Doppler ultrasound of the heart

Alternative names
Transthoracic echocardiogram (TTE); Echocardiogram - transthoracic; Echocardiogram; Surface echo

Echocardiogram is a test that uses sound waves to create a moving picture of the heart. The picture is much more detailed than x-ray image and involves no radiation exposure.

How the test is performed

A trained sonographer performs the test, then your physician interprets the results. An instrument that transmits high-frequency sound waves called a transducer is placed on your ribs near the breast bone and directed toward the heart. The transducer picks up the echoes of the sound waves and transmits them as electrical impulses. The echocardiography machine converts these impulses into moving pictures of the heart.

Echocardiogram works well for most patients and allows doctors to see the heart beating and to visualize many of the structures of the heart. Occasionally, because your lungs, ribs, or body tissue may prevent the sound waves and echoes from providing a clear picture of heart function, the sonographer may administer a small amount of a dye through an IV to better see the inside of the heart.

Very rarely, more invasive testing using special echocardiography probes may be necessary.

If the echocardiogram is unclear due to a barrel chest, congestive obstructive pulmonary disease, or obesity, your health care provider may choose to perform a transesophageal echocardiogram, or TEE. With TEE, the back of your throat is anesthetized and a scope is inserted down your throat. On the end of the scope is an ultrasonic device that an experienced technician will guide down to the lower part of the esophagus, where it is used to obtain a more clear two-dimensional echocardiogram of your heart.

How to prepare for the test
There is no special preparation for the test.

How the test will feel

You will be asked to disrobe from the waist up and will lie on an examination table on your back. Electrodes will be placed onto your chest to allow for an ECG to be done. A gel will be spread on your chest and then the transducer will be applied. You will feel a slight pressure on your chest from the transducer. You may be asked to breathe in a certain way or to roll over onto your left side.

Why the test is performed
This test is performed to evaluate the valves and chambers of the heart in a noninvasive manner. The echocardiogram allows doctors to evaluate heart murmurs, check the pumping function of the heart, and evaluate patients who have had heart attacks. It is a very good screening test for heart disease in certain groups of patients.

Normal Values
A normal echocardiogram reveals normal heart valves and chambers and normal heart wall movement.

What abnormal results mean

An abnormal echocardiogram can mean many things. Some abnormalities are very minor and do not pose significant risks. Other abnormalities are signs of very serious heart disease that will require further evaluation by a specialist. Therefore, it is very important to discuss the results of your echocardiogram in depth with your health care provider.

What the risks are
There are no known risks associated with this test.

Special considerations

Abnormal results may indicate heart valve disease, cardiomyopathy, pericardial effusion, or other cardiac abnormalities. Additional conditions under which the test may be performed include the following:

  • Alcoholic cardiomyopathy  
  • Aortic dissection  
  • Aortic insufficiency  
  • Aortic stenosis  
  • Arrhythmias  
  • Arterial embolism  
  • Atrial fibrillation/flutter  
  • Atrial myxoma; left  
  • Atrial myxoma; right  
  • Atrial septal defect  
  • Cardiac tamponade  
  • Cardiogenic shock  
  • Coarctation of the aorta  
  • Ectopic heartbeat  
  • Heart attack  
  • Heart failure  
  • Hypertensive heart disease  
  • Hypertrophic cardiomyopathy  
  • Idiopathic cardiomyopathy  
  • Infective endocarditis  
  • Ischemic cardiomyopathy  
  • Left-sided heart failure  
  • Mitral regurgitation; acute  
  • Mitral regurgitation; chronic  
  • Mitral stenosis  
  • Mitral valve prolapse  
  • Patent ductus arteriosus  
  • Pericarditis; bacterial  
  • Pericarditis; constrictive  
  • Pericarditis; post-MI  
  • Peripartum cardiomyopathy  
  • Primary amyloidosis  
  • Primary pulmonary hypertension  
  • Pulmonary valve stenosis  
  • Restrictive cardiomyopathy  
  • Right-sided heart failure  
  • Secondary systemic amyloidosis  
  • Senile cardiac amyloidosis  
  • Stroke  
  • Tetralogy of Fallot  
  • Transient ischemic attack (TIA)  
  • Transposition of the great vessels  
  • Tricuspid regurgitation  
  • Ventricular septal defect


Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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