Echocardiogram

How It Is Done

An echocardiogram may be done in a hospital, clinic, or doctor's office. It can also be done at your bedside in the hospital.

You will need to remove any jewelry and clothes above your waist (you may be allowed to keep on your underwear if it does not interfere with the test). You may be given a cloth or paper covering to use during the test.

A transthoracic echocardiogram (TTE), Doppler echocardiogram, and stress echocardiogram are performed by a specially trained ultrasound technician. A transesophageal echocardiogram (TEE) is performed by a cardiologist with the help of assistants.

You may receive an IV so you can get medicine during the test. The IV can be used to give you a contrast material, which helps your doctor check your heart function. A contrast material may be used if it is difficult to get good views of your heart. A good view might be hard to get because of certain conditions such as obesity or chronic lung disease.

Transthoracic echocardiogram (TTE) and Doppler echocardiogram

You will lie on your back or on your left side on a bed or table. Small pads or patches (electrodes) will be taped to your arms and legs to record your heart rate during the test. To learn more, see Electrocardiogram.

A small amount of gel will be rubbed on the left side of your chest to help pick up the sound waves. A small instrument (transducer) that looks like a microphone is pressed firmly against your chest and moved slowly back and forth. This instrument sends sound waves into the chest and picks up the echoes as they reflect off different parts of the heart. The echoes are sent to a video monitor that records pictures of your heart for later viewing and evaluation. The room is usually darkened to help the technician see the pictures on the monitor.

At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side. The transducer is usually moved to different areas on your chest that provide specific views of your heart.

The test usually takes from 30 to 60 minutes. When the test is over, the gel is wiped off and the electrodes are removed.

Exercise stress echocardiogram

An echo without activity or stress will be done before you start exercising. This is called the baseline, and after it is established you will exercise for a specific amount of time. You will either walk on a treadmill or pedal a stationary bicycle while being monitored by an EKG machine. To learn more, see Exercise Electrocardiogram.

You will then lie on a bed or table, and another echocardiogram will be done. At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side. The transducer is usually moved to different areas on your chest that provide specific views of your heart.

An exercise stress echo takes about 30 to 60 minutes.

Dobutamine stress echocardiogram

Sometimes medicine called dobutamine is used instead of exercise to stress your heart. For this test, you will lie on your back or left side on a bed or exam table, and a baseline echocardiogram will be done. EKG electrodes will be taped to your arms and legs to record your heart rate during the test.

Next, the technician cleans the site on your arm where the medicine will be injected, and an intravenous (IV) line will be placed in a vein in your arm.

After the IV is started, you will be given dobutamine, which increases your heart rate and causes your heart to work harder. Echocardiogram images will be taken while you receive the dobutamine. Your peak heart rate is reached in about 15 minutes. At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side. After your peak heart rate is reached, the medicine will be stopped and your heart rate will return to normal (in about 1 to 3 minutes). More echocardiogram images will be taken when your heart rate returns to normal.

A dobutamine stress echo takes about an hour.

Transesophageal echocardiogram (TEE)

Before a TEE, your throat may be numbed with an anesthetic spray, gargle, or lozenge to relax your gag reflex and to ease insertion of the probe. Shortly before the procedure begins, an IV line will be placed in a vein in your arm. Medicine to decrease saliva and stomach secretions may be given through the IV. A pain medicine and sedative will be given to you through the IV in your arm during the procedure. You should feel relaxed and drowsy but still alert enough to cooperate.

Your heart rate, breathing rate, and blood pressure will be monitored throughout the procedure. Also, a small device used to measure the amount of oxygen in your blood (pulse oximeter) may be attached to your finger or earlobe.

You will be asked to lie on your left side with your head tilted slightly forward. A mouth guard may be inserted to protect your teeth from the probe. Then the lubricated tip of the probe will be guided into your mouth while your doctor gently presses your tongue out of the way. You may be asked to swallow to help move the tube along. It may be helpful to remember that the instrument is no thicker than many foods you swallow. When the probe is in your esophagus, it will be moved down gently to the level of your upper right heart chamber (atrium), and ultrasound images will be taken. You will not feel or hear the sound waves during the test.

During the procedure, try not to swallow unless requested. An assistant may remove the saliva from your mouth with a suction device, or you can just let the saliva drain from the side of your mouth. A transesophageal echo is generally painless, though you may feel nauseated and uncomfortable while the probe is in your throat.

The test takes about 2 hours. The probe will be in place in your esophagus for about 10 to 20 minutes.