Echocardiogram

An echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than a plain x-ray image and involves no radiation exposure.

How the Test is Performed

A trained sonographer performs the test, then your cardiologist interprets the results. An instrument called a transducer that transmits high-frequency sound waves is placed on your ribs near the breast bone and directed toward the heart.

Additional images will be taken underneath and slightly to the left of your nipple (at the apex of your heart). The transducer picks up the echoes of the sound waves and transmits them as electrical impulses. The echocardiography machine converts these impulses into moving pictures of the heart. The Doppler probe records the motion of the blood through the heart.

An echocardiogram allows doctors to see the heart beating, and to see many of the structures of the heart. Occasionally, your lungs, ribs, or body tissue may prevent the sound waves and echoes from providing a clear picture of heart function. If so, the sonographer may inject a small amount of liquid (contrast) through an IV to better see the inside of the heart.

How to Prepare for the Test

There is no special preparation for the test.

How the Test Will Feel

You will be asked to remove your clothes from the waist up and lie on an examination table on your back. Electrodes will be placed on your chest to allow for an ECG to be done. A gel will be spread on your chest and then the transducer will be applied. You will feel a slight pressure on your chest from the transducer. You may be asked to breathe in a certain way or to roll over onto your left side.

Why the Test is Performed

This test is performed to evaluate the valves and chambers of the heart in a noninvasive way. The echocardiogram allows doctors to diagnose, evaluate, and monitor:

  • Heart murmurs
  • Abnormal heart valves
  • The pumping function of the heart for people with heart failure
  • Damage to the heart muscle in patients who have had heart attacks
  • Infection in the sac around the heart (pericarditis)
  • Infection on or around the heart valves (infectious endocarditis)
  • The source of a blood clot or emboli after a stroke or TIA
  • Congenital heart disease
  • Atrial fibrillation
  • Pulmonary hypertension

Normal Results

A normal echocardiogram reveals normal heart valves and chambers and normal heart wall movement.

What Abnormal Results Mean

An abnormal echocardiogram can mean many things. Some abnormalities are very minor and do not pose significant risks. Other abnormalities are signs of very serious heart disease that will require further evaluation by a specialist. Therefore, it is very important to discuss the results of your echocardiogram in depth with your health care provider.

Risks

There are no known risks associated with this test.

Stress Echocardiogram

Stress echocardiography is a test that uses ultrasound imaging to determine how the heart muscles respond to stress. It is mainly used to diagnose and evaluate coronary artery disease.

How the Test is Performed

A stress echocardiogram includes the following steps:

A resting echocardiogram will be done first.

  • You will exercise or be given medicine until you reach the target heart rate. This helps reveal how your heart works when you are active.
  • Your blood pressure and heart rhythm (ECG) will be monitored throughout the procedure.
  • Ultrasound images will be recorded during the procedure.
  • Another echocardiogram is taken immediately after your target heart rate has been reached.
  • The ultrasound images will reveal any parts of the heart that may not be receiving enough blood or oxygen because of blocked arteries.

This test differs from an exercise stress test, which does not use ultrasound images.

How to Prepare for the Test

Ask your health care provider if you should take any of your routine medicines on the day of the test (especially if you are taking heart medication). Some medicines may interfere with test results.

DO NOT eat or drink for at least 3 hours before the test. Wear loose, comfortable clothing.

How the Test Will Feel

Electrodes (conductive patches) will be placed on your chest, arms, and legs to record the heart's activity. The preparation of the electrode sites on your chest may produce a mild burning or stinging sensation.

The blood pressure cuff on your arm will be inflated every few minutes, producing a squeezing sensation that may feel tight. Baseline measurements of heart rate and blood pressure will be taken before you start exercising.

You will start walking on a treadmill or pedaling a stationary bicycle. The pace and incline of the treadmill will gradually be increased.

If you are not able to exercise, you will receive a medication such as dobutamine or persantine through a vein (intravenous line). This type of medicine is given to increase your heart rate to a certain level. You may feel your heart beating more rapidly and forcefully. This is called a pharmacologic stress test.

Rarely, people experience chest discomfort, palpitations, dizziness, or shortness of breath during the test.

Why the Test is Performed

The test is performed to see whether your heart muscle is getting enough blood flow and, therefore, enough oxygen when it is working hard (under stress). The purpose is to discover and potentially treat any blockage or disease before serious or life-threatening problems develop.

Your doctor may request this test if you:

  • Have new symptoms of angina or chest pain
  • Have angina that is becoming worse
  • Have recently had a heart attack
  • Are at high risk for heart disease (before having surgery or when beginning an exercise program)
  • Have heart valve problems

Risks

The risks are very low, and health care professionals will monitor you during the entire procedure. Rare complications include:

  • Abnormal heart rhythm
  • Collapse
  • Heart attack

Considerations

A stress echocardiogram is a very effective, noninvasive test that can help determine whether you have blockages in your coronary arteries. If there are blockages, it can determine the severity of the problem. Early diagnosis and monitoring of heart disease allows treatment to begin early. This test does not require any radiation.