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in the Non-Invasive Testing Department

Echocardiogram (Echo)

What is an echocardiogram?

An echocardiogram, or “echo” as it is often called, is a test that uses high frequency sound waves (ultrasound) to create pictures, videos and tracings of your heart. The test is also referred to as “echocardiography” or “diagnostic cardiac ultrasound.”

  • An echo uses sound waves to create pictures of your heart’s chambers, valves and walls, as well as the blood vessels (aorta, arteries, veins) attached to your heart.
  • A probe called a transducer is held onto your chest and operated by a registered diagnostic cardiac sonographer. The probe produces sound waves that bounce off your heart and “echo” back to the probe. These sound waves are changed into pictures and data viewed on a digital video monitor.
  • If your doctor has ordered a “bubble study” or “agitated saline study,” an IV will be placed in your arm by a nurse. A cardiologist will inject saline with a very small amount of air mixed into the form of microbubbles. These microbubbles will help to identify if there are any abnormal connections or holes within the cardiac structure. This procedure has no side effects and is completely harmless.

An echo may consist of any combination of the following:

  • M-mode echocardiogram. This is the simplest type of echocardiogram. It produces an image that is similar to a tracing rather than an actual picture of heart structures. M-mode echo is useful for measuring heart structures, such as the heart's pumping chambers, the size of the heart itself and the thickness of the heart walls.
  • Doppler echocardiogram. This technique is used to measure and assess the flow of blood through the heart's chambers and valves. The amount of blood pumped out with each beat is a sign of how well the heart is working. Also, Doppler can detect abnormal blood flow within the heart, which can mean there is a problem with one or more of the heart's valves or with the heart's walls.
  • Color Doppler. Color Doppler is an enhanced form of a Doppler echocardiogram. With color Doppler, different colors are used to show the direction of blood flow.
  • 2-D (two-dimensional) echocardiogram. This technique is used to see the actual structures and motion of the heart structures. A 2-D echo view looks cone-shaped on the monitor, and the real-time motion of the heart's structures can be seen. This allows the doctor to see the various heart structures at work and evaluate them.
  • 3-D (three-dimensional) echocardiogram. 3-D echo technique captures 3-D views of the heart structures with greater depth than 2-D echo. The live or "real time" images allow for a more accurate assessment of heart function by using measurements taken while the heart is beating. 3-D echo shows enhanced views of the heart's anatomy and can be used to determine best treatment plan.

Frequently Asked Questions about Echocardiograms

Why do people need an echo test?

Your doctor may order an echo test to look at your heart’s structure and to check how well your heart is functioning. The test findings are generated into a report, informing your doctor of the following:

  • The size and shape of your heart
  • The thickness and health of your heart walls
  • The heart’s pumping strength – referred to as the “ejection fraction” or “EF”
  • The integrity and functionality of your heart’s four valves
  • To see if there is valvular regurgitation (leaking)
  • To see if there is valvular calcification or stenosis (narrowing)
  • To evaluate your pulmonary pressures
  • To evaluate for fluid (pericardial effusion) around your heart

The test also will help your doctor evaluate:

  • Problems with the outer lining of your heart (pericardium)
  • Problems with the large blood vessels that enter and leave the heart
  • Blood clots/thrombus in the chambers of your heart
  • Abnormal holes between the chambers of the heart, known as patent foramen ovale (PFO), atrial septal defect (ASD) or ventricular septal defect (VSD)
What are the risks?
  • There are no associated risks with having an echo performed.
  • An echo does not hurt and has no side effects. You may feel pressure from the probe being pressed on your skin and slight discomfort. This is minimal and will subside once the test has ended.
  • Occasionally, if your echo images are suboptimal, an echo image enhancement agent can be injected through an IV. A cardiologist will administer and explain this portion of the exam if it is something that is needed. This contrast is not radioactive.
How do I prepare for the echo?

You don't have to do anything special. You can eat and drink before the test as you usually would. Take your medications as you normally would unless otherwise directed by your physician.

What happens during the echo?

Echo tests are performed by specially trained and credentialed cardiac sonographers. Appointments are scheduled for 1-hour in length, however, they often take less than this. The time that your actual appointment takes will vary depending on how well your heart can be visualized and the reason for the exam.

  • The patient will be asked to remove all clothing from the waist up, as well as any necklaces that might be in the way.
  • The patient will lie on a bed and the cardiac sonographer will place 3 electrodes (small stickers) on your chest. The electrodes will be connected to wires which will monitor your heart rate and rhythm during the exam.
  • The room will be darkened so that the cardiac sonographer can better see the video monitor.
  • Your technician may ask you to move onto your side, lie flat or hold your breath briefly in order to acquire the best possible images of your heart.
  • The cardiac sonographer will put gel on the transducer and then press the transducer to your chest. The gel helps the ultrasound waves pass through your skin to provide a clear image of your heart.
  • The probe (transducer) is passed across your chest. The probe produces sound waves that bounce off your heart and “echo” back to the probe.
  • The sound waves are changed into pictures and displayed on a video monitor. The pictures and video on the monitor are recorded.
What happens after the echo test?
  • The cardiac sonographer will remove the electrodes and gel from your chest.
  • You will be allowed to leave and do not need to check-out from your procedure at the desk.
  • The cardiac sonographer is not permitted to give out any information regarding the findings of your echo.
  • The cardiac sonographer will write up a preliminary report of the echo findings, and this will be reviewed and finalized by a cardiologist.
  • Once finalized, the report will be available for your doctor to view in your medical record. It will also be available for review in Mass General Brigham Patient Gateway.

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