An echocardiogram is a test that utilizes high-frequency sound waves to make pictures of your heart. The test is also called echocardiography or echo. A diagnostic cardiac ultrasound allows your doctor to watch your heart as it beats to identify particular areas of concern.

Although the echo provides a lot of information about cardiac anatomy, the test does not visualize the coronary arteries or blockages in your coronary arteries. Cardiac catheterization is commonly performed if imaging the coronary arteries is necessary. Certain physical irregularities, such as a thick chest wall or emphysema, can intervene with visualization of the heart during an echocardiogram.

A technician or a doctor performs echo. Often, a technician does some or all of the test, but a doctor, usually a cardiologist, will look at the heart images while the patients are having their echo, and they\ may tune the transducer to visualize additional views, if necessary.

• Pre-Test

Patients are asked to get dressed in an examination gown.

• During the Test

As the test begins, the patients are made to lie on an examination table and a technician places some gel on their chest, followed by a transducer which is a small device shaped like a microphone. The transducer sends sound waves toward the patient's hearts. Like the sonar on a ship, the waves bounce off the structures of the heart and return to the transducer where they are collected and then processed by a computer and appear on a screen, providing a visual of the patients beating hearts. Patients may be asked to roll on their side or to hold their breath for a few seconds during the test. Usually, an echo usually takes 30 to 60 minutes to complete.

The echocardiogram is a completely safe procedure.

The physician may suggest an echocardiogram to check for problems with the valves or chambers of the heart, check if heart problems are the cause of symptoms such as shortness of breath or chest pain, and detect congenital heart defects before birth.

Evidence of blockages in the arteries can sometimes be seen on echocardiography.

Clogged arteries may cause the following symptoms:

• Chest pain.
• Shortness of breath.
• Heart palpitations.
• Weakness or dizziness.
• Nausea.
• Sweating

Information from the echocardiogram may reveal:

• Changes in your heart size.
• Pumping strength.
• Damage to the heart muscle.
• Valve problems. 
• Heart defects (including defects present at the birth)

Some heart problems, particularly those involving the arteries that supply blood to your heart muscle, occur only during physical activity. In a stress echocardiogram, ultrasound images of the heart are taken before and immediately after the patient walks on a treadmill or ride a stationary bike, and if the patient is unable to exercise, he or she may get an injection of a medication to make their heart pump as hard as if they were actually exercising.

Sound waves change pitch when they bounce off blood cells that are moving through the heart and blood vessels. These changes which are also called Doppler signals can help the physician measure the speed and direction of the blood flow in the heart. This method is can also be used to check blood flow problems and blood pressure in the arteries of the heart which traditional ultrasound might not be able to detect. The blood flow shown on the monitor is colorized to help the physician pinpoint all problems.

The electrocardiogram is the process in which the electrical activity of the heart is recorded over a period of time using electrodes placed over the skin. An echocardiogram is a test that utilizes high- frequency sound waves to make pictures of your heart. An electrocardiogram is used to test for damage to the heart’s tissues, an irregular heartbeat, chemical or electrolyte imbalances, and enlarged or thickened muscles in the walls of the heart’s chambers. An echocardiogram is used to test for tumors, infections, blood clots within the vessels of the heart, deficiencies in the heart’s ability to pump blood, signs of past heart attacks or other heart diseases, and defects in the heart’s valves.

The cost of echocardiogram in India varies across different cities and hospitals.

An echocardiography is performed for the following reasons:

• To check how well the heart is pumping blood
• Locating blood clots
• Locating tumors
• Assessment of the cause of abnormal electrical activity of the heart, known as an electrocardiogram or (EKG)
• For diagnosis of heart diseases
• Identification of congenital (present at birth) heart diseases  
• Assessment of the pressure in the heart
• Monitoring the response of the heart to various heart treatments

An echocardiogram can show the following changes in the heart:

1. Abnormal size of the heart chambers
2. Damaged tissue of the heart muscle
3. Thin or thick ventricular (the lower chambers of the heart) walls
4. Poor functioning of the heart valves
5. Decrease in the strength of the heart to pump blood to the rest of the body
6. Presence of masses in the heart, like tumors or blood clots

The various symptoms of a heart condition may indicate the need for an echocardiogram:

• Arrhythmia (irregular heartbeat)
• Swelling of legs
• Shortness of breath
• High blood pressure
• Low blood pressure
• Abnormal results of an ECG
• Heart murmurs (a whooshing sound heard by the doctor on a stethoscope)

The different types of echocardiograms are:
1. Transthoracic echocardiogram: An ultrasound wand, known as a transducer, is placed on the outside of the chest, near the heart region. Sound waves are sent by the device through the chest, into the heart.
2. Transesophageal echocardiogram: It uses a thinner transducer attached to the end of a long tube. This tube is inserted via the mouth into the esophagus (food pipe), to give detailed images of the heart.
3. Doppler ultrasound: Sound waves are used at specialized frequencies to determine how the sound waves bounce off and return to the transducer.
4. Stress echocardiogram: A transthoracic echocardiogram is taken before and after a stress test, which involves monitoring the patient’s heart rate, the electrical activity of the heart, and blood pressure after performing physical activity.
5. 3D echocardiogram: It helps in creating detailed images of the heart.
6. Fetal echocardiogram: The unborn baby’s heart is viewed at approximately 18 to 22 weeks of pregnancy by a fetal echocardiogram.

The doctor may advise the following diagnostic procedures before an echocardiogram:

1. Physical examination: The patient is examined physically. All the symptoms of the patient are noted, along with his/her medical history and family history.
2. Chest x-ray: This is an imaging test done to obtain images of the heart and lungs.
3. Electrocardiogram (ECG): This test helps in recording the electrical activity of the heart. An abnormal ECG may indicate a heart condition that may require an echocardiogram.

The following preparation may be required before an echocardiogram:

• The doctor should be told about any medical conditions that you may be having.
• The doctor should be told about any medications or supplements that you are taking.
• Tell the doctor if you have a pacemaker or some other implanted cardiac device.
• A transthoracic echocardiogram does not require any preparation as such. The patient can eat, drink, and take all his/her medications as usual.
• In the case of a transesophageal echocardiogram, fasting of eight hours is required before the procedure.
• Arrange for a family member or friend to take you home after a transesophageal echocardiogram, as you may be under the effect of medications given during the procedure.

In the case of a transthoracic echocardiogram, the procedure is performed as follows:

• The patient is asked to undress from the waist upwards and lie on the examination bed or table.
• Electrodes or sticky patches are attached to the body to conduct and detect the electric currents of the heart.
• A gel is applied to the transducer to improve the conduction of sound waves.
• The transducer is moved back and forth over the chest for recording the pictures of the sound wave echoes from the heart.
• A pulsing whoosh sound may be heard, due to the recording of the blood flowing through the heart by the ultrasound.
• In the case of a transesophageal echocardiogram, the procedure is performed as follows:
• The throat is numbed using a spray or gel.
• A sedative may be given to help the patient relax.
• The tube that contains the transducer is guided down the throat into the esophagus, and then positioned to obtain the images of the heart.
• An echocardiography procedure normally takes less than one hour to complete.

• Most people can resume their normal daily activities after having an echocardiogram.
• In the case of a transesophageal echocardiogram, the patient stays in the hospital for a couple of hours after the test for observation.
• It is normal to have a sore throat for a few hours after a transesophageal echocardiogram.
• If you have received a sedative before the test, you should avoid driving for a couple of hours after an echocardiogram.
• Most people can resume their normal diet and exercise immediately after the transthoracic echocardiogram procedure.

Some of the possible risks of an echocardiogram are:

• Allergic reaction to the contrast agent used
• Irritation of the esophagus
• Esophageal perforation 
• Sore throat
• Discomfort on the removal of the sticky patches
• Drowsiness 
• Irregular heartbeat (arrhythmia) in case of a stress echocardiogram
• Heart attack in case of a stress echocardiogram