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Echocardiogram - Heart Health

An echocardiogram uses ultrasound to view and take pictures of your heart while it's in motion. Seeing your heart in action allows doctors to check its structure and function and see where there may be problems.

As well as diagnosing coronary artery disease, an echocardiogram can be used to:

  • Check the pumping function of the heart, for example if you’ve had a heart attack or have symptoms of heart failure
  • Look for damage to the heart valves
  • Check for heart defects in unborn babies, newborns and young children.

Types of echocardiogram

There are several different types of echocardiogram.

A trans-thoracic echocardiogram. In a trans-thoracic echocardiogram, the ultrasound images are taken through your chest while you’re at rest. This is the most common type.

A stress echocardiogram. This type of echocardiogram involves taking exercise in controlled conditions (on a treadmill or exercise bike) then having the echocardiogram to gauge how the increased demands of exercising affected your heart. This kind of echocardiogram can be used when the doctor suspects that the problem may involve diseased heart muscle or heart valves either instead of or in addition to coronary artery disease. It is performed as an ‘add-on’ to the exercise stress ECG and requires a baseline echocardiogram before the exercise.

A transoesophageal echocardiogram (TOE). This is a type of echocardiogram in which the images are taken from a probe placed inside your oesophagus, the tube that leads from your mouth to your stomach. If a TOE is recommended, it is usually because it can provide better images of certain parts of the heart such as your valves than the trans-thoracic echocardiogram. This is because the transducer (the tip that produces and receives the ultrasound waves) is only millimetres from the target structures and there is less interference to the image by intervening bone, skin, other organs and fat.

So if your condition or suspected condition involves the aorta, pulmonary artery, valves, atria, atrial septum or coronary arteries, this type of echocardiogram may be recommended for you. A TOE is also often used to detect a blood clot in the left atrium.

A transoesophageal stress echocardiogram (TOE) coupled with a stress component. This combination of tests can be used to see how your heart works under pressure. However, instead of performing physical exercise, you will usually be given medication that simulates the effect of physical activity on your heart while the TOE is taken.

What to expect and how to prepare

For a trans-thoracic echocardiogram. This is a brief and painless procedure – it can take anywhere from 20 minutes to less than an hour. You will be asked to remove the clothing from your upper body and lie on your side on an examination table.

A doctor or ultrasound technician will then apply a lubricating gel to your chest, and run a probe, or transducer, over the area. This emits and receives ultra-high-frequency sound waves which bounce off the structures of your heart and blood vessels to produce images that can be recorded and watched on a video screen. You’ll hear ‘squishing’ noises which reflect the blood flow through the heart. Special technology allows the blood to be pictured with different colours.

Similarly, if you’re undergoing a stress echocardiogram, you’ll first be asked to exercise at gradually increasing levels of intensity. Once your maximum safe heart rate is achieved, you’ll be asked to lie on the examination table and the procedure will begin. This kind of echocardiogram may take a little longer than the resting type.

For a trans-oesophageal echocardiogram. The preparation is somewhat different to the trans-oesophageal echocardiogram than for the trans-thoracic echocardiogram. It can also be more uncomfortable.

You’ll usually be asked to fast for at least six hours before it takes place. Before the transducer is inserted through your mouth and into your oesophagus, you’ll be sedated, so you’re aware of what’s going on but feel very relaxed about it and may not remember all the details afterwards. Your gag reflex will also be subdued by spraying the back of your throat with a local anaesthetic. Once it’s over, you may have a sore throat – this usually passes after a few days.

This kind of procedure will generally take longer than a trans-thoracic echocardiogram, including a couple of hours to fully recover from the sedation.

Echocardiogram results: what they can show

After your echocardiogram, your doctor should have a clearer picture of how your heart is working and where there might be problems. It might also help rule out specific concerns about your heart health.

Results of your echocardiogram will be used to decide whether further diagnostic tests are needed and, if so, what they should be.

While very accurate, an echocardiogram may not provide all the answers to the questions you and your doctor may have about your condition. It does, however, help form part of the whole picture. Along with ECG, X-rays, blood tests and, if necessary, other types of cardiac imaging, it can provide vital information to help you decide on the best type of treatment.

Risks of an echocardiogram

An echocardiogram is, in general, a very low-risk procedure, and a resting trans-thoracic echocardiogram is risk free. During an exercise stress echocardiogram or a TOE stress test there is a very low risk of feeling chest pain or even a heart attack. However, the stress test is closely controlled and your heart monitored to avoid this. The test takes place in a hospital, so if problems do occur, expert help is at hand.

A TOE carries greater risk than a trans-thoracic echocardiogram. You may find it uncomfortable, experience gagging and after the procedure have bruising and soreness in the area where the transducer was inserted. The most serious risk is perforation of the oesophagus – a medical emergency. However, once again, in expert hands this risk is very low.

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This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

Bupa Australia Pty Ltd makes no warranties or representations regarding the completeness or accuracy of the information. Bupa Australia is not liable for any loss or damage you suffer arising out of the use of or reliance on the information. Except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health. For more details on how we produce our health content, visit the About our health information page.

Last published 31 October 2010

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