An echocardiogram is an ultrasound image of the heart. It can help doctors diagnose a range of heart problems.
Doctors use echocardiograms to help them diagnose heart problems, such as damaged cardiac tissue, chamber enlargement, stiffening of the heart muscle, blood clots in the heart, fluid around the heart, and damaged or poorly functioning heart valves.
In this article, we explain how doctors use echocardiograms, what to expect during the test, and how to interpret the results.
What is it?
Ultrasound waves are used in echocardiography to create a picture of the heart, which is referred to as an echocardiogram (echo).
It is a minimally invasive medical technique that emits no radiation and has few negative effects.
A doctor can see the following things during an echocardiogram:
- any blood clots in the heart
- areas of damaged or weak cardiac muscle tissue
- the size and thickness of the chambers
- how the valves of the heart are functioning
- problems affecting the pericardium, which is the fluid-filled sac around the heart
- causes of a stroke
- the direction of blood flow through the heart
What is the procedure?
Echocardiograms are simple, noninvasive procedures that require little preparation.
We’ll go over what to expect before, during, and after an echocardiography in the sections below.
The person does not need to prepare if the echocardiogram is taken from the outside of the body by a healthcare expert.
A doctor will advise people who are getting a transesophageal echocardiography to avoid eating or drinking anything for at least 6 hours before the procedure. Following the local anesthetic wears off, people can resume eating and drinking 1–2 hours after the echocardiography.
During the test
The transthoracic (external) echocardiography will be performed by a sonographer. Sonographers are medical practitioners who specialize in producing images and movies for diagnostic purposes utilizing ultrasound instruments.
The person getting the echocardiography will take off their clothes from the waist up throughout the procedure. If they want to be covered during the exam, they can wear a hospital gown.
The sonographer will then urge the patient to lie on their back or left side on a table. They may inject a saline solution or dye into the veins of the patient to make the heart seem more distinct on an echocardiogram.
The type of echocardiography determines the procedure. Consider the following example:
The sonographer will apply a gel to the chest if a doctor has ordered a transthoracic echocardiogram. After that, the sonographer will move the transducer across the chest to obtain various images of the heart.
The sonographer may ask someone to change positions or take or hold a deep breath throughout the examination. To gain a better view of the heart, they could press the transducer into the chest.
If a clinician wants more detailed or sharper images of the heart than a transthoracic echocardiogram can provide, they may perform a transesophageal echocardiogram.
The person may be given a small sedative to help relax the muscles in their throat and a topical anesthetic to block the gag reflex during a transesophageal echocardiogram.
A doctor will guide a small transducer on the end of a long tube down the throat and esophagus until it reaches the back of the heart once the sedative and local anesthetic have taken effect.
As the doctor moves the transducer around the esophagus, the sonographer will record images of the heart. After swallowing the probe, the user should not feel the transducer or tube in their esophagus.
After the test
After a transthoracic echocardiography, most people can resume their normal activities.
After a transesophageal echocardiography, people may be required to stay at the hospital or healthcare center for a few hours. They may have a sore throat at first, but it should go away within a day or two.
If you were given a sedative prior to the exam, you should not drive for many hours afterward.
What does it diagnose?
Echocardiograms allow doctors to see the size, structure, and activity of different parts of the heart.
This allows them to identify heart abnormalities, assess the need for additional tests, decide their next actions, and monitor changes and improvements.
Doctors may use this approach to examine for signs or symptoms that could indicate the following:
- Heart attack: The test can look for anomalies in the heart muscle tissue’s blood supply, as well as wall irregularities and blood flow, all of which can signal a heart attack.
- Blood clots (thrombus) or tumors: In a study published in 2021, echo was proven to be a viable alternative to cardiac magnetic resonance in detecting thrombosis. According to a 2020 study, it is also an important noninvasive method for detecting heart masses such as malignancies.
- Atherosclerosis and coronary artery disease (CAD): While an echo cannot detect artery blockages, narrowing and obstructed arteries can impair the heart’s ability to pump blood and disrupt the heart’s wall motion. This is more noticeable during times of stress, making a stress echo a useful diagnostic tool.
- Aortic aneurysm and aortic dissection: An echo can detect a wide, weaker aorta, as well as unruptured aneurysms and their size, as well as fibrosis and thrombus formation in the vessel.
- Cardiomyopathy: The test can determine the size and function of the heart and link it to factors such as wall thickness, weak heart muscle, leaky heart valves, heart failure, and high blood pressure.
- Pulmonary hypertension: The test can measure heart pressure, which can indicate the presence of pulmonary hypertension and aid doctors in determining the following steps in the diagnosis.
- Congenital heart disease: In newborns and early children, the test can detect congenital cardiac problems such as septal defects and holes.
- Heart valve disease: The test checks for leakage, constriction, infection, and blockage in heart valves, as well as irregular cardiac blood flow.
- Problems with the pericardium: The test can determine whether the pericardium (the sac that surrounds the heart) is inflamed (pericarditis) or has become filled with fluid or blood (pericardial effusion).
- Heart failure: It can detect cardiac muscle that is weak, stiff, or thickened, which can be a symptom of heart failure.
Doctors frequently utilize the test to determine the cause of an abnormal electrical heart test, known as an electrocardiogram (EKG).
The method is also used to track how effectively the heart responds to various heart treatments, such as heart failure, drugs, prosthetic valves, and pacemakers.
If a doctor suspects a patient has cardiac abnormalities, an echocardiography will be ordered. The following are signs and symptoms that could suggest a cardiac condition:
- an irregular heartbeat (arrhythmia)
- shortness of breath
- high or low blood pressure
- leg swelling
- abnormal EKG results
- unusual sounds between heartbeats, known as heart murmurs
Types of echocardiogram
Different types of echocardiograms are available, all of which use high-frequency sound waves. The following are some of the most frequent types.
The most common form of echocardiography is the transthoracic echocardiogram.
An ultrasound wand called a transducer is placed on the outside of the chest, near the heart, for this test. Sound waves are sent through the chest and into the heart via the device.
Sound waves move more easily when a gel is applied to the chest. These waves bounce off the heart and appear on a screen as images of the heart’s architecture.
A thinner transducer attached to the end of a lengthy tube is used in a transesophageal echocardiogram. The tube will be swallowed and inserted into the esophagus, which connects the mouth to the stomach and runs behind the heart.
Because it gives a “close up” view of the heart, this type of echocardiography produces more detailed images of the heart than the typical transthoracic echocardiogram.
Doppler ultrasounds are used by doctors to check blood flow. They accomplish this by producing sound waves at specified frequencies and observing how the waves bounce off and return to the transducer.
Color doppler ultrasounds can be used by doctors to map the direction and velocity of blood flow in the heart. The blood flowing toward the transducer shows red, while the blood flowing away appears blue. It can also tell you how bad the blockages are.
A doppler ultrasound can detect issues with valves or holes in the heart’s walls, as well as let doctors examine how blood flows through it.
A detailed 3D image of the heart is created through a 3D echocardiography. 3D echocardiograms can be used by doctors to:
- plan heart valve or structural interventional surgery
- image complex structures within the heart
- assess valve functionality in people who have heart failure
- assess the function of the heart in 3D
- diagnose heart problems in infants and children
A doctor can order an echocardiogram as part of a stress test. A stress test involves physical exercise, such as walking, jogging on a treadmill, or riding a bike.
During the test, the doctor will keep track of your heart rate, blood pressure, and electrical activity in your heart.
Before and after the activity, a sonographer will do a transthoracic echocardiogram.
Stress tests are used by doctors to diagnose:
- heart failure
- problems affecting the heart valves
- ischemic heart disease
- coronary heart disease
Point-of-care (POC) echocardiogram
A POC echocardiogram is a type of echocardiogram that can be performed at a patient’s bedside by a clinician. These can assist a doctor in answering specific inquiries about possible differential diagnoses.
Limited and focused POC echo are the two types of POC echo.
A limited echocardiogram aids a clinician in determining the cause and repercussions of a heart injury. A focused echo is used by a doctor to assist narrow down the list of other possible diagnoses or to answer a specific query.
With each heartbeat, a POC echocardiogram can determine how well the left or right ventricles pump blood.
A fetal echocardiogram allows doctors to see the heart of an unborn baby. This check is normally done between 18 and 22 weeks of pregnancy. Because echocardiograms do not involve radiation, they are safe for both the mother and the infant.
Interpreting the results
The echocardiographic images will be sent to the doctor who requested the test by the sonographer after the exam. The doctor will examine the photos for indicators of cardiac disease, such as:
- abnormal chamber size
- poorly functioning valves
- chamber size
- masses in the heart, such as blood clots or tumors
- damaged heart muscle tissue
- pumping function of the heart
- thick or thin ventricle walls
What can it miss?
Echocardiograms are very useful in detecting structural heart abnormalities. They may, however, not be the ideal way to check the coronary arteries.
Blockages can cause the structure of the heart. Changes in cardiac function, weak muscles, or thinner heart walls are frequently detected by doctors, prompting them to order additional tests such as a coronary angiogram.
Echocardiograms cannot detect conduction disorders or electrical difficulties that impact the heart’s rhythm, but they can measure the effects of these abnormalities on the heart.
Echocardiogram vs. electrocardiogram
An echocardiogram should not be confused with an electrocardiogram, or EKG, which is another diagnostic procedure. The electrical impulses or waves that flow through cardiac muscle tissue are measured by an EKG.
The electrical activity in the heart causes the heart muscle tissues to contract and relax, resulting in the rhythmic heartbeat that a stethoscope can detect.
Electrodes are placed on the skin of the chest, arms, or legs by a qualified technician, nurse, or doctor. These electrodes capture electrical activity and transfer it to a computer, which translates it into a graph that a doctor may see.
Are there any side effects?
An echocardiogram has a very minimal risk of problems or side effects. When the sonographer guides the tube down the throat during a transesophageal electrocardiogram, the person’s gag reflex may be triggered. After the exam, some people may experience a sore throat.
A significant consequence, such as injury to the throat, vocal cords, or esophagus, can occur very rarely as a result of the transesophageal echocardiogram.
Some people may have an adverse reaction to local anesthetics, sedatives, contrast dyes, or saline used during the exam. Only use contrast dyes if absolutely essential when pregnant.
The following are some of the potential negative effects of contrast dyes:
During a stress test, some people may experience changes in blood pressure or a reduction in oxygen delivery to the heart. In the event that a person has any issues during the assessment, a stress test will be performed in a fully equipped medical facility.
When a person is given sedatives, the stomach contents have a risk of entering the lungs. To avoid this, the patient will be asked to come to the surgery on an empty stomach.
Doctors utilize echocardiography to diagnose heart-related issues. A doctor will assess how well a person’s heart pumps blood during the test.
Doctors can also use echocardiography to check for indicators of cardiac disease such weak heart muscle, blood clots inside the heart, or malfunctioning heart valves.
An echocardiogram may be ordered by a clinician if a patient exhibits symptoms of heart disease, such as:
- heart murmurs
- irregular heartbeat
- shortness of breath
- abnormal blood pressure
- leg swelling
The test has a low risk of serious problems or side effects in general. However, some people may have discomfort, and other people may be allergic to the contrast material or anesthesia.