouth. They will numb your throat to make this procedure easier and eliminate the gag reflex.

The transducer tube is guided through your esophagus, the tube that connects your throat to your stomach. With the transducer behind your heart, your doctor can get a better view of any problems and visualize some chambers of the heart that are not seen on the transthoracic echocardiogram.

What to expect

Before the appointment, your doctor will likely ask you to not eat or drink anything for 8 hours before the test.

In the procedure, they:

• may inject a mild sedative to help you relax before starting
• will numb your throat with an anesthetic gel or spray
• will gently insert the tube into your mouth and guide it down your throat, taking care to avoid injury
• will move the tube up, down, and sideways to get clear images

You should not feel any pain during the procedure, and there will be no difficulty breathing. The procedure usually takes 20 to 40 minutes.

After the procedure, you can expect the following:

• You may need to stay a few hours in the hospital while the doctor monitors your blood pressure and other signs.
• Your throat may be sore for a few hours.
• The doctor will likely advise you to not eat or drink anything for 30 to 60 minutes after the procedure and to avoid hot liquids for a few hours.
• You will be able to return to your daily activities after 24 hours.

Stress echocardiography

A stress echocardiogram uses transthoracic echocardiography, but the doctor takes images before and after you’ve exercised or taken medication to make your heart beat faster. This allows your doctor to test how your heart performs under stress.

It can also show if there are any signs of heart failure, high blood pressure, and other problems.

What to expect

Your doctor will attach patches to your chest that link up to the echocardiogram machine.

Then they will use one of the following to slightly increase the stress on your heart:

• exercise on a treadmill or stationary bicycle
• medications, such as dobutamine
• adjusting a pacemaker, if you have one

The echocardiogram and other devices will collect data at intervals to see how the heart responds and how well it is working.

They will measure your:

• heart rhythm
• breathing
• blood pressure

For an exercise stress test:

• Come to the test prepared to exercise.
• Before the test, a doctor may inject a contrast dye to help provide a clearer image.
• The doctor will measure your heart rate and blood pressure before you start, during, and after the exercise.

Before the appointment, your doctor will tell you if you need to make any changes, such as stopping medication, before coming to the test. The stress echo usually takes about 20 to 30 minutes but can vary depending on how long you exercise or how long it takes the medication to raise your heart rate.

Learn more here about a stress echocardiogram and what it involves.

Three-dimensional echocardiography

A three-dimensional (3-D) echocardiogram uses either transesophageal or transthoracic echocardiography to create a 3-D image of your heart. This involves multiple images from different angles. It’s used before heart valve surgery and to diagnose heart problems in children.

What to expect

In some cases, a doctor may use a contrast agent to gain a clearer picture. You will receive this as an injection during the scan.

Fetal echocardiography

Fetal echocardiography is used with expectant mothers sometime during weeks 18 to 22 of pregnancy. The transducer is placed over the abdomen of the pregnant person to check for heart problems in the fetus. The test is considered safe for an unborn child because it does not use radiation, unlike an X-ray.

What to expect

The procedure is similar to that for transthoracic echocardiography, but the doctor will pass the wand over the pregnant person’s belly around the place where the baby’s heart is.

Find out more about fetal echocardiography here.

Risks

Echocardiograms are considered very safe. Unlike other imaging techniques, such as X-rays, echocardiograms do not use radiation.

Contrast dyes and patches

If a scan involves a contrast injection or agitated saline, there is a slight risk of complications such as allergic reaction to the contrast. Contrast should not be used during pregnancy.

There’s a chance for slight discomfort when the EKG electrodes are removed from your skin. This may feel similar to pulling off a Band-Aid.

Transesophageal echocardiogram

There’s a rare chance the tube used in a transesophageal echocardiogram may scrape the esophagus and cause irritation. In very rare cases, it can puncture the esophagus and cause a potentially life threatening complication called esophageal perforation.

The most common side effect is a sore throat due to irritation of the back of the throat. You may also feel a bit relaxed or drowsy due to the sedative used in the procedure.

Stress echocardiogram

The medication or exercise used to get your heart rate up in a stress echocardiogram could temporarily cause an irregular heartbeat or precipitate a heart attack. Medical professionals will supervise the procedure, reducing the risk of a serious reaction such as heart attack or arrhythmia.

During the procedure

Most echocardiograms take less than an hour and can take place in a hospital or doctor’s office.

For a transthoracic echocardiogram, the steps are as follows:

• You will need to undress from the waist up.
• The technician will attach electrodes to your body.
• The technician will move a transducer back and forth on your chest to record the sound waves of your heart as an image.
• You may be asked to breathe or move in a certain way.

For a transesophageal echocardiogram, the steps are as follows:

• Your throat will be numbed.
• You will then be given a sedative to help you relax during the procedure.
• The transducer will be guided down your throat with a tube and will take images of your heart through your esophagus.

A stress echocardiogram is the same as a transthoracic echocardiogram, except a stress echocardiogram takes pictures before and after performing exercise. The duration of the exercise is usually 6 to 10 minutes but can be shorter or longer depending on your exercise tolerance and fitness level.

How to prepare for an echocardiogram

A transthoracic echocardiogram requires no special preparation.

However, if you undergo a transesophageal echocardiogram, your doctor will instruct you to not eat anything for 8 hours before the test. This is to prevent you from vomiting during the test. You may also not be able to drive for a few hours afterward due to the sedatives.

If your doctor has ordered a stress echocardiogram, wear clothes and shoes that are comfortable to exercise in.

Recovery after an echocardiogram

Generally, there is little to no recovery time needed for an echocardiogram.

After a transesophageal echocardiogram, you may experience some throat soreness for a few hours, but you should be able to return to your usual activities the next day.

Results

Once the technician has obtained the images, it usually takes 20 to 30 minutes to perform the measurements. Then the doctor can review the images and inform you of the results either at once or within a few days.

The results may reveal irregularities such as:

• damage to the heart muscle
• heart defects
• abnormal cardiac chamber size
• problems with pumping function
• stiffness of the heart
• valve problems
• clots in the heart
• problems with blood flow to the heart during exercise
• pressure in the heart

If your doctor is concerned about your results, they may refer you to a cardiologist. This is a doctor who specializes in the heart. Your doctor may order more tests or physical exams before diagnosing any issues.

If you’re diagnosed with a heart condition, your doctor will work with you to develop a treatment plan that works best for you.

Takeaway

Echocardiograms can show how well your heart is performing and highlight areas where there may be a problem. In most cases, the procedure is noninvasive, but your doctor may inject a contrast dye or agitated saline to get a clearer picture.

In the case of a transesophageal echocardiogram, your doctor will numb the throat and pass a transducer down it to get a clearer picture. In an exercise stress test, you should come prepared to exercise, unless your doctor says exercise is not involved.

Echocardiograms are effective ways of providing accurate information about the heart. They can help a doctor diagnose heart and cardiovascular problems and find the right treatment if a problem arises.

Read this article in Spanish.