What To Expect From An Echocardiogram

What is an Echocardiogram?


An Echocardiogram, often referred to as an Echo, is a two dimensional way of looking at the heart with live moving images. Somewhat like a movie of your heart that a heart doctor will view and assess. It is not to be confused with an EKG which is an Electrocardiogram. An EKG looks at the heart's rhythm only. Nor can an Echocardiogram take a look at stents within the heart. An Echo is normally ordered by a physician of some kind that may want to take a closer look at the heart and see how it is functioning. An Echo is often ordered to help rule out whether the symptoms a patient is experiencing could be heart related. What an Echo does is it takes a detailed look at the inside of the heart along with a glimpse of the outer lining of the heart as well.


2nd probe from the right.
2nd probe from the right.
If you're lucky some facilities have bottle warmers.
If you're lucky some facilities have bottle warmers.

What equipment is used?


There are different brands, types and sizes of machines that can be used for this exam. Most machines are "portable" which means that they can be used for outpatients as well as taken out of the department to a patient’s room. The machine will consist of a monitor just like on a laptop or it will look somewhat like a TV screen. There are also EKG leads or wires attached to the machine that the technician will place upon the patient for monitoring their heart rate on the screen during the test. In order to perform the actual test, the use of a transducer or probe that produces sound waves will be used along with a water-based gel that helps the waves keep contact with the skin. As of today, there has been no reason to believe that this test is unsafe. There is no radiation or unsafe particles involved with this examination.


IVS - Interventricular Septum, LV - Left Ventricle, AO - Aorta, LA - Left Atrium, DAO - Descending Aorta
IVS - Interventricular Septum, LV - Left Ventricle, AO - Aorta, LA - Left Atrium, DAO - Descending Aorta
RV - Right Ventricle, TV - Tricuspid Valve, RA - Right Atrium, LV - Left Ventricle, MV - Mitral Valve, LA - Left Atrium
RV - Right Ventricle, TV - Tricuspid Valve, RA - Right Atrium, LV - Left Ventricle, MV - Mitral Valve, LA - Left Atrium

How Long Does It Take and What Does It Show?


In most cases the test normally takes about 25-30 minutes to perform. First the technician will ask the patient to lay on their left side. This often helps the heart to shift more to the left and out from behind the sternum bone allowing the technician to see the heart better. The technician will start off at the center left side of the chest. At this point they are getting images of the left side of the heart and analyzing chamber size and evaluating the aortic and mitral valves that function on the left side of the heart.

The technician will then move onto the left under side of the patient. For women this will normally be right underneath the left breast. The heart does not go this far down but with the angling of the probe that the technician uses they are able to get views of the heart that show all four chambers functioning in one image. The technician then is evaluating all four valves and checking for leakage, stenosis (blocked heart valves that aren't allowing proper blood flow) and any other abnormalities with them. In this view, the technician will also check for an Ejection Fraction (how much the heart muscle squeezes) percentage by measuring the left ventricle as it expands (fills with blood) and contracts (pushes blood out to the body).

Once they have assessed all involved with that particular area the Echo technician will move on to gathering views from the stomach area. Again, the heart does not go anywhere near the level of the stomach area but the ultrasound beam is able to emit its waves and get another view of the heart. This particular area searches for fluid around the heart as well as checking for any holes located in the septum (the muscle that separates the chambers of the heart) of the heart.

Depending on the facility, another view obtained may be from the throat. This view takes a look at a patient’s aortic arch which is the main artery in the body that carries the oxygenated blood out to the rest of the body.


What Can Cause A “Bad Echo”?


What is considered a "bad" Echocardiogram or study? This is defined as an Echo that is difficult for the technician to obtain clear images from. Not the results from the study. There are a few factors that can cause difficulty in obtaining images such as body types, lung interference and body movement. Whether man or woman, large or thin, body types can cause either a bad imaging of a patient or hard to get views. Lots of men think it is probably hard to image women because of their breasts and large people think it’s probably easier to get images on a thinner person. Neither of those statements have to be true.

No matter, it is unclear of how anyone will image based on body type alone. However, body types do play a role in performing a good or unclear study. Larger patients are sometimes hard to scan due to the fatty tissue a patient may have; impeding the sound waves of the probe used by the technician. Someone that is too thin may be difficult as well because of rib interference. The sound waves may bounce back to the probe instead of penetrating to the heart.

Another reason that can cause interference of an Echocardiogram is breathing or lung interference of some type. If a smoker is imaged it may be more difficult to view their heart due to lung interference. What most people don’t realize or think about is that the heart lies right behind the lungs. If the lungs are clouded by smoking habits it may be difficult to see the heart. The same theory applies to those that also have lung disease or other lung issues. Heavy breathers can also affect the test. Perhaps not in the sense of making it difficult to image a person but it may take the technician longer to perform the Echo if someone holds their breath too long or breathes too shallow. When a patient does this, they can completely wipe out the image the tech has tried to obtain. It is always best if the patient breathes normally or doesn’t take such deep breaths during the exam. However the sonographer may have the patient hold their breath or release it all out and hold it out if it helps with obtaining the images.

Lastly, movement can affect the imaging of an Echo. Yes, the heart is within the body and really doesn’t do much moving but any movement that moves the steady hand of a sonographer can cause them to lose the image they have worked hard to get in. By laying still, this will help the technician get what they need, allowing the patient to get in and out quickly.


Do Children Get Echocardiograms?

Yes they do. The most given reason a child receives an Echocardiogram is in search of a murmur that was heard by their family doctor or pediatrician. In those cases, a murmur can be anything ranging from a leaky valve, stenotic valve that they may have had from birth to a hole in the heart that has stemmed from a congenital defect. At times echoes on children are the hardest to obtain. Children most of the times have short attention spans. It is expected that there will be crying or squirming from the toddler because they do not understand what is going on. But this can make it hard on a technician to find the source of any problem areas in the child's heart. Sometimes this difficulty can result in an incomplete study or not being able to obtain images at all. This can be an inconvenience for mommy and daddy as well as the child and technician. In order to try to prevent this it is most helpful if the parent of a toddler bring to the test enough milk or juice to last the test, make sure the child has had a nap before the test or perhaps even bring in their favorite toy or pacifier to occupy them. Whatever will calm the child down as best as possible. And for those parents who have children that can comprehend well, it is helpful to take the time to explain the test to them so that they are aware of what to expect from start to finish well in advance before they have their test. Practice with them what the test may feel like so they are prepared for what may happen. Replacing any fears they may have of the test with knowledge can only help. With children it is crucial to get the best images as possible in order to not miss anything. Any steps towards helping the tech get through the test without interruption will be well appreciated and beneficial.


Other Things To Expect


  • Some patients might be expected to wear a hospital gown in order to prevent gel from getting on a patient's clothing. If this is necessary the patient will be asked to take everything from the waist up off.
  • Technicians will stop throughout the test and take routine measurements of structures and flows throughout the heart.
  • The patient may notice occasional colors that may come across the monitor. This color is called color doppler. Colors that can be seen range from reds and blues to yellows and oranges. This color merely shows the blood flow as it flows between the valves and in and out of the heart.
  • Noises can also be heard throughout the exam. This is the interpreted sound that the machine gives to the blood flow as it goes through the heart.
  • Though it is normal to be curious of test results, in most cases it is not the technicians right to give a diagnosis on the performed test. It is up to a heart doctor or someone that has the proper authority to assess the study to do so.


Echocardiograms are beneficial and at times life saving tests that can prevent surgeries or tell the physician if heart surgery is necessary. Looking into the heart with ultrasound is an amazing technology that is accurate and effective when checking for the overall function of the heart. With the proper cooperation from the patient, the test can be performed thoroughly and in a timely manner.


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