What Is Echocardiography?
Echocardiography (EK-o-kar-de-OG-ra-fee), or echo,
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.
Who Needs Echocardiography?
Your doctor may recommend echocardiography (echo) 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.
- Blood clots or tumors. If you've had a stroke,
echo might be done to check for blood clots or tumors that may have caused
it.
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 (tranz-thor-AS-ik) 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
(tranz-ih-sof-uh-JEE-ul) echo (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.
Three-Dimensional 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. (See above for
more information on how transthoracic echo and TEE are done.)
3D echo may be used to diagnose heart problems in
children. This method also may be used for planning and monitoring
heart
valve surgery.
Researchers continue to study new ways to use 3D
echo.
Other Names for Echocardiography
- Echo
- Surface echo
- Ultrasound of the heart
What To Expect Before Echocardiography
Echocardiography (echo) 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.
Echocardiography
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.
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.
This process is similar for fetal echo. However, in
that test the transducer is placed over the pregnant woman's belly at the
location of the baby's heart.
Transesophageal Echocardiography
Transesophageal echo (TEE) is used when your doctor
needs a more detailed view of your heart. For example, TEE may be used to look
for blood clots in your heart. A doctor, not a sonographer, performs this type
of echo.
The test uses the same technology as transthoracic
echo, but the transducer is attached to the end of a flexible tube. The tube
will be guided down your throat and into your esophagus (the passage leading
from your mouth to your stomach). From this angle, your doctor can get a more
detailed image of the heart and major blood vessels leading to and from the
heart.
For TEE, you'll likely be given medicine to help you
relax during the test. The medicine will be injected into one of your veins.
Your blood pressure, the oxygen content of your blood, and other vital signs
will be checked during the test. You'll be given oxygen through a tube in your
nose. If you wear dentures or partials, you'll have to remove them.
The back of your mouth will be numbed with a gel or
a spray so that you don't gag when the transducer is put down your throat. The
tube with the transducer on the end will be gently placed in your throat and
guided down until it's in place behind the heart.
The pictures of your heart are then recorded as your
doctor moves the transducer around in your esophagus and stomach. You shouldn't
feel any discomfort as this happens.
Although the imaging usually takes less than an
hour, you may be watched for a few hours at the doctor's office or hospital
after the test.
Stress Echocardiography
Stress echo is a transthoracic echo combined with
either an exercise or pharmacological (FAR-ma-ko-LOJ-i-kal) 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.
A technician will take pictures of your heart using
echo before you exercise and as soon as you finish. The Diseases and Conditions
Index
Stress
Testing article provides more information about what to expect during a
stress test.
What You May See and Hear During
Echocardiography
As the doctor or sonographer moves the transducer
around, different views of your heart can be seen on the screen of the echo
machine. The structures of the heart will appear as white objects, while any
fluid or blood will appear black on the screen.
Doppler ultrasound techniques often are used during
echo tests. Doppler ultrasound is a special ultrasound that shows how blood is
flowing through the blood vessels.
This test allows the sonographer to see blood
flowing at different speeds and in different directions. The speeds and
directions appear as different colors moving within the black and white
images.
The human ear is unable to hear the sound waves used
in echo. If Doppler ultrasound is used, you may be able to hear "whooshing"
sounds. Your doctor can use these sounds to learn about blood flow through your
heart.
What To Expect After Echocardiography
You usually can go back to your normal activities
right after having echocardiography (echo).
If you have a transesophageal echo (TEE), you may be
watched for a few hours at the doctor's office or hospital after the test. Your
throat might be sore for a few hours after the test.
You also may not be able to drive right after a TEE.
Your doctor will let you know whether you need to arrange for someone to take
you home.
What Does Echocardiography Show?
Echocardiography (echo) shows the size, structure,
and movement of the various parts of your heart. This includes the valves, the
septum (the wall separating the right and left heart chambers), and the walls
of the heart chambers. Doppler ultrasound shows the movement of blood through
the heart.
Echo can be used to:
- Diagnose heart problems
- Guide or determine next steps for treatment
- Monitor changes and improvement
- Determine the need for more tests
Echo can detect many heart problems. Some may be
minor and pose no risk to you. Others can be signs of serious heart disease or
other heart conditions. Your doctor 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 could mean that the area isn't getting enough blood
supply, which may be due to
coronary
heart disease.
- Problems with your heart's valves. Echo can show
whether any of the valves of your heart 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. Congenital heart defects are structural problems present at
birth.
- Blood clots or tumors. If you've had a stroke,
echo might be done to check for blood clots or tumors that may have caused
it.
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.
Key Points
- Echocardiography (echo) is a painless test that
uses sound waves to create pictures of your heart.
- This test gives your doctor information about the
size and shape of your heart and how well your heart's chambers and valves are
working. In addition, a type of echo called Doppler ultrasound shows how well
blood flows through the chambers and valves of your heart.
- Your doctor may recommend echo if you have signs
and symptoms of heart problems. The test can be used to confirm a diagnosis,
determine the status of an existing problem, or help guide treatment.
- There are several types of echo. Transthoracic
and stress echo are standard types of the test. Transesophageal echo (TEE) is
used if the standard tests don’t produce clear results. A fetal echo is
used to look at an unborn baby’s heart. A three-dimensional (3D) echo may
be used to help diagnose heart problems in children or plan and monitor
heart
valve surgery.
- Echo is done in a doctor's office or hospital.
The test usually takes up to an hour to do. A standard echo doesn't require any
special preparations or followup. If you're having a TEE, you usually
shouldn’t eat or drink for 8 hours prior to the test.
- During a standard echo, your doctor or
sonographer will move a wand-like device called a transducer around on your
chest to get pictures of your heart. During a TEE, the transducer will be put
down your throat to get a better view of your heart.
- A cardiologist (heart specialist) will review the
results from your echo.
- You usually can go back to your normal activities
right after having echo. If you have TEE, you may be watched for a few hours at
the doctor’s office or hospital after the test.
- Transthoracic and fetal echo have no risks. If
you have TEE, some risks are associated with the medicine given to help you
relax. Rarely, the tube used in TEE can cause minor throat injuries. The risks
for stress echo are related to the exercise or medicine used to raise your
heart rate. Serious complications from stress echo are rare.
Links to Other Information About
Echocardiography
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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