Echocardiogram

An echocardiogram is a test that uses sound waves to produce images of your heart. This commonly used test makes it possible for your doctor to see your heart beating and pumping blood.

Your doctor can use the images from an echocardiogram to identify a heart disease. You may have one or several echocardiograms depending on what information your doctor needs. Each type of echocardiogram has few, if any, risks involved.

Here are the most common reasons to undergo an echocardiogram.

Your doctor may suggest an echocardiogram if he or she has suspicions of problems with the valves or chambers of your heart or if heart problems are the cause of different symptoms, such as shortness of breath or chest pain.

An echocardiogram can also be used to detect congenital heart defects in unborn babies (fetal echocardiogram).

Depending on what information your doctor needs, you may have one of the following types of echocardiograms:

Transthoracic echocardiogram

This is a standard, noninvasive echocardiogram.

• A technician (sonographer) spreads gel on your chest and then presses a device known as a transducer firmly against your skin, aiming an ultrasound beam through your chest to your heart.
• The transducer records the sound wave echoes from your heart.
• A computer converts the echoes into moving images on a monitor.
• If your lungs or ribs block the view, you may need a small amount of liquid (contrast agent) injected through an intravenous line (IV) that will make your heart's structures show up more clearly on a monitor, improving the images.

Transesophageal echocardiogram

If it's difficult to get a clear picture of your heart with a standard echocardiogram or if there is a reason to see the heart and valves in more detail, your doctor may recommend a transesophageal echocardiogram.

In this procedure, a flexible tube containing a transducer is guided down your throat and into your esophagus, which connects your mouth to your stomach. From there, the transducer can be positioned to obtain more-detailed images of your heart.

Your throat will be numbed, and you'll have medications to help you relax during a transesophageal echocardiogram.

Doppler echocardiogram

When sound waves bounce off blood cells moving through your heart and blood vessels, they change pitch. These changes (Doppler signals) can help your doctor measure the speed and direction of the blood flow in your heart.

Doppler techniques are used in most transthoracic and transesophageal echocardiograms, and they can be used to check blood flow problems and blood pressures in the arteries of your heart that traditional ultrasound might not detect.

Sometimes the blood flow shown on the monitor is colorized to help your doctor pinpoint any problems.

Stress echocardiogram

Some heart problems — particularly those involving the coronary arteries that supply blood to your heart muscle — occur only during physical activity. For a stress echocardiogram, ultrasound images of your heart are taken before and immediately after walking on a treadmill or riding a stationary bike.

If you're unable to exercise, you may get an injection of a medication to make your heart pump as hard as if you were exercising.

There are no risks involved in a standard transthoracic echocardiogram. You may have a sensation similar to pulling off an adhesive bandage when the technician removes the electrodes placed on your chest during the procedure.

If you have a transesophageal echocardiogram, your throat may be sore for a few hours afterward. In rare cases, the tube may scrape the inside of your throat.

Your oxygen levels will be monitored during the exam to check for any breathing problems caused by sedation medication. During a stress echocardiogram, exercise or medication, not the echocardiogram itself, may temporarily cause an irregular heartbeat. Serious complications, such as heart attack, are rare.

There are no special preparations for a standard transthoracic echocardiogram. You can eat, drink and take medications as you normally would.

If you are having a transesophageal or stress echocardiogram, your doctor will ask you not to eat a few hours before. If you have any trouble swallowing, let your doctor know, as this may affect his or her decision to order a transesophageal echocardiogram.

If you will be walking on a treadmill during a stress echocardiogram, make sure you wear comfortable shoes. You will not be able to drive yourself afterward if you are having a transesophageal echocardiogram because of the sedating medication you will likely be given.

Before you have your transesophageal echocardiogram, be sure to make arrangements to get home.

Read on to learn more about what to expect before, during, and after your echocardiogram.

An echocardiogram can be performed in the doctor's office or a hospital. You will first be asked to undress from the waist up. You will then lie on an examination table or bed. The technician will attach sticky patches (electrodes) to your body, these will help detect and conduct the electrical currents of your heart.

During the procedure

The technician will dim the lights to better view the image on the monitor. The technician will apply a special gel to your chest that improves the conduction of sound waves and eliminates air between your skin and the transducer, which is a small, plastic device that sends out sound waves and receives those that bounce back.

The technician will move the transducer back and forth over your chest. The sound waves create images of your heart on a monitor, which are recorded for your doctor to review. You may hear a pulsing "whoosh," which is the ultrasound recording the blood flowing through your heart.

If you have a transesophageal echocardiogram, your throat will be numbed with a numbing spray or gel to make inserting the transducer into your esophagus more comfortable. You'll likely be given a sedative to help you relax.

Most echocardiograms take less than an hour, but the timing may vary depending on your condition.

During a transthoracic echocardiogram, you may be asked to breathe in a certain way or to roll onto your left side. Sometimes the transducer must be held very firmly against your chest. This can be uncomfortable — but it helps the technician produce the best images of your heart.

After the procedure

Usually, you can resume your normal daily activities after an echocardiogram.

If your echocardiogram is normal, no further testing may be needed. If the results are concerning, you may be referred to a doctor trained in heart conditions (cardiologist) for more tests.

Treatment depends on what's found during the exam and your specific signs and symptoms.

You may need a repeat echocardiogram in several months or other diagnostic tests, such as a cardiac computerized tomography (CT) scan or coronary angiogram.

Your doctor will look for healthy heart valves and chambers, as well as normal heartbeats.

Information from the echocardiogram may show the following results:

• Heart size: Weakened or damaged heart valves, high blood pressure or other diseases can cause the chambers of the heart to enlarge or the walls of your heart to achieve abnormal thickness. Your doctor can use an echocardiogram to evaluate the need for treatment or to monitor treatment effectiveness.

• Pumping strength: This test can also aid your doctor in determining your heart's pumping strength. Specific measurements may include the percentage of blood that is pumped out of a filled ventricle with each heartbeat (ejection fraction) and the volume of blood pumped out of the heart per minute (cardiac output).

  If your heart is not able to pump enough blood to meet your body's needs, this could result in heart failure.

• Damage to the heart muscle: Your doctor can determine whether all parts of the heart are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may be an indication of coronary artery disease or various other conditions.
• Valve problems: An echocardiogram shows how your heart valves move when your heart is beating. Your doctor can determine if the valves open wide enough for adequate blood flow or close fully to avoid blood leakage.
• Defects of the heart: Many heart defects can be detected with an echocardiogram, including problems with the chambers of the heart, abnormal connections between the heart and the major blood vessels, and complex heart defects that may be present at birth. Echocardiograms can even be used to monitor a baby's heart development prior to birth.

Call your doctor right away if you experience any of these side effects:

• A headache, dizziness, and changes in vision
• Lightheadedness
• Unusual feeling of weakness or tiredness
• Stomach cramps or diarrhea
• Easy bruising or bleeding (nosebleeds, bleeding gums)