Echocardiogram: how to read your results

What’s on this page:

• Echocardiograms explained
• Ejection fraction (EF)
• Left ventricular systolic dysfunction (LVSD)
• Left ventricular diastolic dysfunction (LVDD)
• Mitral valve regurgitation and aortic stenosis
• Left ventricular hypertrophy (LVH)
• Pericardial effusion
• Patent foramen ovale (PFO)

Echocardiograms explained 

An echocardiogram (or echo) is an ultrasound scan that uses sound waves to create images of your heart.

It looks at the structure of your heart, how well it pumps blood around the body, and the blood vessels around it.

There are several types of echocardiograms, including:

• Transthoracic echocardiogram (TTE) – this is performed by moving a probe over your bare chest using a gel. It is also known as a ‘standard echo’.
• Transoesophageal echocardiogram (TOE) – this is performed by inserting a small tube into your mouth and down your throat to get more detailed images of your heart.

In some cases, the person who carries out the test – an echocardiographer or a doctor – will discuss your results with you straight away, but usually they will be sent to your GP surgery or the doctor who referred you for the test.

You may also be able to access your echocardiogram results on your online GP health record or on the NHS app, where you may see some medical terms you’ve not heard of before.

Make sure to speak with your doctor if you’re not sure what your results mean.

Ejection fraction (EF)

Your heart pumps blood around the body by filling up with blood and then squeezing it back out again. However, not all the blood in your heart is pumped out with every heartbeat.

Ejection fraction (or EF) is the percentage of blood your heart squeezes (ejects) out of its main chamber with each beat. Measuring the ejection fraction helps your doctor understand how well your heart is pumping.

A normal ejection fraction is over 50 to 55 per cent. If your ejection fraction is below 49 per cent, it’s a sign that your heart is not pumping as well as it should be.

However, while ejection fraction is important, it’s not the only way to measure how well your heart is working.

• Learn more about how your heart works.

Left ventricular systolic dysfunction (LVSD)

The heart has 4 chambers – 2 at the top and 2 at the bottom: the left atrium, right atrium, left ventricle and right ventricle.

The left ventricle is the largest and most muscular of the 4 chambers of your heart. It pumps oxygenated blood out of the heart and around your body.

The term ‘systolic’ refers to the part of the heartbeat where the heart contracts and squeezes to pump out the blood.

So left ventricular systolic dysfunction (LVSD) means that the left ventricle is pumping out less blood to your body than it should.

This is accompanied by a lower ejection fraction, and can cause symptoms like breathlessness and swelling around the feet, ankles and stomach because of fluid build up in the body.

Some people with LVSD may be diagnosed with heart failure with reduced ejection fraction (HFrEF).

LVSD is often a result of the blood vessels supplying blood to the heart becoming narrowed (coronary heart disease) or blocked because of a heart attack, however there are also other causes.

While it’s more common on the left side of the heart, systolic dysfunction can also happen in the right ventricle, which pumps blood to the lungs.

• Read more about living with heart failure.

Left ventricular diastolic dysfunction (LVDD)

The opposite to ‘systolic’ is ‘diastolic’, which describes the time in the heartbeat when the heart relaxes between beats and fills up with blood again.

If the left ventricle does not relax properly, it fills up with less blood. This means that less blood is then squeezed out of the heart and pumped around the body.

This is known as left ventricular diastolic dysfunction (LVDD) and can cause the same symptoms as LVSD.

If you have severe LVDD, you may be diagnosed with heart failure with preserved ejection fraction (HFpEF).

Mitral valve regurgitation and aortic stenosis

An echocardiogram also looks at the 4 valves in your heart, which open and close to keep blood flowing in the right direction.

These valves are called the aortic, mitral, tricuspid and pulmonary valves.

Your echocardiogram report may say that there’s some ‘regurgitation’ or ‘stenosis’ at 1 or several of your heart’s valves, most commonly the mitral or aortic valves.

Mitral valve regurgitation means that the mitral valve does not completely close, so some blood flows backwards through the heart.

While mild regurgitation is common and not usually a cause for concern, severe regurgitation puts more strain on the heart.

Aortic stenosis means the aortic valve does not open as wide as it should. This reduces the amount of blood that flows through the heart and means the heart must work harder.

In some cases, the extra strain caused by regurgitation or stenosis can lead to heart failure, atrial fibrillation (an irregular heartbeat), stroke, and endocarditis, where your heart becomes infected.

• Learn more about heart valve disease.

Left ventricular hypertrophy (LVH)

An echocardiogram can also pick up on left ventricular hypertrophy (LVH), which is when the walls of the left ventricle become thickened and stiff. This can make it harder for the heart to pump blood around the body.

It’s often caused by conditions that make the heart work harder, such as high blood pressure, or by an inherited heart condition called hypertrophic cardiomyopathy.

Pericardial effusion

Pericardial effusion is when there is extra fluid in the pericardial space (the protective sac around your heart).

It may be caused by a condition called pericarditis, where the pericardium becomes inflamed. The most common symptom is chest pain, especially when lying down or breathing in.

Patent foramen ovale (PFO)

If an echocardiogram detects some blood flowing between the 2 upper chambers of the heart, this is commonly a sign of a patent foramen ovale (PFO).

A PFO is a small flap-like opening that usually closes after you’re born. However, for some people, it may stay partially or completely open. It’s thought that around 1 in 4 people have a PFO.

PFOs usually do not cause any symptoms or any harm. However, there is some evidence that they may increase the chances of having a stroke, so you might be offered surgery to close it if your doctor thinks you’re at risk. 

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