Echocardiography (heart echo)
An echo uses sound waves to make pictures of the heart. It shows how the heart pumps and how the valves work, and it uses no radiation. This page explains what an echo shows, what it does not show, and the main types.
What is an echo?
Echocardiography, or a “heart echo”, is a scan that uses sound waves to make pictures of the heart. The NHS compares it to an ultrasound scan in pregnancy and says it is usually done by a sonographer, someone trained for this work. The aim is to see how the heart is working.
Cleveland Clinic says an echo shows the structure and pumping strength of the heart and the blood flow through it, including through each valve. With it, a doctor can see the state of the valves, the size of the heart chambers and the movement of the heart wall.
An echo is different from an ECG. An ECG records electrical activity, that is, the rhythm and the heart rate, while an echo gives a picture of the structure and the blood flow (BHF and NHS).
Who may need an echo?
The NHS gives two main reasons: to check whether your symptoms come from a heart condition, and to check how well the heart is working if you have or have had a heart problem. Examples are after a heart attack, when heart failure is diagnosed, in heart valve disease and in congenital heart disease.
So an echo is usually considered in situations like these:
- Breathlessness, swollen legs or palpitations with no clear cause
- An extra sound (a murmur) heard during an examination
- Another doctor has sent you for an echo or a heart opinion
- Follow-up of a known condition, such as heart failure or valve disease
Not everyone with symptoms needs an echo, and not every echo needs to be repeated. The doctor decides this from your history and examination.
What can an echo show?
According to the sources we read, an echo can help to diagnose or assess:
- The pumping strength of the heart and the movement of its wall
- Narrowing or leaking of the valves
- Congenital heart disease
- The effects of a heart attack on the heart muscle
- Diseases of the heart muscle (cardiomyopathy) and inflammation of the lining around the heart (pericarditis)
- Clots in the heart chambers and heart tumours
A fuller list is given by Cleveland Clinic and the BHF. Which of these applies to you is something only a doctor can say.
What does an echo not show?
- It does not record the heart rhythm. For rhythm you need an ECG, and if the problem comes and goes, a portable ECG, which the NHS describes as worn for 24 to 48 hours and sometimes up to 7 days.
- It does not see every part of the heart equally well. Cleveland Clinic says an echo through the food pipe gives better quality pictures and shows the back of the heart better.
- It is a picture taken at rest. If symptoms come only during activity, a stress echo may be needed. The BHF also lists this echo for checking coronary artery disease.
Because each test gives only part of the picture, the doctor puts the echo result together with your history, examination and ECG.
Types of echo
- Standard echo on the chest (TTE): the most common type. The probe is moved over the chest.
- Exercise or stress echo: like a standard echo, but with exercise on a treadmill or exercise bike, or with a medicine that has an effect on the heart similar to exercise. You are scanned again afterwards. Cleveland Clinic says the exercise may cause chest pain or breathlessness.
- Echo through the food pipe (TOE or TEE): a thin tube with a small ultrasound device goes through the mouth into the food pipe to get a more detailed picture. The NHS says it is not painful but is unpleasant; the throat is numbed and you can ask for a sedative. A sedative does not put you to sleep but makes you very drowsy, and you should not drive for 24 hours.
- Contrast echo: a small amount of liquid is injected into a vein in the arm to make the picture clearer. Cleveland Clinic says it may cause an allergic reaction.
Which of these types this clinic carries out is not stated on this page. This page is a general explanation only, and you need to contact the clinic to ask.
How is a standard echo done?
According to the NHS:
- You take off your top and put on a gown.
- You lie on a couch. A few stickers on your chest record your heartbeat.
- Gel is put on your chest or on the probe.
- The sonographer moves the probe gently over your chest. The machine makes a loud whooshing sound.
For what to bring with you, see the guide “Preparing for an echo”.
The result and the next step
The NHS says sometimes the doctor tells you the result on the same day, and sometimes a separate appointment is given to explain it. The doctor says what was seen and whether any other test or treatment is needed. If you hear nothing after a few weeks, contact the doctor who referred you.
What does treatment look like in general?
An echo is not a treatment; it is a tool for looking and measuring. If something is found, treatment depends on the cause. For example, regular follow-up alone may be enough (the NHS says this for mild valve disease), or medicines, or in some conditions procedures. The doctor chooses the treatment taking all your information into account. For each problem, see its page in this section.
What can you do yourself?
- Write down your symptoms. When they started, what makes them worse, how long they last.
- Bring earlier documents. Previous echo and ECG results and your medicine list.
- Read the instructions from the centre doing the test. Fasting, clothing and driving after a sedative differ for each type of echo (Cleveland Clinic).
- Do not stop medicines on your own. Only if a doctor tells you to.
- Ask if you do not understand the result. The NHS also says to ask if anything is unclear.
When to seek urgent care
These signs do not wait for an echo or an appointment. Call 115 (Iran’s emergency number) and do not drive yourself:
- Sudden chest pain or pressure that continues and may spread to the arm, neck, jaw or back
- Chest pain with cold sweat, nausea, dizziness or breathlessness
- Severe breathlessness, or pale or bluish lips and skin
- Fainting, or fainting during exercise
- Weakness on one side of the face or body, or confused speech
For the full list, see the guide “When to seek urgent care”.
Symptoms and plans differ from patient to patient. Talk to a doctor about your own situation.
Frequently asked questions
Does an echo use radiation?
No. An echo uses sound waves, much like an ultrasound scan in pregnancy. Cleveland Clinic states clearly that an echo does not use radiation, unlike a plain X-ray or a CT scan, which use a small amount.
Does an echo hurt?
A standard echo (on the chest) does not hurt. The gel is cold and you may feel the pressure of the probe. The BHF says a standard echo has no risks or side effects. An echo through the food pipe is more unpleasant: the throat is numbed and it may stay sore for a day or two.
How long does an echo take?
It depends on the type. For a standard echo the NHS gives about 30 to 40 minutes, Cleveland Clinic 40 to 60 minutes, and the BHF anything from 15 minutes to an hour. Other types, such as an echo through the food pipe or a stress echo, usually take longer.
If my echo is normal, do I have no heart problem?
An echo is only one tool. It shows the structure and pumping of the heart and the blood flow through the valves, but the heart rhythm is recorded by an ECG, and some areas are shown better by an echo through the food pipe. The NHS also says the doctor explains the result and tells you whether any other test or treatment is needed. The doctor weighs what the result means together with your symptoms and examination.
Do I need to fast before an echo?
For a standard echo, the NHS says you can usually eat and drink as normal. For an echo through the food pipe, fasting may be needed. The exact instructions come from the centre doing the echo. Stop your medicines only if a doctor tells you to.
Is the echo done at this clinic?
This page only explains echo in general. Which type of echo is done at this clinic is not stated here; please ask the clinic.