What is an echocardiogram?

An ultrasound machine used for an echocardiogram

An echocardiogram provides ultrasound images of your heart. Dr Rajan Sharma, Consultant Cardiologist and Head of Clinical Services at St George's Hospital, London, explains this common test to our Senior Cardiac Nurse Emily Reeve.

Why would I have an echocardiogram?

An echocardiogram is an important investigation for anyone with suspected heart failure, heart valve problems or cardiomyopathy. It can help your doctor make an early diagnosis. You might be referred for an echocardiogram if you have suspected heart valve disease, for example because of symptoms such as breathlessness and/or a heart murmur (an unusual sound in your heartbeat). This test is also used to diagnose patients with inherited heart disease, including cardiomyopathy.

It uses ultrasound scanning to give a picture of your heart. It is cost-effective and safe.

When might I have an echocardiogram?

There are three main areas for its use: diagnosis, prognosis and follow up. At any of these points, it can provide measures of heart function, including an ejection fraction (the amount of blood pumped out of the heart with each heartbeat – a ‘normal’ level is around 55 per cent). This helps to establish how severe the problem is and the likely prognosis, which then help your doctor decide on appropriate treatment options.

Follow up is very important

Follow up is very important and must be done once or twice yearly for heart failure and valve disease patients to see how they are responding to their medication and/or device (such as a pacemaker or ICD).

What does the test involve?

A transthoracic echo (TTE), the most common type, involves the patient taking their clothes off from the waist up, lying on a couch on their left side and an ultrasound probe being placed on the chest and abdomen to take images.

This echocardiogram can be done as a full scan or a focal scan. A full scan takes 40–45 minutes and gives a complete assessment of the size and function of all heart structures. The British Society of Echocardiography recently introduced focal scans. This lasts 20–25 minutes. It is mainly used for people with suspected heart failure. If it suggests there are abnormalities, a full scan will be performed.

In the future, it’s likely we will see more 3D scans

I've heard you can get 3D ultrasound scans – is that true?

Yes, although in the UK 2D is still more common. 3D is good at quantifying heart function and there are fewer variations in results caused by variations in investigation technique – this is particularly useful for measurements such as ejection fraction. Cost is the only reason some places have 3D scanners and not others. In the future, it’s likely we will see more 3D scans.

What is a TOE and why would you have one?

A transoesophageal echo (TOE) is much more focused and less commonly used than a TTE. It’s an invasive test as the probe is put on the end of a long endoscope that the patient has to swallow. The scan is taken from inside the oesophagus, which is right next to the heart.

The test provides views of the back of the heart from the left atrium, and is mostly used for patients with problems in this area, including mitral valve disease. It can give a clearer view as the ultrasound signal doesn’t have to travel as far.

Do I need to do anything to prepare for the test?

Not for a standard echocardiogram (TTE), but for a TOE you will need to fast for four hours beforehand and two hours afterwards.

Will it hurt?

Either type of echocardiogram can give better understanding of your condition

The TOE can be uncomfortable, but should be tolerable. You will usually be offered anaesthetic (general or, more often, local) and/or some form of sedation.

Are there any after effects?

Not for the standard echocardiogram. After a TOE you will feel like you can’t swallow for a couple of hours. If they haven't had sedation, most people can carry on as normal in the afternoon if they had it in the morning.

What will it tell me?

Either type of echocardiogram can give better understanding of your condition. For example if someone has a leaky valve, it can tell you the severity of the leak and whether it can be repaired or replaced.

What are the latest developments in this area?

The most exciting development is that echocardiograms can now be used beyond hospitals. There are pocket-sized devices providing access for more patients. Image quality has also got better over the years, with clearer images.

We’re working on echocardiography for patients who don’t yet have symptoms and appear to have a normal heart, but have very early signs of disease. This can be useful for people having chemotherapy for breast cancer, for example, which can sometimes damage the heart. If damage is detected early by echocardiography, stopping chemotherapy can allow the heart to recover.

In future, I hope echos will give more information in a single scan – not just heart and valve function, but also mapping out coronary arteries.

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