ECHO (Echocardiogram)
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Overview
An echocardiogram — often called an ECHO or 2D Echo — is an ultrasound scan of the heart. It shows the size of the heart’s chambers, the structure and function of its valves, and how strongly it is pumping. It is one of the most useful cardiac tests available. At St. Stephen’s Hospital, echocardiograms are performed and reported by cardiologists or trained sonographers, with reports shared directly with your treating doctor.
What is this test?
Standard echocardiography (transthoracic echo, or TTE) uses an ultrasound probe placed on your chest. The most common version is a 2D Echo, which produces moving images of the heart in real time.
Specialised versions include: Doppler echo (measures blood flow), stress echo (done before and after exercise), and transoesophageal echo or TEE (probe passed down the food pipe for closer views — done under sedation, used in selected cases).
Why your doctor may order it
- Heart failure — to assess pumping function (ejection fraction)
- Valve problems — narrowing or leaking
- Congenital heart disease
- After a heart attack — to assess damage
- Unexplained breathlessness, chest pain, or fatigue
- Murmurs heard on examination
- Before certain surgeries or before starting some chemotherapy drugs
- Routine assessment in some chronic conditions
How long does it take?
A standard transthoracic echo takes 30 to 45 minutes. A stress echo takes about an hour. A TEE takes 30 to 60 minutes including the sedation and recovery period.
How to prepare
- For standard echo: no fasting is needed.
- For TEE (transoesophageal echo): fast for 6 hours before the test.
- Wear a top that can be easily removed or opened at the front. A two-piece outfit is most convenient.
- Avoid heavy lotions on the chest on the day of the test.
- Bring your prescription, ID, previous echo reports, and any previous ECGs.
- If you take heart medications, continue them unless told otherwise.
What to expect during the test
You lie on your left side on a couch. The sonographer applies a gel to your chest and moves the ultrasound probe across the chest wall. You may be asked to roll, take a deep breath, or hold your breath briefly. You will probably see your own heart on the screen — and hear the sound of the blood flow, which can be loud at times. This is normal. For a TEE, sedation is given through a vein. A flexible probe is passed through the mouth into the food pipe (oesophagus), which sits just behind the heart. This gives much clearer images. You are monitored throughout and recovered for an hour afterwards.
After the test
- For standard echo: you can leave immediately and resume normal activities.
- For TEE: you will rest for 1 to 2 hours. Do not eat or drink until your throat sensation returns (usually 2 hours). Do not drive that day.
- The report is usually ready the same day.
- Discuss the results with your treating doctor — they will explain what the ejection fraction, valve findings, and other measurements mean for you.
Do's and Don'ts
- Lie still and breathe normally unless instructed otherwise.
- Tell the team about all heart medications you take.
- Bring previous echo and ECG reports for comparison.
- Wear easy-to-remove clothing for chest access.
- Arrange for someone to drive you home after a TEE.
- Don't eat for 6 hours before a TEE.
- Don't apply heavy chest lotions on the day of a standard echo.
- Don't drive after a TEE — even if you feel fine, the sedation can impair reflexes for hours.
- Don't be alarmed by the ultrasound sounds — they are just the blood flow being measured.
- Don't skip a follow-up echo if your doctor recommended one — many heart conditions are tracked over time.
Understanding your results
An echo report describes the size of each heart chamber, how well the heart is pumping (ejection fraction or EF), and the condition of the heart valves. An EF of 55% or higher is generally considered normal. Lower numbers indicate weaker pumping function. Valves are described as normal, mildly leaking (regurgitation), or narrowed (stenosis). The pressure inside certain chambers and the thickness of the heart muscle are also reported. Your doctor will interpret these in light of your symptoms and decide on the next steps.
Frequently asked questions
EF is the percentage of blood pumped out of the left ventricle with each beat. Normal is 55% or higher. EF of 40 54% is mildly reduced; below 40% is significantly reduced and usually needs treatment.
Yes, the ultrasound gel feels cool when first applied. It warms up quickly. The team can warm it slightly on request.
They give different information. ECG looks at the heart's electricity. Echo looks at the heart's structure and pumping. Both are commonly used together rather than one instead of the other.
Many heart conditions change over time. Tracking how your heart is doing year to year is more useful than a single snapshot.
Not directly. A standard echo shows pumping function and valves, not the coronary arteries. To check for blocked arteries, your doctor may order a stress test, CT coronary angiogram, or invasive angiogram.