An echocardiogram is a common test that uses high-frequency ultrasound waves to create a moving picture of the heart while it is beating. It shows the size and shape of the heart, and provides images of the chambers, walls, valves, and blood vessels, tipping off your doctor if there are any problems.

Echocardiograms are used to assess heart health in both adults and children. They are low-risk and painless. But they provide critical information about your heart that can be invaluable in determining the next steps for treating a heart problem.

“An echocardiogram is often the first-line imaging procedure ordered when evaluating suspected cardiac disease,” says Sarah C. Hull, MD, MBE, a Yale Medicine cardiologist who specializes in echocardiography. “It can be done rapidly and portably, involves no radiation, and provides a wealth of information about cardiac structure and function in real time, at a fraction of the cost of other imaging modalities.”

An echocardiogram, also known as an echo, may be part of a routine examination, or your doctor may recommend it if you have the following symptoms, which may suggest cardiac disease:

• Chest pain
• Shortness of breath
• Lightheadedness
• Dizziness
• Fainting
• Unusual fatigue
• A strong heart murmur or a change in a heart murmur

This test is a way to detect abnormalities (including congenital heart defects) and other problems with the heart’s chambers, and any thickening of the walls or enlargement of the heart. An echo can also provide information on clots, infections around the valves, or tumors.

An echo will show whether the four heart valves are opening and closing properly as the heart pumps to direct adequate blood flow in the right direction. It can also be used to evaluate whether there is damage to heart muscle and weakened pumping function from a heart attack. 

The most common type of echocardiogram is a transthoracic echocardiogram, which takes about an hour to perform.

A trained sonographer will ask you to lie on a table. He or she will apply gel and then place electrodes on your chest. A device called a transducer is passed across your chest and upper abdomen. The transducer will pick up the “echoes” of sound waves coming from the heart and turn them into electrical impulses, which are then converted into moving pictures on a monitor.

A Doppler echo is a part of a standard, complete transthoracic echo that evaluates changes, or Doppler signals, in the pitch of the sound waves. Doppler signals may provide clues about problems with movement—the direction and speed—of blood through the heart.

In some cases, your provider may inject liquid contrast intravenously to better see the heart. 

There are other types of echocardiograms, in addition to the transthoracic echo:

• Stress echo: This test detects heart problems that surface during exercise. You will walk or run on a treadmill, and a technician will take pictures of your heart before and after you exercise. Alternatively, your doctor may give you medicine that will mimic the heart’s function during exercise.

• Transesophageal echo: This test involves numbing the throat and inserting a flexible tube with a transducer through your mouth and down to the esophagus, located behind the heart. It provides a more detailed look at certain structures than a regular echo can provide.

If coronary artery disease is suspected, a doctor may order additional imaging, such as a stress echocardiogram, a nuclear stress test, a stress cardiac MRI, or a coronary CT angiography.

Transthoracic echos are considered to be safe with no significant risks, pain, or side effects.

A transesophageal echo poses a very small risk (on the order of a 1 in 10,000 chance) of mechanical damage to the teeth, mouth, or throat. Providers ask careful screening questions about any conditions that might increase this risk; if they find any concerns, they make sure those are fully evaluated by the appropriate specialist before proceeding.  

“The risk of complications in otherwise healthy patients is very low, but regardless we only perform this test if the risk is outweighed by the potential benefits,” says Dr. Hull. These benefits include the ability to identify heart valve infections and to assess the mechanism of mitral regurgitation (backward blood flow that, when severe, can lead to heart failure). This information is helpful in determining the best treatment approach, she explains. She adds that an echo also enables doctors to make sure there are no hidden blood clots that could cause a stroke, so patients can be more safely “shocked” out of an abnormal rhythm.

Yale Medicine doctors working in the Yale Echo Laboratory at Yale New Haven Hospital utilize the latest technologies in cardiac ultrasound imaging. These include 3D echocardiography and strain imaging (tracking the movement of heart muscle) technologies that are not available at every medical center. Yale’s lab has been digital for over a decade and has image management software that enables a database search and off-line processing of 3D and strain images.

Yale echocardiograms are performed at locations throughout Connecticut. Collectively, we perform over 15,000 transthoracic studies, 700 transesophageal echos, and 2,000 stress studies per year.