What is an Echocardiogram?

An echocardiogram (also called an “echo” or, simply, a heart ultrasound) is a non-invasive procedure used to examine the structure and overall function of the heart. During the exam, a transducer is placed on the chest at several different locations and angles. Sound waves from the transducer travel through the body tissues to reach the heart where they bounce off the structures and come back to the probe. This ‘echo’ is analyzed by a computer to create moving images of the heart in real time.

There are several components to an echocardiogram:

1. Doppler: A tool used to evaluate the flow of blood through the heart’s chambers and valves. This is what causes the sounds you may hear during the exam (many people associate the sound to what you would hear during an ultrasound of a fetus).
2. Color Doppler: A version of Doppler where color is used to designate the direction and speed of blood flow.
3. 2-D (or 2-dimensional) echo: A 2-D echo view appears cone-shaped on the monitor and is where the real-time motion of the heart can be seen. This lets the provider see the various heart structures at work.

How long does an echocardiogram take?

A full resting echocardiogram typically takes 30-45 minutes of scanning time. If a bubble study or ultrasound-enhancing agent (UEA), like Definity, is needed, an IV will need to be placed. The total amount of time if a UEA is needed may take 15-20 minutes longer. The majority of the testing will be performed with you laying on your left side.

Why might I need an echocardiogram?

Your physician may order an echocardiogram for further evaluation of signs and symptoms that may suggest:

• Atherosclerosis (blockages in the vessels that supply the heart muscle).
• Cardiomyopathy (disease of the heart muscle).
• Heart failure (a condition in which the heart muscle can’t pump enough blood to meet the body’s needs for blood and oxygen).
• Aortic aneurysm (an enlargement, or “bulging” of the aorta).
• Heart valve disease (where one or more of the four heart valves do not open and/or close properly).
• Pericarditis/Pericardial Effusion or Tamponade (an excess amount of fluid around the heart which hinders the heart’s ability to fill completely with each beat).
• ASDs/VSDs (these are holes between the upper chambers of the heart, the atria, or between the lower chambers, the ventricles).

What are the risks of an echocardiogram?

This imaging procedure is not invasive and carries little to no risks. You may have discomfort from the positioning of the transducer on your ribs. Some views also require slightly more pressure than others. For some people, having to lie still on the exam table for the length of the procedure may cause some discomfort or pain.

How do I get ready for an echocardiogram?

There are no specific preparations needed for an echocardiogram. You may eat, drink and take your medications as you normally would. We recommend that you hydrate the day of and the day before the exam in case we need to start an IV (see section on Definity and bubble studies below).

What happens during the procedure?

You will be asked to undress from the waist up (including bra and possibly necklaces). Women will be given a gown to put on for privacy, which is also available for men if preferred. You will then lay on your left side with your left arm up under your head and your right arm resting on your hip. Cool gel is applied to the transducer and is placed on the middle of your chest to start. For additional images, a small piece of the bed under you will fold down which allows the transducer to be placed on your left side. Images will also be taken from your upper abdomen just under the ribs, and at the base of your neck. You may be asked to modify your position and/or follow some breathing instructions during your exam—this is all in effort to get the best images. Depending on the specific exam needs, an ultrasound-enhancing agent called “Definity” may need to be used. This is injected directly in to an IV that will be placed by a nurse.

What is Definity and why would I need it?

Definity is an ultrasound-enhancing agent. Once an IV is started, this liquid is injected while the technologist takes images. In some cases, we are not able to visualize parts of the heart as well as we would like. This is common for many patients. Using this imaging agent helps us view those hard-to-see parts of your heart. It is incredibly important to have all this information so that your cardiologist can make an accurate diagnosis. 

Definity is not radioactive and it is not a dye. Extensive studies of this agent have shown a significant safety profile with no evidence of toxicity. It is widely used across the United States in cardiology practices. 

What is a bubble study and why would I need one?

A bubble study, or a “saline contrast study,” is an extra procedure we do at the end of an echocardiogram if requested by the physician. Saline is agitated to create harmless, small bubbles. Once an IV is placed, this is injected while the technologist takes ultrasound images. Multiple injections are usually performed with some cycles at rest and some while either tightening the stomach muscles, coughing, etc. 

A bubble study is often performed to help diagnose a patent foramen ovale (PFO)—a hole between the upper chambers of the heart. Statistically these are present in about 20% of the population. Most people with these have no issues, but when a person has stroke-like symptoms, a PFO can be a contributing factor. 

What happens after an echocardiogram?

There are no aftercare instructions for an echocardiogram. If you had an IV placed and then removed, you can remove the bandage after 30 minutes. 

The technologist is not allowed to give any results on your echocardiogram. If there is something that needs immediate attention, a cardiologist will be consulted before you leave. Otherwise, you will be sent home and the cardiologist (or their care team) will contact you after the study has been interpreted. 

How and when should I expect results?

Clinic-performed echoes are generally interpreted by the cardiologist within two business days. If you are not scheduled to see your cardiologist within the following week, you can expect to be contacted via MyChart or by phone. If you do not hear from our office within a week, we advise you to contact the cardiologist’s office (through MyChart is the simplest and fastest way to receive a response).