Echocardiogram (Echo)

Introduction

An echocardiogram — usually shortened to “echo” — is an ultrasound scan of the heart. It uses sound waves, not radiation, to create moving pictures of the heart as it beats. Doctors use these images to see the size of the heart chambers, how strongly the heart is pumping, how the valves are opening and closing, and how blood is flowing through the heart.

If your doctor has ordered an echo, or if you have already had one, this article will help you understand what the test shows, the different types of echo, how it is done, and what the results may mean. Echocardiography is one of the most commonly used heart tests in the world because it is safe, painless, and gives a great deal of information in a short time.

The test takes about 30 to 60 minutes for most people and does not require an overnight stay. Some specialised forms of echo, such as transesophageal echo or stress echo, take longer and need a little more preparation. The sections below explain each type in plain language.

What Is an Echocardiogram?

An echocardiogram is a heart ultrasound. A small handheld device called a transducer sends harmless high-frequency sound waves into the chest. These waves bounce back from the heart and are turned into moving images on a screen. Because the heart is constantly moving, an echo shows it in real time — the muscle squeezing with each beat, the valves opening and closing, and blood moving from chamber to chamber.

Cross-section of the heart showing: ① left ventricle, ② right ventricle, ③ left atrium, ④ right atrium, ⑤ mitral valve, ⑥ aortic valve, ⑦ tricuspid valve, ⑧ pulmonary valve.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

An echo can show:

• The size and shape of the four heart chambers
• The thickness and movement of the heart muscle walls
• How well the heart is pumping (often described as the ejection fraction)
• The structure and function of the four heart valves
• The direction and speed of blood flow through the heart
• Pressure inside the heart chambers and the main blood vessels
• Fluid around the heart (a pericardial effusion)
• Blood clots, masses, or congenital differences in the heart

Because it does not use radiation, an echocardiogram can be repeated safely as often as needed. It can be done on newborns, pregnant women, and adults of any age. It is sometimes performed at the bedside in a hospital, in a clinic, or even on an unborn baby through the mother’s abdomen (fetal echo).

Echocardiogram vs Other Heart Tests

Patients often confuse the echocardiogram with the electrocardiogram (ECG or EKG). They sound similar and are often done together, but they show different things.

• An ECG records the electrical activity of the heart through stickers placed on the skin. It shows rhythm problems and signs of strain or damage but does not show pictures of the heart.
• An echo shows pictures of the heart’s structure and movement but does not record electrical signals in detail.

Other heart imaging tests include cardiac MRI, cardiac CT, nuclear scans, and coronary angiography. Each has its own strengths. Doctors often start with an echo because it is safe, gives quick answers, and can be done easily.

Types of Echocardiogram

There are several different ways of performing an echo. The choice depends on what the doctor needs to see and on the patient’s individual situation.

Transthoracic Echocardiogram (TTE)

This is the standard echo and the type most patients have. “Transthoracic” means “through the chest.” The sonographer places the transducer on different spots on the chest, applies a clear gel to help the sound waves travel, and takes images from several angles. It is painless and usually takes 30 to 45 minutes. A transthoracic echo can answer most everyday cardiac questions: pumping strength, valve function, chamber size, and overall structure.

Sonographer performing a transthoracic echocardiogram, with the transducer placed on the chest and real-time images displayed on the monitor.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

Transesophageal Echocardiogram (TEE or TOE)

• To look more closely at the heart valves, particularly when the standard echo is unclear
• To check for blood clots in the left atrium before procedures such as cardioversion or ablation for atrial fibrillation
• To look for infection on the valves (endocarditis)
• To check for a hole between the heart’s upper chambers (patent foramen ovale or atrial septal defect)
• To guide certain procedures in the operating room or catheter lab

Diagram showing the transesophageal echocardiogram probe positioned in the esophagus, lying directly behind the heart for close-up imaging.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

Because the probe goes into the esophagus, a TEE usually requires fasting, throat numbing spray, and light sedation. It takes about 30 to 60 minutes including preparation.

Stress Echocardiogram

• Exercise stress echo — the patient walks on a treadmill or rides a stationary bike, and images are taken before and immediately after exercise.
• Pharmacological stress echo — for people who cannot exercise, a medicine (commonly dobutamine) is given through a vein to make the heart beat faster and stronger. Images are taken at different stages.

A stress echo usually takes about 60 minutes in total. Major cardiology societies, including the American College of Cardiology and the American Society of Echocardiography, list stress echo as one of the established tests for evaluating suspected coronary disease and for assessing certain valve conditions.

Doppler Echocardiogram

Doppler is not a separate test you book on its own — it is a feature built into modern echo machines. It measures how fast and in which direction blood is moving. Colour Doppler shows blood flow in colour on the screen (commonly red toward the probe and blue away). Doppler is essential for assessing valve leaks (regurgitation), valve narrowing (stenosis), holes between chambers, and pressures in the lungs.

Colour Doppler echocardiogram view showing blood flowing through the heart valves, with red indicating flow toward the probe and blue away.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

Three-Dimensional (3D) Echocardiogram

Standard echocardiography produces two-dimensional images. Newer machines can build three-dimensional images of the heart and its valves. 3D echo is especially useful for planning valve surgery or transcatheter procedures and for assessing complex congenital heart conditions. Not every centre offers 3D echo for every patient, but it is now standard in many specialised cardiology units.

Contrast Echocardiogram

Sometimes the heart chambers are difficult to see clearly — for example, in patients with thicker chest walls or lung disease. A contrast agent made of tiny harmless microbubbles can be injected into a vein to improve the clarity of the images. It does not contain iodine and is generally well tolerated. Contrast can also be used to look for certain types of shunts (abnormal connections) in the heart.

Fetal Echocardiogram

A fetal echo is an ultrasound of an unborn baby’s heart. It is performed through the mother’s abdomen, usually between 18 and 24 weeks of pregnancy. It is offered when there is a higher chance of congenital heart disease in the baby — for example, a family history, certain maternal conditions such as diabetes, or an abnormal finding on the routine pregnancy scan.

Why Is an Echocardiogram Performed?

Doctors order an echo for many reasons. The most common include:

To Investigate Symptoms

• Shortness of breath
• Chest pain or chest discomfort
• Palpitations (awareness of heartbeats)
• Dizziness or fainting
• Swelling of the legs or ankles
• Unexplained tiredness

To Diagnose Specific Conditions

• Heart failure — to measure the pumping strength (ejection fraction) and to look for the underlying cause
• Heart valve disease — to look for narrowing (stenosis) or leakage (regurgitation) of the mitral, aortic, tricuspid, or pulmonary valves
• Cardiomyopathy — diseases of the heart muscle, including dilated, hypertrophic, and restrictive types
• Congenital heart disease — differences in the heart present from birth
• Pericardial disease — inflammation or fluid build-up around the heart
• Endocarditis — infection on the heart valves
• Pulmonary hypertension — high pressure in the lung arteries
• Cardiac masses or clots

To Monitor Known Conditions

If you already have a diagnosed heart condition, echo is the main test used to follow it over time. For example, people with heart failure, valve disease, or cardiomyopathy commonly have a repeat echo every six to twelve months, or more often if the condition changes.

To Assess Heart Function Before or After Treatments

• Before non-cardiac surgery in patients with known or suspected heart disease
• Before and during chemotherapy with drugs that can affect the heart
• After a heart attack to assess damage and pumping function
• Before and after heart valve surgery or transcatheter valve procedures
• After heart transplant or other major cardiac surgery

For Screening in High-Risk Groups

Family members of people with inherited heart conditions, such as hypertrophic cardiomyopathy, may be offered echo screening. Some athletes also have echo as part of pre-participation evaluation when concerns arise on history or examination.

Preparation

How you prepare depends on the type of echo.

Standard Transthoracic Echo

No special preparation is usually needed. You can eat, drink, and take your usual medicines as normal. You will be asked to undress from the waist up and put on a gown so the sonographer can place the transducer on different parts of the chest. Women may want to avoid wearing a one-piece dress on the day. Avoid heavy creams or lotions on the chest, as they can interfere with the gel.

Stress Echo

You may be asked to:

• Avoid eating for two to four hours before the test
• Avoid caffeine for about 24 hours, especially before pharmacological stress echo
• Wear comfortable clothing and walking shoes if you will be using a treadmill
• Ask your doctor specifically about heart medicines such as beta-blockers, as some are held before the test and others are continued

Transesophageal Echo (TEE)

Because TEE involves passing a probe into the esophagus under sedation, more preparation is needed:

• Fasting for six hours or as advised — nothing to eat or drink
• Arrange for someone to take you home, since sedation makes it unsafe to drive afterwards
• Tell the team about loose teeth, dentures, swallowing problems, or known esophageal conditions
• Discuss blood-thinning medications with your doctor in advance — most are continued, but some procedures done at the same time may require adjustment

Things to Tell the Team Before Any Echo

• Allergies, including to latex or any contrast agents
• Whether you are pregnant or might be pregnant (fetal echo or careful approach may apply)
• Current medications, including blood thinners and asthma inhalers
• Pacemakers or implanted devices (echo is safe with these, but the team will want to know)
• Recent illnesses, especially chest or lung infections

What Happens During the Test

During a Standard Transthoracic Echo

You will lie on an examination bed, usually on your left side, with your left arm under your head. The sonographer places a few small ECG stickers on your chest to follow your heart rhythm during imaging. A clear gel is applied to the chest, and the transducer is moved firmly across different areas: just below the breastbone, between the ribs, and near the base of the neck.

You may be asked to hold your breath briefly, breathe in deeply, or change position to get the best views. The sonographer will often press fairly firmly — this can feel uncomfortable but is not usually painful. You may hear “whooshing” sounds from the machine when Doppler is switched on; these are the sounds of blood flowing through the heart, amplified for the operator.

The test usually lasts 30 to 45 minutes. When it is finished, the gel is wiped off and you can dress and leave straight away.

During a Stress Echo

Resting images are taken first, in the same way as a standard echo. Then:

• For an exercise stress echo, you walk on a treadmill or cycle while your blood pressure, ECG, and symptoms are monitored. The speed and incline increase in stages until you reach a target heart rate or cannot continue. As soon as you stop, you return to the bed and the sonographer rapidly captures images while the heart is still working hard.
• For a pharmacological stress echo, you stay on the bed and a medicine is given through a small drip in your arm. The dose is increased in stages, raising your heart rate gradually. Images are taken at each stage.

Stress echocardiogram stages: ① resting images acquired, ② exercise on treadmill with ECG monitoring, ③ immediate return to bed, ④ post-stress cardiac images captured.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

You may feel your heart racing, mild chest fluttering, breathlessness, or a flushed feeling. The team monitors you closely throughout. The test is stopped immediately if there are concerning symptoms or changes on the ECG.

During a Transesophageal Echo

A small drip is placed in your arm. Your throat is numbed with a spray, and a sedative is usually given through the drip. A mouth guard is placed between your teeth to protect them and the probe. You will be asked to lie on your left side. Once you are comfortably sedated, the doctor passes the probe gently through your mouth into the esophagus.

Most people remember little of the procedure afterwards. It takes about 20 to 40 minutes once the probe is in place. Your oxygen level, blood pressure, and heart rhythm are watched throughout. After the test, you will rest in a recovery area until the sedation wears off, usually one to two hours.

Recovery and Aftercare

After a Standard or Stress Echo

There is essentially no recovery needed after a transthoracic echo. You can return to work, drive, and resume normal activities immediately. After a stress echo, you may feel tired for a short time, especially if you exercised hard or had medication, but most people are back to usual activity within an hour or two.

After a Transesophageal Echo

Because sedation is used, recovery is more important:

• You will rest in the recovery area until you are alert and your vital signs are stable
• You should not eat or drink until the throat numbness has worn off (usually one to two hours), to avoid choking
• Mild sore throat is common for a day or so and usually settles with soft food and warm fluids
• You should not drive, sign legal documents, drink alcohol, or operate machinery for the rest of the day
• You should have someone with you on the journey home

Contact your doctor or go to an emergency department if, after a TEE, you develop severe chest or abdominal pain, difficulty breathing, vomiting blood, black stools, or a high fever — these are uncommon but warrant urgent assessment.

Understanding the Results

The cardiologist reviews the images and writes a detailed report. Your treating doctor explains the findings in the context of your symptoms, examination, and other tests. Many echo reports contain a long list of measurements; the important ones for most patients are described below.

Ejection Fraction (EF)

• 50–70% is generally considered normal
• 40–49% is described as mildly reduced
• Below 40% is described as reduced and may indicate heart failure with reduced ejection fraction
• Above 70% can sometimes occur in certain conditions and is interpreted in context

Heart failure can also occur with a normal ejection fraction; in that case the problem is with how the heart relaxes and fills between beats (diastolic function), which echo can also assess.

Valve Function

Each of the four heart valves — mitral, aortic, tricuspid, and pulmonary — is checked for:

• Stenosis (narrowing): graded as mild, moderate, or severe
• Regurgitation (leakage): graded as trivial, mild, moderate, or severe

Trivial or mild leaks are very common, often present in healthy people, and usually need no treatment. Moderate and severe valve disease are followed more closely and may eventually lead to a discussion about valve repair or replacement.

Chamber Size and Wall Thickness

Enlarged chambers can indicate long-standing valve disease, high blood pressure, or cardiomyopathy. Thickened walls (hypertrophy) most often reflect high blood pressure but can also indicate inherited conditions such as hypertrophic cardiomyopathy.

Pericardial Findings

The report will note whether there is fluid around the heart (pericardial effusion) and its amount. Small effusions are often harmless. Larger or rapidly developing effusions can affect heart function and may need treatment.

Pulmonary Artery Pressure

An estimate of the pressure in the lung arteries is included where possible. Elevated values can indicate pulmonary hypertension, which may need further specialised tests.

What to Ask Your Doctor

If you receive an echo report and are not sure what it means, useful questions include:

• What is the main finding, and is it new or unchanged?
• Does it explain my symptoms?
• Do I need any further tests?
• Does this finding require treatment now, or watching over time?
• When should the echo be repeated?

Risks and Complications

Echocardiography is one of the safest cardiac tests available. The risks vary by type.

Transthoracic Echo

There are essentially no risks. There is no radiation, no needles, and no medication involved in a standard echo. Some patients find the pressure of the transducer uncomfortable, or feel slightly cold from the gel, but these are minor.

Stress Echo

The risks are similar to those of any exercise test or medication stress test:

• Temporary chest pain, palpitations, or breathlessness during the test
• Changes in blood pressure
• Abnormal heart rhythms, which usually settle when the test is stopped
• Very rarely, more serious events such as heart attack or arrhythmia

The test is performed in a monitored setting with trained staff and emergency equipment available to manage these uncommon events.

Transesophageal Echo

Most patients have only a mild sore throat afterwards. Less common risks include:

• Reaction to the sedative
• Damage to teeth, dentures, or dental work
• Minor bleeding from the mouth or throat
• Aspiration of stomach contents into the lungs
• Very rarely, a tear or perforation of the esophagus — this is a serious but uncommon complication

The risk of serious complications is low, and the team will discuss them with you before the procedure.

Contrast Agents

Echo contrast (microbubbles) is generally well tolerated. Mild reactions such as flushing, headache, or back discomfort are uncommon. Serious allergic reactions are rare but possible, as with any injected agent.

Echocardiogram in Children

Echocardiography is the main imaging test for heart disease in babies, children, and unborn infants. Because it does not use radiation, it can be repeated as often as needed during growth and follow-up.

Pediatric Echo

A pediatric echo is performed in much the same way as an adult echo, but the equipment, probes, and approach are tailored to the child’s size and age. Very young children may need distraction, a parent at the bedside, or, occasionally, light sedation if they cannot lie still. Pediatric cardiologists often perform or directly supervise the scan because congenital heart conditions can be complex and require expert interpretation.

An echo may be ordered in a child for reasons such as:

• A heart murmur heard on examination
• Known or suspected congenital heart disease
• Family history of inherited heart conditions
• Kawasaki disease, to assess the coronary arteries
• Rheumatic heart disease, to assess valve damage
• Chest pain, fainting, or palpitations
• Genetic syndromes associated with heart problems (such as Down, Turner, or Marfan syndrome)
• Monitoring during or after treatments that can affect the heart, including some chemotherapy

Fetal Echo

A fetal echo looks at the unborn baby’s heart, usually between 18 and 24 weeks of pregnancy. It is offered when there is an increased chance of congenital heart disease, for example:

• Family history of congenital heart disease
• Maternal diabetes, lupus, or certain medications during early pregnancy
• Abnormal findings on routine pregnancy scans or non-invasive prenatal testing
• Increased nuchal translucency on first-trimester ultrasound

The scan is similar to a standard pregnancy ultrasound for the mother but is performed by specialists trained in fetal cardiac imaging. If a heart difference is found, it allows the family and medical team to plan for delivery and any treatment the baby may need.

Alternatives and Complementary Tests

Echocardiography is not the only way to image the heart. Doctors may use other tests instead of or in addition to echo, depending on the clinical question.

Electrocardiogram (ECG)

An ECG records the heart’s electrical activity. It is usually done before or alongside an echo. It is the main test for rhythm and conduction problems but does not show the heart’s structure.

Cardiac MRI

Cardiac magnetic resonance imaging uses powerful magnets to produce detailed images of the heart muscle, scar tissue, and blood flow. It is particularly useful when echo images are limited or when fine detail of the heart muscle is needed — for example, in suspected myocarditis, certain cardiomyopathies, or to characterise heart masses. It does not use radiation but takes longer than an echo and is not suitable for all patients (for example, some with certain implanted devices or severe claustrophobia).

Cardiac CT

A cardiac CT scan uses X-rays to create detailed pictures, especially of the coronary arteries. CT coronary angiography is often used to look for blockages in patients with suspected coronary disease. It uses radiation and intravenous contrast.

Nuclear Cardiac Imaging

Nuclear tests such as myocardial perfusion imaging use small amounts of radioactive tracer to show blood flow to the heart muscle, often combined with exercise or medication. They are an alternative to stress echo for assessing suspected coronary disease.

Coronary Angiography

This is an invasive test in which a thin catheter is passed into the heart’s arteries and dye is injected to map them in detail. It is the most accurate way to look at coronary blockages and may be used when non-invasive tests suggest significant disease or when treatment such as stenting is being considered.

Holter and Event Monitors

For symptoms like palpitations or fainting, doctors may use portable ECG monitors that record the heart rhythm over hours or days. These complement echo rather than replacing it.

Major cardiology societies, including the American Heart Association and the European Society of Cardiology, generally describe echo as the first-line cardiac imaging test for most structural and functional questions, with other tests added when echo cannot answer the question or when a specific concern requires a different approach.

Frequently Asked Questions

Is an echocardiogram painful?

A standard transthoracic echo is not painful, although the pressure of the transducer can feel firm. A stress echo can cause the same kind of breathlessness or tiredness as exercise. A transesophageal echo may cause a sore throat afterwards but is performed under sedation, so most people remember little of it.

How long does an echocardiogram take?

A standard echo usually takes 30 to 45 minutes. A stress echo takes about an hour. A transesophageal echo takes about 30 to 60 minutes, plus recovery time from sedation.

Can I eat before an echo?

You can eat normally before a standard transthoracic echo. For stress echo, you may be asked to avoid food for a few hours and to avoid caffeine. For transesophageal echo, you usually need to fast for about six hours.

Is the test safe in pregnancy?

Yes. Echo uses ultrasound, not radiation, and is considered safe at any stage of pregnancy. Echocardiography is also the standard way to image an unborn baby’s heart.

Can children have echocardiograms?

Yes. Echo is the main heart imaging test for children of all ages, including newborns and infants. Pediatric cardiologists use specialised equipment and techniques.

How often will I need a repeat echo?

This depends on your condition. People with stable, mild findings may have an echo every few years or only when symptoms change. People with more significant valve disease, heart failure, or cardiomyopathy commonly have an echo every six to twelve months. Your cardiologist will set a schedule based on your particular situation.

What does “ejection fraction” mean on my report?

Comparison of left ventricular ejection fraction: ① normal EF (50–70%), ② mildly reduced EF (40–49%), ③ reduced EF (below 40%), showing how much blood remains after each heartbeat.

*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.

Are mild valve leaks something to worry about?

Trivial and mild valve leaks are very common, often found in healthy people, and usually do not need any treatment. Your doctor will explain whether the finding on your scan is something to follow or simply note in your record.

Can an echo show a blockage in the heart arteries?

A standard echo does not directly show blockages in the coronary arteries. However, it can show indirect signs — such as areas of the heart muscle that move poorly — that suggest reduced blood supply. A stress echo, cardiac CT, nuclear scan, or coronary angiography is generally used when blockages need to be assessed directly.

Will I get the results immediately?

The sonographer who performs the scan does not usually give a diagnosis. The images are reviewed by a cardiologist who writes a formal report, which your referring doctor then discusses with you. Some clinics provide a same-day summary; others give results within a few days.

Can I exercise or drive after the test?

After a standard echo, you can drive and exercise straight away. After a stress echo, most people can resume normal activity within an hour or two. After a transesophageal echo, you should not drive or do anything requiring full alertness for the rest of the day because of the sedation.

Conclusion

An echocardiogram is a safe, painless, and powerful test that lets doctors see the heart in motion. For most people, the standard transthoracic echo answers the clinical question quickly and without any discomfort beyond the pressure of the probe. For more detailed views or specific situations, transesophageal, stress, 3D, contrast, or fetal echo may be used.

The information an echo provides — pumping strength, valve function, chamber sizes, pressures, and blood flow — sits at the heart of how cardiologists diagnose, monitor, and plan treatment for a wide range of conditions. Understanding what the test shows and what the report means can help you take part in your own care, ask clear questions, and follow your heart health with confidence over time.