16947 Echocardiogram

Overview

An echocardiogram — most people just call it an 'echo' — is a painless test that uses sound waves to make moving pictures of your heart. It shows the heart's chambers, its valves, and how blood flows through them. It also shows how strongly your heart pumps. An echo is not an X-ray, so you are not exposed to radiation. It is one of the most useful and safest ways for a doctor to see what is happening inside your heart.

Very common. An echo is one of the most widely used heart tests in the world, and hospitals and clinics carry out thousands of them every week.

Anyone, at any age — from newborn babies to people in their nineties. Babies and children may have one to check for heart problems present from birth. Adults often have one to look into breathlessness, chest pain, a heart murmur, high blood pressure or a weakened heart muscle.

Symptoms

Common symptoms

• Breathlessness, especially when you are active or lying flat
• Chest pain or discomfort that your doctor wants to look into
• A heart murmur — an extra sound your doctor hears through a stethoscope
• Palpitations (a feeling that your heart is racing, fluttering or thumping)
• Swelling in your ankles or legs
• Feeling very tired or light-headed during everyday activity
• Fainting or near-fainting spells
• Follow-up after a heart attack or heart surgery
• Monitoring a known heart condition or its treatment over time

Symptoms in children

• A heart murmur heard at a routine check
• Poor feeding, slow weight gain or sweating during feeds in a baby
• Turning blue around the lips or fingernails, especially when crying
• Getting very tired quickly when playing
• Fainting during sport or exercise
• A family history of heart problems present from birth

Symptoms in older adults

• Getting more breathless or more tired than usual doing everyday tasks
• New ankle swelling or needing extra pillows to sleep comfortably
• Dizziness or falls linked to a fast or uneven heartbeat
• A heart murmur found during a routine check-up
• Monitoring a valve problem or a weakened heart muscle over the years

Causes

Main causes

• An echocardiogram is a test, not an illness, so nothing 'causes' it. It is requested when your doctor needs a clearer picture of your heart.
• Checking a heart murmur or an unusual heart sound
• Looking into breathlessness, chest pain, palpitations or fainting
• Monitoring heart failure, or a heart muscle that is not pumping as strongly as it should
• Checking heart valves for narrowing or leaking
• Follow-up after a heart attack, heart surgery or a procedure such as a stent
• Checking a heart problem that has been present since birth
• Looking for infection or fluid around the heart
• Checking the heart before or during certain treatments, such as some cancer medicines that can affect the heart
• Checking the heart during pregnancy if you have a known heart condition

Risk factors

• High blood pressure
• A heart condition that runs in your family
• Previous heart attack or heart surgery
• Diabetes or kidney disease
• Being very overweight
• Smoking
• Some treatments, such as certain cancer drugs or chest radiotherapy, which can affect the heart over time
• Being pregnant with a known heart condition

When to see a doctor

See a doctor urgently if:

• You have new breathlessness or it is getting worse quickly
• You have chest pain that concerns you but is not severe — get it checked the same day
• You have fainting spells or near-fainting
• You notice a fast or uneven heartbeat that will not settle
• Swelling in your legs is getting worse or you are gaining weight quickly

Book a routine appointment if:

• You have a heart murmur and want to know what it means
• You feel more tired or breathless than usual during everyday activity
• You have a family history of heart muscle problems or sudden cardiac death
• You are due a follow-up scan for a known heart condition
• You have questions about an echo you or your child has been offered

Diagnosis

An echocardiogram is done by a trained sonographer (a specialist in ultrasound scanning) or a cardiologist. You lie on a couch, usually on your left side, with your chest partly uncovered. A small handheld probe with a little gel on it is moved over your chest and sometimes the base of your neck. The probe sends out sound waves that bounce off your heart and create live pictures on a screen. You may hear swooshing sounds — that is the sound of blood flowing, and it is normal. The scan does not hurt. The person scanning may ask you to hold your breath for a few seconds or to lie in a certain position to get a better view. Afterwards, they write a report and send it to the doctor who referred you, who will explain the results to you.

Tests that may be done

• Transthoracic echocardiogram — the standard test, done through the chest wall
• Doppler echo — a setting that shows the direction and speed of blood flow
• Transoesophageal echo — a special tube passed gently down the throat while you are sedated, used when clearer pictures of the valves are needed
• Stress echo — pictures taken before and after exercise or a medicine that makes the heart work harder
• Contrast echo — a harmless liquid given through a small tube in your arm to make the heart's edges show up more clearly
• Other tests often done alongside, such as an ECG (heart tracing), blood tests, a chest X-ray, a heart monitor worn at home, or a cardiac MRI

What to expect at your appointment

You can usually eat, drink and take your usual medicines as normal. Wear a top that is easy to take off. The test takes about 20 to 60 minutes and you can go home and drive yourself afterwards, unless you had a sedative. The gel may feel a little cold, and the probe presses lightly on your chest — some people find it slightly uncomfortable over the ribs, but it is not painful. You will not get the full results on the day, because the pictures need to be studied. Ask the clinic roughly how long the report will take, and book a follow-up with your doctor to talk it through.

Treatment

An echocardiogram does not treat anything itself — it is a test that gives your doctor the information they need to decide what happens next. What follows depends completely on what the scan shows. Many people need no treatment at all. Others may need a change in medicine, regular monitoring, or, in some cases, a procedure or surgery. Your scan results will be discussed with you in plain language, and you should feel free to ask questions.

Self-care at home

• There is no special preparation for a standard echo — you can eat, drink and take your usual medicines
• Wear a loose top with buttons or a zip that is easy to open
• Bring a list of your medicines and any previous heart test results
• Write down your questions beforehand so you do not forget them
• Ask the clinic when and how you will get the results, and who will explain them
• If you had a sedative for a transoesophageal echo, arrange for someone to take you home

Medical treatments

Treatment depends on what the scan finds. If your heart looks normal, you may not need anything. If the echo shows high blood pressure straining the heart, a valve that is not working properly, or a heart muscle that is weaker than it should be, your doctor will discuss options with you. These may include lifestyle changes, medicines to help the heart work more efficiently or to control blood pressure, regular check-ups and repeat scans, or referral to a heart specialist. Any medicine is chosen for you personally, so always ask your doctor or pharmacist what it is for and how to take it safely.

When is surgery considered?

Most people who have an echo never need surgery. Occasionally the scan shows a problem that may be helped by a procedure — for example a badly narrowed or leaking valve, a hole in the heart, or a blocked artery. If that happens, your cardiologist will explain the options, the benefits and the risks, and you will be fully involved in the decision. Many of these procedures are now done through a small tube rather than open surgery, and recovery is often quicker than people expect.

Living with this condition

Waiting for results can feel unsettling. Try to keep to your normal routine, and remember that an echo is a routine test that thousands of people have every week. Once you have your results, you will have a clearer plan — whether that is 'all fine', 'we will keep an eye on it', or 'here is a treatment to try'. If you have a heart condition that is being monitored, keep your follow-up appointments and repeat scans, even when you feel well.

Lifestyle tips

• Stay active in a way that suits you — walking, swimming, cycling or whatever you enjoy
• If you smoke, ask your doctor or pharmacist for help to stop; it is the single biggest thing you can do for your heart
• Keep alcohol within the recommended limits
• Aim for a healthy weight and get enough sleep
• Take any prescribed medicines as directed and do not stop them without advice
• Tell any doctor, dentist or nurse that you have a heart condition or valve problem, if you have one

Diet and exercise

A heart-friendly way of eating means plenty of vegetables, fruit, whole grains, beans and lentils, some fish, and less salt, sugar and heavily processed food. Choose healthy fats such as olive oil and nuts rather than hard fats. For exercise, aim for something that makes you slightly warm and a little out of breath for around 30 minutes on most days — but build up gently, and follow any advice your doctor gives you. If you have a heart condition, ask what level of exercise is safe for you before starting something new or intense.

Mental health and emotional wellbeing

It is very normal to feel anxious before a heart test or while you wait for the result. Some people find their mind jumps to worst-case scenarios. Talking to someone you trust helps, and so does writing down your questions for your doctor. If worry is affecting your sleep, appetite or mood for more than a couple of weeks, please tell your doctor — this is a common and treatable problem. If you ever feel you cannot keep yourself safe, contact your local emergency number or a local crisis support service straight away.

Prevention

An echocardiogram is a test, so there is nothing to prevent. What you can do is look after your heart so that you are less likely to need heart tests in the future: keep your blood pressure and cholesterol in a healthy range, stay active, eat well, avoid smoking, and go for recommended check-ups. If a heart condition runs in your family, tell your doctor — they may suggest earlier checks for you and your relatives.

Vaccines

Some infections can affect the heart, so staying up to date with the vaccines your local health service recommends — including flu and, where offered, pneumococcal vaccines — is a simple way to protect your heart, especially if you already have a heart condition. Ask your doctor or pharmacist what is right for you.

Screening programmes

An echocardiogram is not a routine screening test for everyone. It is used when there is a reason — symptoms, a murmur, a known condition, or a strong family history. If a heart muscle problem or a condition present from birth runs in your family, your doctor may recommend screening for close relatives.

Complications

If left untreated

• An echocardiogram itself has no complications — it is safe and painless
• The scan can pick up problems early, which is exactly why doctors use it
• If a heart problem is found but not monitored or treated, it can slowly get worse — for example a weakened heart muscle or a leaking valve
• Untreated high blood pressure can strain the heart over time
• Ignoring new symptoms such as breathlessness or ankle swelling can delay help

Long-term outlook

For most people, an echo brings good news or a simple plan. Even when a heart problem is found, catching it early usually means it can be monitored or treated effectively, and many people live full, active lives with a heart condition. The test gives you and your doctor the information you need to make good decisions — that is a positive step, not a reason to panic.

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