Echocardiography

Basic Facts:

  • Echocardiography is a diagnostic test that uses ultrasound, or high-frequency sound waves, to create images of the heart’s structure and function, to measure the blood pressure inside the heart, and to measure the direction and speed of blood flow.  

Echocardiography is primarily used to detect and assess the following:

  • Heart failure or cardiomyopathy (enlargement of the heart),
  • Congenital (present at birth) heart defects,
  • Damage from hypertension (high blood pressure),
  • Heart attack damage or scarring,
  • Pericardial disease (the membrane that surrounds the heart), and
  • Function of the heart muscle and valves.
Several echocardiographic techniques can be used, including:
  • Transthoracic echocardiography – With this most common echocardiogram, views of the heart are obtained by moving a transducer over the chest wall. 
  • Echocardiographic stress testing – During this test, an echocardiogram is done both before and after your heart is stressed during exercise. People who cannot exercise are given medications that simulate the effects of exercise on the heart.
  • Transesophageal echocardiography - Done as an outpatient procedure in the hospital. A slender, flexible tube is inserted into the mouth, through the esophagus, and into the stomach. Transesophageal echocardiography produces a highly detailed image of the heart because there are no internal structures to obstruct the view, and is used to detect and assess the following:
    • Blood clots,
    • Congenital abnormalities,
    • Disease of the aorta,
    • Heart infection, and
    • Heart valve malfunctions.

 

Pre-Test Guidelines

The physician will give the patient specific pre-test directions to follow, but patients are often given common guidelines, such as:

  • Patients should not eat, drink, or smoke for four hours before stress echocardiography, but should take any medications as usual unless otherwise directed, and
  • Patients receiving transesophageal echocardiography should not eat after midnight the night before the test, but should take any medications as usual. 

Testing 

Echocardiography is performed by a trained sonographer or technician at an echocardiography lab, a clinic, or in the patient's hospital room. Throughout the test, an electrocardiogram, or ECG, which record's the heart's electrical activity, is performed to monitor the heartbeat and blood pressure is monitored. For transthoracic and stress echocardiography, a gel is used on the chest to improve conduction and reception, it may feel cold and moist. The transducer is moved across the chest to gather data and the patient may feel slight pressure surrounding the area being examined. The patient may hear a 'whooshing' sound, which is the amplified sound of the blood flowing.

For transesophageal echocardiography, a sedative will be administered. For a transesophageal echocardiogram, the patient swallows a long, slender, flexible tube that has an ultrasound-imaging device near its tip. The tube is directed from the mouth, through the esophagus, and into the stomach.

For stress echocardiography, the patient exercises on a treadmill or stationary bicycle until reaching a pre-determined target heart rate, then stops exercising and the transthoracic echocardiographic technique is used.

Occasionally, the patient may be asked remain silent or hold his or her breath so that the heart may be seen more clearly.

The procedure lasts approximately 30 to 60 minutes.

For instructions on what to expect for a Stress Echo, click here.

 

There are no post-test restrictions for transthoracic echocardiography or stress echocardiography.

For transesophageal echocardiography, patients should observe the following restrictions:

  • Avoid driving for 24 hours if a sedative was administered, and 
  • Avoid eating and drinking, especially hot foods and liquids, for at least two hours after the test.