What is an echocardiogram? — An echocardiogram, also called an “echo,” is an imaging test that creates pictures of your heart as it beats. During an echo, a doctor, nurse, or technician uses a thick wand, called a “transducer” or “probe,” to send sound waves into the heart. The sound waves create images that show the size of the heart chambers, how well the heart pumps, and how well the heart valves work (figure 1).

An echo can be done in 2 main ways:

  • The doctor, nurse, or technician can put the transducer on the outside of your chest. This is called a “transthoracic echo,” or “TTE.”
  • The doctor can put a tube with the transducer on the end down your throat and into your esophagus. This is called a “transesophageal echo,” or “TEE.”

Sometimes, doctors do a test called a “stress test” along with a TTE. A stress test measures how well the heart works when it pumps very fast. When the heart pumps fast, it needs more blood. A stress test shows if the heart gets enough blood during these times. When a stress test is done with an echo, it’s called a “stress echo.”

Why might my doctor order an echo? — Your doctor might order an echo to:

  • Look for a problem in the heart or in the blood vessels around the heart.
  • Follow a known heart problem or condition.
  • Try to find the cause of symptoms such as shortness of breath, leg swelling, or an irregular heartbeat.
  • Check your heart after a heart attack or heart surgery.
  • Check how well your heart medicines are working.

Your doctor might order a stress echo to:

  • Check for heart problems that get worse or are visible only when the heart pumps fast.
  • See if you can safely exercise after a heart attack.

How do I prepare for an echo? — It depends on how the echo is done.

  • For a TTE, you don’t need to do anything special to prepare.
  • For a TEE, your doctor will ask you not to eat or drink for 8 hours beforehand.
  • For a stress echo, your doctor will probably ask you not to eat, drink, or smoke for 3 hours beforehand. He or she might also change or stop some of your heart medicines, if you take any.

What happens during an echo? — Before the echo starts, the doctor, nurse, or technician will put some stickers on your chest to monitor your heartbeat (figure 2).

For a TTE, you will lie on your back or left side. The doctor, nurse, or technician will put a small amount of gel on your chest. Then he or she will press the transducer against your chest and move it around. He or she might ask you to hold your breath or change positions during the test. Images of your heart will appear on a computer screen (figure 3).

If you have a stress echo, the doctor, nurse, or technician will do an echo while you are resting. Then he or she will “stress” your heart and raise your heart rate with 1 of the following:

  • Have you run or walk on a treadmill (figure 4)
  • Have you pedal a stationary bike (a bike that doesn’t move, except for the pedals)
  • Give you medicine to make your heart pump faster – People who can’t run or walk can get medicine instead of exercising.

Immediately after these, while your heart is still pumping fast, he or she will do another echo.

For a TEE, you will have an IV (needle) put in your arm or hand. Your doctor will give you medicines through the IV to make you feel relaxed. He or she will give you a mouth spray or gargle to numb your throat. Then he or she will put a thin tube with a transducer on the end down your throat and into your esophagus. He or she will press the transducer against the esophagus wall to create images of the heart.

What are the downsides of an echo? — It depends on the type of echo.

  • A TTE does not have any downsides.
  • A TEE can cause a sore throat or throat injury. The medicines used to help you relax can make you groggy. You will need someone to drive you home afterward.

A stress echo can also have downsides. But they are caused by the stress test and not by the echo. When people exercise and their heart pumps very fast, they can have symptoms that include:

  • An abnormal heartbeat
  • Trouble breathing
  • Feeling dizzy or faint