Echocardiography is a painless test that uses sound waves to create pictures of the heart.
Echocardiography can detect many different types of heart problems. Some of these can be minor and pose no risk to you. Others can be signs of serious heart disease or other heart problems.
Doctors need a noninvasive test that will give them insight into how a patient’s heart is built (size and shape) and how well the heart’s chambers and valves are working. Doctors also may be looking for confirmation based on a previous diagnosis to determine the status of an existing problem, or help guide ongoing treatment. Additionally, the diagnostic tool needs to work on infants and children.
There are a number of alternatives to having an echocardiogram. Some of these are listed below.
- Electrocardiogram (ECG). This test measures the electrical activity of the heart to see how well it’s working, but doesn’t give any information about how the heart valves are working.
- Transoesophageal echocardiogram (TOE). This is another type of echocardiogram used to get clear pictures of the heart valves. Images are taken from a probe placed inside the oesophagus (the pipe that goes from the mouth to the stomach). This is good if you have artificial heart valves (because they shown up less well with a conventional echocardiogram) and for detecting any blood clot (thrombus) in the heart.
- Radionuclide test. During this test you’re injected with a harmless, radioactive substance when you’re resting and when the heart is under stress. The radioactive substance is seen with a special camera as it travels through the heart.
- Cardiac MRI (magnetic resonance imaging) test. An MRI scan uses magnets and radiowaves to produce images of the inside of the body.
Radionuclide tests and MRI scans aren’t often used and are only available at a few specialist hospitals.
Echocardiography is the most noninvasive yet comprehensive test available for determining overall heart health. The test can identify areas of heart muscle that aren’t contracting normally due to poor blood flow or injury from a previous heart attack. In addition, a type of echo called Doppler ultrasound shows how well blood flows through the chambers and valves of the heart.
Echo can detect possible blood clots inside the heart, fluid buildup in the pericardium, and problems with the aorta. Specifically, routine Echocardiography can be rationalized in patients with hypertension, atrial fibrillation, stroke and endocarditis.
Echocardiograms are done at the doctor’s office and require less than an hour. Patients can typically go back to their normal activities right after having an echo. Doctors should order an Echocardiogram to help diagnose any of the following:
- Evaluate a heart murmur
- Diagnose and determine the extent of valve conditions
- Determine the presence of abnormalities in the structure of the heart
- Measure the size and thickness of the heart and its chambers
- Assess the motion of the chamber walls and the extent of damage to the heart muscle after a heart attack
- Assess how different parts of the heart are functioning in patients with chronic heart disease
- Determine if fluid is collecting around the heart (Congestive Heart Problems)
- Identify presence of tumors in the heart
- Assess for and monitor congenital defects
- Evaluate a patient’s response to a treatment or a corrective procedure
- Evaluate blood flow through the heart
- Assess the heart condition prior to transplant; see if major blood vessels have been damaged by traumatic injury
- Assess problems with the heart muscle (known as cardiomyopathy)
- Assess abnormal heart rhythms (arrhythmias)
- Assess Bacterial Endocarditis (BE—an infection of the valves and inner lining of the heart. This happens when bacteria from the skin, mouth or intestines enter the bloodstream and infect the heart.
- Assess EF –ejection fraction levels (heart flow)
- Rule out any of the above mentioned abnormalities
Heart Ultrasounds are not for everyone, but patients with a family history of heart disease, are in a high-risk group, or are experiencing any symptoms (shortness of breath, pain in your arm, etc.—see AHA guidelines), are candidates for Echo Screening.
- Kisslo J. A letter from America. Br Heart J 1994; 71[Suppl]:28-30.
- Sheps SG, Frohlich ED. Limited echocardiography for hypertensive left ventricular hypertrophy. Hypertension 1997; 29:560-3.
- Popp RL. The challenge of quality versus quantity in echocardiography. J Am Soc Echocardiogr 1992; 5:1-4.
- Monaghan M, Anderson V, Chalmers J, et al. Training in echocardiography. Br Heart J 1994; 71[Suppl]:2-5.
- Weyman AE. Principles and practice of echocardiography. 2nd edition. Philadelphia: Lea & Febiger; 1994. p. 1290-5.
- Feigenbaum H. Echocardiography. 5th edition. Philadelphia: Lea & Febiger; 1994. p. 658-65.
- St. John Sutton M, Oldershaw PJ, Kotler MN. Textbook of echocardiography and Doppler in adults and children. 2nd edition. Cambridge: Blackwell Scientific Publications; 1996. p. 945.
- Fisch C, Beller GA, DeSanctis RW, et al. ACC/AHA guidelines for the clinical application of echocardiography. Circulation 1990; 82:2323-45.
- Pearlman AS, Gardin JM, Martin RP, et al. Guidelines for optimal physician training in echocardiography: recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography. Am J Cardiol 1987; 60:158-63.
- Popp RL, Winters WL, Williams SV, et al. Clinical competence in adult echocardiography: a statement for physicians from the ACP/ACC/AHA Task Force on Clinical Privileges in Cardiology. J Am Coll Cardiol 1990; 15:1465-8.
- Kisslo J, Byrd BF III, Geiser EA, et al. Recommendations for continuous quality improvement in echocardiography from the American Society of Echocardiography. J Am Soc Echocardiogr 1995; 8[Suppl]:S1-28.
- Sahn DJ, DeMaria A, Kisslo J, et al. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58:1072-83.
- Henry WL, DeMaria A, Gramiak R, et al. Report of the American Society of Echocardiography Committee on nomenclature and standards in 2-dimensional echocardiography. Circulation 1980; 62:212-5.
- Schiller NB, Shah PM, Crawford M, et al. Recommendations for the quantitation of the left ventricle by 2-dimensional echocardiography: American Society of Echocardiography Committee on standards, subcommittee on quantitation of 2-dimensional echocardiograms. J Am Soc Echocardiogr 1989; 2:358-67.
- Wallerson DC, Devereux RB. Reproducibility of echocardiographic left ventricular measurements. Hypertension 1987; 9[Suppl II]:II-6-18.
- Schieken RM, Clarke WR, Mahoney LT, et al. Measurement criteria for group echocardiographic studies. Am J Epidemiol 1979; 110:504-14.
- Gottdiener JS, Livengood SV, Meyer PS, et al. Should echocardiography be performed to assess effects of antihypertensive therapy? Test-retest reliability of echocardiography for measurement of left ventricular mass and function. J Am Coll Cardiol 1995; 25:424-30.
- Sunderman FW Jr. Computer applications in laboratory medicine: the delineation of normal values. Ann N Y Acad Sci 1969; 161:549.
- Murphy EA. The normal, and the perils of the sylleptic argument. Perspect Biol Med 1971; 15:566-82.
- Murphy EA. A scientific viewpoint on normalcy. Perspect Biol Med 1965; 9:333-48.
- Harris EK, Boyd EK. Some history of reference values. In: Statistical bases of reference values in laboratory medicine. New York: Marcel Dekker, Inc; 1995. p. 3-22.
- Solberg HE. Approved recommendations (1986) on the theory of reference values, I: the concept of reference values. J Clin Chem Clin Biochem 1987; 25:337-42.
- Solberg HE. Approved recommendations (1987) on the theory of reference values, II: selection of individuals for the production of reference values. J Clin Chem Clin Biochem 1987; 25:639-44.
- Solberg HE. Approved recommendations (1987) on the theory of reference values, V: statistical treatment of collected reference values. Determination of reference limits. J Clin Chem Clin Biochem 1987; 25:645-56.
- Dybkær R, Solberg HE. Approved recommendations (1987) on the theory of reference values, VI: presentation of observed values related to reference values. J Clin Chem Clin Biochem 1987; 25:657-62.
- Sunderman FW Jr. Current concepts of “normal values,” “reference values” and “discrimination values” in clinical chemistry. Clin Chem 1975; 21:1873.
- Simonson E. The concept and definition of normality. Ann N Y Acad Sci 1966; 134:541-58.
- Elvebach LR. The population of healthy persons as a source of reference information. Hum Pathol 1973; 4:9-16.
- Munan L, Kelly A. Epidemiologic observations underlying the production and use of reference values in laboratory medicine. In: Heusghem C, Albert A, Benson ES, editors. Advanced interpretation of clinical laboratory data. New York: Marcel Dekker, Inc; 1982. p. 351-60.
- Elvebach LR. How high is high? A proposed alternative to the normal range. Mayo Clin Proc 1972; 47:93-7.
- Ash KO. Research needed to set geriatric reference values. Clin Chem News 1986;Nov:7-8.
- Reed AH, Henry RJ, Mason WB. Influence of statistical method used on the resulting estimate of normal range. Clin Chem 1971; 17:275-84.
- Elvebach LR, Guillier CL, Keating FR Jr. Health, normality and the ghost of Gauss. JAMA 1970; 211:69-75.
- Lott JA, Mitchell LC, Moeschberger ML, et al. Estimation of reference ranges: how many subjects are needed? Clin Chem 1992; 38:648-50.
- Geigy Scientific Tables. Vol 5. Lentner C, editor. Basel, Switzerland: CIBA-GEIGY Limited; 1990. p. 63-100.
- Levy D, Anderson KM, Savage DD, et al. Echocardiographically detected left ventricular hypertrophy: prevalence and risk factors: the Framingham Heart Study. Ann Intern Med 1988; 108:7-13.
- De Simone G, Daniels SR, Devereux RB, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 1992; 20:1251-60.
- Gardin JM, Siscovick D, Anton-Culver H, et al. Sex, age, and disease affect echocardiographic left ventricular mass and systolic function in the free-living elderly: the Cardiovascular Health Study. Circulation 1995; 91:1739-48.
- Gardin JM, Henry WL, Savage DD, et al. Echocardiographic measurements in normal subjects: evaluation of an adult population without clinically apparent heart disease. J Clin Ultrasound 1979; 7:439-47.
- Triulzi M, Gillam LD, Gentile R, et al. Normal adult cross-sectional echocardiographic values: linear dimensions and chamber areas. Echocardiography 1984; 1:403-26.
- Henry WL, Gardin JM, Ware JH. Echocardiographic measurements in normal subjects from infancy to old age. Circulation 1980; 62:1054-61.
- Nidorf SM, Picard MH, Triulzi MO, et al. New perspectives in the assessment of cardiac chamber dimensions during development and adulthood. J Am Coll Cardiol 1992; 19:983-8.
- Roman MJ, Devereux RB, Kramer-Fox R, et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 1989; 64:507-12.
- Valdez RS, Motta JA, London E, et al. Evaluation of the echocardiogram as an epidemiologic tool in an asymptomatic population. Circulation 1979; 60:921-9.
- Schnittger I, Gordon EP, Fitzgerald PJ, et al. Standardized intracardiac measurements of 2-dimensional echocardiography. J Am Coll Cardiol 1983; 2:934-8.
- Snider AR, Enderlein MA, Teitel DF, et al. Two-dimensional echocardiographic determination of aortic and pulmonary artery sizes from infancy to adulthood in normal subjects. Am J Cardiol 1984; 53:218-24.
- Knutsen KM, Stugaard M, Michelsen S, et al. M-mode echocardiographic findings in apparently healthy, non-athletic Norwegians aged 20 to 70 years: influence of age, sex, and body surface area. J Intern Med 1989; 225:111-5.
- Huwez FU, Houston AB, Watson J, et al. Age and body surface area related normal upper and lower limits of M mode echocardiographic measurements and left ventricular volume and mass from infancy to early adulthood. Br Heart J 1994; 72:276-80.
- Devereux RB. Echocardiography: state of art: 1984. Cardiology 1984; 71:118-35.
- Biamino G, Lange L. Echokardiographie. Frankfurt am Main: Hoechst Akiengesellschaft; 1983. p. 44.
- Voogd PJ, Rijsterborgh H, Lubsen J, et al. Reference ranges of echocardiographic measurements in the Dutch population. Eur Heart J 1984; 5:762-70.
- Erbel R, Henkel B, Ostlander C, et al. Normal values for 2-dimensional echocardiography [in German]. Deutsche Medizinische Wochenschrift 1985; 110:123-8.
- Burke GL, Arcilla RA, Culpepper WS, et al. Blood pressure and echocardiographic measures in children: the Bogalusa Heart Study. Circulation 1987; 75:106-14.
- Laird WP, Fixler DE. Left ventricular hypertrophy in adolescents with elevated blood pressure: assessment by chest roentgenography, electrocardiography and echocardiography. Pediatrics 1981; 67:255-9.
- Michelsen S, Hurlen M, Otterstad JE. Prevalence of tricuspid and pulmonary regurgitation diagnosed by Doppler in apparently healthy women: possible influence on their physical performance. Eur Heart J 1988; 9:61-7.
- Washburn RA, Savage DD, Dearwater SR, et al. Echocardiographic left ventricular mass and physical activity: quantification of the relation in spinal cord injured and apparently healthy active men. Am J Cardiol 1986; 58:1248-53.
- Manyari DE, Duff HJ, Kostuk WJ, et al. Usefulness of noninvasive studies for diagnosis of right ventricular dysplasia. Am J Cardiol 1986; 57:1147-53.
- Lauer MS, Larson MG, Levy DL. Sex-specific reference M-mode values in adults: population-derived values with consideration of the impact of height. J Am Coll Cardiol 1995; 26:1039-46.
- Vasan RS, Larson MG, Benjamin EJ, et al. Echocardiographic reference values for aortic root size: the Framingham Study. J Am Soc Echocardiogr 1995; 8:793-800.
- St. John Sutton M, Reichek N, Lovett J, et al. Effects of age, body size, and blood pressure on the normal human left ventricle [abstract]. Circulation 1980; 62[Suppl III]:III-305.
- Devereux RB, Lutas EM, Casale TN, et al. Standardization of M-mode echocardiographic left ventricular measurements. J Am Coll Cardiol 1984; 4:1222-30.
- Kitzman DW, Scholz DG, Hagen PT, et al. Age-related changes in normal human hearts during the first 10 decades of life, II: Maturity: a quantitative anatomic study of 765 specimens from subjects 20 to 99 years old. Mayo Clin Proc 1988; 63:137-46.
- Oberman A, Myers AR, Karunas TM, et al. Heart size of adults in a natural population: Tecumseh, Michigan: variation by sex, age, height and weight. Circulation 1967; 35:724-33.
- Hanley PC, Zinsmeister AR, Clements IP, et al. Gender-related differences in cardiac response to supine exercise assessed by radionuclide angiography. J Am Coll Cardiol 1989; 13:624-9.
- Wahr DW, Wang YS, Schiller NB. Left ventricular volumes determined by 2-dimensional echocardiography in a normal adult population. J Am Coll Cardiol 1983; 1:863-8.
- Byrd BF, Wahr D, Wang YS, et al. Left ventricular mass and volume/mass ratio determined by 2-dimensional echocardiography in normal adults. J Am Coll Cardiol 1985; 6:1021-5.
- de Simone G, Devereux RB, Daniels SR, et al. Gender differences in left ventricular growth. Hypertension 1995; 26[part 1]:979-83.
- Gardin JM, Wagenknecht LE, Anton-Culver H, et al. Relationship of cardiovascular risk factors to echocardiographic left ventricular mass in healthy young black and white adult men and women: the CARDIA Study. Circulation 1995; 92:380-7.
- Gardin JM, Siscovick D, Anton-Culver H, et al. Sex, age, and disease affect echocardiographic left ventricular mass and systolic function in the free-living elderly: the Cardiovascular Health Study. Circulation 1995; 91:1739-48.
- Goble MM, Mosteller M, Moskowitz WB, et al. Sex differences in the determinants of left ventricular mass in childhood: the Medical College of Virginia Study. Circulation 1992; 85:1661-5.
- Daniels SR, Kimball TR, Morrison JA, et al. Effect of lean body mass, fat mass, blood pressure, and sexual maturation on left ventricular mass in children and adolescents: statistical, biological, and clinical significance. Circulation 1995; 92:3249-54.
- Astrand PO, Rodahl K. Textbook of work physiology. 2nd edition. New York: McGraw-Hill; 1977. p. 318-25.
- Chaturvedi N, Athanassopoulos G, Mckeigue PM, et al. Echocardiographic measures of left ventricular structure and their relation with rest and ambulatory blood pressure in blacks and whites in the United Kingdom. J Am Coll Cardiol 1994; 24:1499-505.
- Hinderliter AL, Light KC, Willis PW IV. Racial differences in left ventricular structure in healthy young adults. Am J Cardiol 1992; 69:1196-9.
- Dunn FG, Oigman W, Sungaard-Riise K, et al. Racial differences in adaptation to essential hypertension determined by echocardiographic indexes. J Am Coll Cardiol 1983; 1:1348-51.
- Gottdiener JS, Reda DJ, Materson BJ, et al. Importance of obesity, race and age to cardiac structural and functional effects of hypertension. J Am Coll Cardiol 1994; 24:1492-8.
- Cornoni-Huntley J, LaCroix AZ, Havlik RJ. Race and sex differentials in the impact of hypertension in the United States: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Survey. Arch Intern Med 1989; 149:780-8.
- Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the third National Health and Nutrition Examination Survey, 1988-1991. Hypertension 1995; 25:305-13.
- The Sixth report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC VI). Arch Intern Med 1997; 157:2413-46.
- Stamler J, Stamler R, Neaton JD. Blood pressure, systolic and diastolic, and cardiovascular risks: US population data. Arch Intern Med 1993; 153:598-615.
- Senior PA, Bhopal R. Ethnicity as a variable in epidemiologic research. Br Med J 1994; 309:327-30.
- Witzig R. The medicalization of race: scientific legitimization of a flawed social construct. Ann Intern Med 1996; 125:675-9.
- Wei JY. Aging and the cardiovascular system. N Engl J Med 1992; 327:1735-9.
- SHEP Cooperative Research Group. Prevention of stoke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265; 3255-64.
- Dahlof B, Lidholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients With Hypertension (STOP-Hypertension). Lancet 1991; 338:1281-5.
- Urbina EM, Gidding GS, Bao W, et al. Effect of body size, ponderosity and blood pressure on left ventricular growth in children and young adults in the Bogalusa Heart Study. Circulation 1995; 91:2400-6.
- Savage DD, Levy D, Dannenberg AL, et al. Association of echocardiographic left ventricular mass with body size, blood pressure and physical activity (The Framingham Study). Am J Cardiol 1990; 65:371-6.
- Dannenberg AL, Levy D, Garrison RJ. Impact of age on echocardiographic left ventricular mass in a healthy population (The Framingham Study). Am J Cardiol 1989; 64:1066-8.
- de Simone G, Devereux RB, Roman MJ, et al. Gender differences in left ventricular anatomy, blood viscosity and volume regulatory hormones in normal adults. Am J Cardiol 1991; 68:1704-8.
- Shub C, Klein Al, Zachariah PK, et al. Determination of left ventricular mass by echocardiography in a normal population: effect of age and sex in addition to body size. Mayo Clin Proc 1994; 69:205-11.
- Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990; 322:1561-6.
- Schmidt-Nielsen K. Scaling: why is animal size so important? New York: Cambridge University Press; 1984. p. 1-32, 56-98, 115-64, 209-23.
- Levy D, Savage DD, Garrison RJ, et al. Echocardiographic criteria for left ventricular hypertrophy: the Framingham Heart Study. Am J Cardiol 1987; 59:956-60.
- Tanner JM. Fallacy of per weight and per surface standards, and their relation to spurious correlation. J Appl Physiol 1949; 2:1.
- Gutgesell HP, Rembold CM. Growth of the human heart relative to body surface area. Am J Cardiol 1990; 65:662.
- Malcolm DD, Burns TL, Mahoney LT, et al. Factors affecting left ventricular mass in childhood: the Muscatine Study. Pediatrics. 1993; 92:703-9.
- Lauer MS, Anderson KM, Larson MG, et al. A new method for indexing left ventricular mass for differences in body size. Am J Cardiol 1994; 74:487-91.
- Daniels SR, Kimball TR, Morrison JA, et al. Indexing left ventricular mass to account for differences in body size in children and adolescents without cardiovascular disease. Am J Cardiol 1995; 76:699-701.
- Maron BJ, Pelliccia A, Spirito P. Cardiac disease in young trained athletes. Circulation 1995; 91:1596-601.
- Robson HC, Hunter S, Moore M, et al. Hemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study. Br J Obstet Gynaecol 1987; 94:1028-39.
- Rubler S, Damani PM, Pinto ER. Cardiac size and performance during pregnancy estimated with echocardiography. Am J Cardiol 1977; 40:534-40.
- Martin WH, Coyle EF, Ehsani AA. Effects of physical deconditioning after intense endurance training on left ventricular dimensions and stroke volume. J Am Coll Cardiol 1986; 7:982-7.
- Devereux RB, Casale PN, Wallerson DC, et al. Cost-effectiveness of echocardiography and electrocardiography for detection of left ventricular hypertrophy in patients with systemic hypertension. Hypertension 1987; 9[Suppl II]:II-69-76.
- Vasan RS, Larson MG, Levy D, et al. Distribution and categorization of echocardiographic measurement in relation to reference limits: the Framingham Heart Study: formulation of a height- and sex-specific classification and its prospective validation. Circulation 1997; 96:1863-73.
- King DL, Harrison MR, King DL Jr, et al. Ultrasound beam orientation during standard two-dimensional imaging: assessment by 3-dimensional echocardiography. J Am Soc Echocardiogr 1992; 5:569-76.
- Pandian NG, Roelandt JRTC, Nanda NC, et al. Dynamic 3-dimensional echocardiography: methods and clinical potential. Echocardiography 1994; 11:237-59.
- Thomas JD. The DICOM image formatting standard: what it means for echocardiographers. J Am Soc Echocardiogr 1995; 8:319-27.
- Poh KK, Levine RA, Solis J, Shen L, Flaherty M, Kang YJ, Guerrero JL, Hung J. (2008). “Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography”. Eur Heart J 29 (20): 2526. doi:10.1093/eurheartj/ehn022. PMID 18263866.
- Goland S, Czer LS, Luthringer D, Siegel RJ. (2008). “A case of arrhythmogenic right ventricular cardiomyopathy”. Can J Cardiol 24 (1): 61–2. PMID 18209772.
- Impact of Multiplanar Review of Three-Dimensional Echocardiographic Data on Management of Congenital Heart Disease. Ann. Thorac. Surg., September 2008; 86: 875 – 881)
- Comparison of Fluoroscopic versus Real Time Three-Dimensional Transthoracic Echocardiographic Guidance of Endomyocardial Biopsies. D Platts, M Brown, G Javorsky, C West, N Kelly, D Burstow. European Journal of Echocardiography (2010) doi: 10.1093/ejechocard/jeq03
- Dynamic Echocardiography Textbook by The American Society of Echocardiography
- Echocardiography Textbook by Bonita Anderson
- American Society of Echocardiography
- British Society of Echocardiography
- International Society of Cardiovascular Ultrasound
- European Association of Echocardiography
- 3D Echo Box: Interpretation of 3 Dimensional Echocardiography images and derive information online
- Basic Echocardiography Course: From physics to anatomy, and assessment of heart chambers and valvular structures
- VIRTUAL TEE – online self-study and teaching resource
- Echobasics – free online echocardiography tutorial
- Algorithms and System for Digital Echocardiogram Video Indexing and Su
- CT2TEE – transesophageal echocardiography simulator