Free Guide to Understanding Echocardiograms and Heart Tests

What an Echocardiogram Is and Why Doctors Order Them

An echocardiogram is an ultrasound test of your heart. It uses sound waves to create pictures of your heart's structure and how it works. Think of it like a video camera that shows doctors what's happening inside your chest without any cuts or needles. The test is painless and usually takes about 20 to 30 minutes.

Doctors order echocardiograms for many reasons. They may want to look at the heart's chambers, which are the four sections that pump blood. They might check the heart valves, which are like doors that control blood flow. Doctors use echocardiograms to see if the heart is pumping blood with enough force, or if there are any holes or leaks. Sometimes they order this test after a patient has chest pain, shortness of breath, or an irregular heartbeat. Other times, they use it to check on patients who have known heart problems and need monitoring over time.

About 10 million echocardiograms are performed each year in the United States, according to data from the American Heart Association. This makes it one of the most common heart tests. The test works on people of all ages, from babies to elderly patients. Insurance often covers echocardiograms when a doctor writes an order for one, though coverage rules vary by plan.

Understanding what an echocardiogram does can help you feel less nervous before the test. Knowing the basics means you can listen better when your doctor explains what they found and what it means for your health.

• Echocardiograms use ultrasound technology, the same kind used to look at babies during pregnancy
• The test produces both still images and video of your heart beating
• No radiation is involved, making it very low-risk
• Results are available within a few days, though sometimes same-day in urgent cases

How the Test Works: Step-by-Step What to Expect

When you arrive for an echocardiogram, you'll change into a hospital gown or remove your shirt so the technician can place sensors on your chest. You'll lie on your left side on a comfortable table. The room is usually dimmed so the technician can see the monitor better. The technician applies a cool gel to your chest—this helps the ultrasound wand, called a transducer, make better contact with your skin and send sound waves through to your heart.

The technician then moves the transducer slowly across your chest in different positions. You might feel mild pressure but no pain. The transducer sends sound waves into your body, and these waves bounce off your heart. The machine picks up the echoes and turns them into pictures on a monitor. The technician may ask you to take a deep breath, hold it, or roll onto your other side to get different views. Some people are asked to perform simple movements like raising their arm or leg while the test happens.

During the test, you can watch the monitor if you want to see your heart beating in real time. The black and white images show the heart chambers filling with blood and then squeezing to pump it out. You might see color on the screen—this shows blood flow direction. Red usually means blood flowing toward the transducer, and blue means blood flowing away.

The whole process is quiet except for the beeping sound of the machine tracking your heartbeat. Most people describe the experience as relaxing. After the test, the gel is wiped off, and you can dress and go about your day. There are no aftereffects, and you can drive, work, or exercise right after.

• The test is performed by a cardiac sonographer, a technician trained specifically in heart ultrasound
• A cardiologist (heart doctor) reviews the images and writes a report
• The entire appointment, including paperwork, usually takes 45 minutes to an hour
• You can eat and take your regular medicines before the test unless told otherwise

What the Results Mean: Understanding Your Report

After your echocardiogram, a cardiologist examines all the images and writes a report. This report includes measurements and observations about your heart. Understanding the main parts of the report helps you talk with your doctor about what was found.

One key measurement is ejection fraction, which shows what percentage of blood the heart pumps out with each beat. A normal ejection fraction is 50% to 70%. This means that 50 to 70 percent of the blood in the left ventricle (the heart's main pumping chamber) is pushed out each time it contracts. If your ejection fraction is lower, it means your heart is not pumping as forcefully as normal. If it's higher than 70%, that can sometimes indicate a stiff heart. Your doctor will explain what your specific number means for you.

The report also describes the heart's chambers. Doctors look at their size and shape. An enlarged chamber might suggest the heart is working harder than normal. The report mentions the heart's walls and whether they are thick or thin. Wall thickness matters because overly thick walls can mean the heart is straining to pump. The report describes all four valves and whether they open and close properly or if there are leaks.

The report may use words like "normal," "mild," "moderate," or "severe" to describe any problems found. For example, doctors might say there is "mild mitral regurgitation," meaning a small amount of blood leaks backward through one valve. The report explains if the heart lining, called the pericardium, looks normal or if there is fluid around the heart.

Many reports also include information about blood pressure readings taken during the test and notes about the heart's rhythm. Your doctor will go over the report with you and explain what the findings mean for your health and what steps come next.

• Ejection fraction is one of the most important numbers in the report
• The report compares your heart to normal measurements for your age and size
• Previous echocardiograms are often compared to see if anything has changed over time
• Ask your doctor to explain any medical terms you don't understand

Common Heart Conditions Detected by Echocardiograms

Echocardiograms can detect many different heart problems. Understanding what doctors look for can help you know why your doctor ordered the test and what they might be concerned about.

Valve disease is one of the most common findings. Heart valves can leak, allowing blood to flow backward, or they can become stiff and not open fully. Mitral valve problems are very common, affecting about 2% of the population. Aortic valve problems affect about 1% of people. When a valve is not working right, the heart has to work harder to move blood around the body. Some valve problems cause no symptoms for years, while others cause fatigue or shortness of breath.

Cardiomyopathy is a condition where the heart muscle becomes weak or thick. In dilated cardiomyopathy, the heart chambers become enlarged and the muscle weakens, leading to a low ejection fraction. In hypertrophic cardiomyopathy, the heart walls thicken. This can run in families and sometimes affects young athletes. Echocardiograms show these changes clearly.

Heart failure is another condition doctors look for. When the heart cannot pump blood out as well as normal, fluid backs up into the lungs and the rest of the body. There are two main types: systolic heart failure (where the heart doesn't squeeze hard enough) and diastolic heart failure (where the heart doesn't relax enough). About 6.2 million American adults have heart failure, according to the CDC. Echocardiograms help doctors figure out which type someone has.

Pericarditis is inflammation of the sac around the heart. Echocardiograms can show if fluid is collecting inside this sac, a condition called pericardial effusion. Pulmonary hypertension, which is high blood pressure in the arteries going to the lungs, can also be seen on echocardiograms. Birth defects of the heart, such as holes between chambers, show up on these tests too. Doctors can also spot clots inside the heart or problems with the aor