ECHO (echocardiography) is an imaging method that evaluates the structure, valves, pumping power, and blood flow of the heart using ultrasound waves. Also known as a heart ultrasound, ECHO is used in the diagnosis and follow-up of heart failure, valve diseases, cardiac enlargement, and certain congenital heart diseases.
During a standard ECHO scan, gel is applied to the chest area, and moving images of the heart are obtained using an ultrasound probe. The procedure can usually be completed within 15–40 minutes; it may take longer depending on the scope of the examination. A standard ECHO is generally painless and does not involve ionizing radiation. ECHO results provide information about the heart's pumping function, the condition of the valves, and the structure of the heart chambers. The findings are evaluated together with other clinical data by a cardiology specialist.
What is an Echo Used For?
An echocardiogram (Echo) allows the anatomical structure and working functions of the heart to be examined with the help of ultrasound. It helps obtain information about the contraction movements of the heart muscle, the size of the heart chambers, valve functions, and blood flow.
The main features that can be evaluated with echocardiography include:
- Pumping power of the heart: The contraction movements of the heart muscle and its function of pumping blood to the body are examined.
- Heart valves: It is evaluated whether there is any narrowing, regurgitation, or structural changes in the valves.
- Heart chambers: The dimensions and wall thicknesses of the atria and ventricles are examined.
- Blood flow: Information about the direction and velocity of blood flow inside the heart is obtained using the Doppler method.
- Pericardium: The membrane surrounding the heart and whether there is fluid accumulation in this area can be evaluated.
An Echo is an examination that shows the structural and functional properties of the heart. For evaluating the electrical activity of the heart, different tests such as an ECG are utilized.
Why is an Echo Performed?
An Echo may be requested in cases where heart disease is suspected or to monitor an existing heart disease. The circumstances underization for the procedure are determined based on the patient's complaints and the physician's evaluation.
The main conditions that may lead to an Echo request include:
- Shortness of breath: Investigation of causes that may be related to the heart's pumping function and valve diseases.
- Fatigue easily: Evaluation of the contraction power of the heart muscle and general functions of the heart.
- Heart murmur: Examination of the heart valves and blood flow inside the heart.
- Swelling in the legs: Evaluation of findings that may be related to conditions such as heart failure.
- Known heart diseases: Follow-up of heart failure, valve diseases, and diseases of the heart muscle.
- Suspected congenital heart disease: Examination of the structural features of the heart and certain congenital differences.
Echo results alone may not explain the cause of every complaint. Diagnostic evaluation is performed together with a physical examination and other necessary tests.
How is an Echo Performed?
A standard Echo is an ultrasound examination performed through the chest wall. The patient generally lies down on the examination table and is usually asked to turn onto their left side. With the help of gel applied to the chest area, the ultrasound probe is moved over the skin to capture images of the heart from different angles.
The stages of a standard Echo procedure are as follows:
| Stage | Application |
| Preparation | The patient lies down in the proper position, and the chest area is prepared for imaging. |
| Imaging | Gel is applied to the chest area, and moving images of the heart are obtained using the ultrasound probe. |
| Measurement | The heart chambers, valves, contraction movements, and other necessary measurements are examined. |
| Evaluation | The obtained images are evaluated by the physician and reported. |
During the procedure, you may be asked to hold your breath for a short time or change position.
What Should Be Considered Before an Echo?
Preparation before an Echo varies depending on the type of echocardiography to be performed. A standard transthoracic echocardiogram (TTE) usually requires no special preparation or fasting.
However, the following preparations may be required for different Echo methods:
- Standard Echo (TTE): You can generally eat normally, drink water, and continue taking daily medications.
- Transesophageal Echo (TEE): You may be asked to remain fasting and thirsty for a certain period before the procedure. If sedation is to be administered, an escort may be required after the procedure.
- Stress Echo: Specific instructions regarding food, caffeine consumption, and certain medications may be given depending on the type of test.
- 3D Echo: There is no separate fasting rule; preparation depends on whether the imaging is performed via TTE or TEE.
Medications being used should not be discontinued without the explicit recommendation of the physician.
How Many Minutes Does an Echo Take?
A standard transthoracic Echo generally takes about 15–40 minutes. The examination may take longer due to the need for more detailed measurements or imaging conditions.
The durations of other Echo methods vary. TEE may require additional time for preparation and observation after sedation. In a Stress Echo, exercise or drug administration and recovery periods can extend the total duration.
Which Diseases Can Be Detected on an Echo?
An Echo is used in the evaluation of many diseases that can cause changes in the structure and functions of the heart. It can provide diagnostic information, particularly in heart failure, valve diseases, and issues related to the heart muscle.
The main diseases and conditions that can be evaluated with an Echo include:
- Heart failure: Examination of findings related to the contraction and relaxation functions of the heart.
- Heart valve diseases: Evaluation of whether there is narrowing or regurgitation in the valves, primarily the mitral and aortic valves.
- Cardiomegaly (enlarged heart): Examination of changes such as the enlargement of the heart chambers and thickening of the heart walls.
- Cardiomyopathy: Evaluation of diseases affecting the structural and functional properties of the heart muscle.
- Congenital heart diseases: Determination of certain structural differences between the heart chambers and large blood vessels.
- Fluid accumulation in the pericardium: Examination of a condition called pericardial effusion.
- Suspicion of a clot or mass inside the heart: Evaluation of certain formations under appropriate imaging conditions.
- Suspicion of heart valve infection: Examination of valve structures that may be associated with infective endocarditis.
In some diseases, a standard Echo may not provide sufficient information. In such cases, a transesophageal Echo, cardiac MRI, or different examinations may be needed.
How Are Echo Results Interpreted?
Echo results are interpreted by evaluating measurements that show the structural features and functions of the heart. The physician examines the dimensions of the heart chambers, the movements of the heart muscle, the condition of the valves, blood flow, and the pumping power of the heart together.
Some frequently encountered expressions in Echo reports include:
| Parameter | What Does It Mean? |
|
EF (Ejection Fraction) | Indicates what percentage of the blood inside the left ventricle is pumped out with each contraction. |
| Left ventricle | The lower left chamber of the heart that pumps blood to the body. |
| Valve regurgitation | Refers to the leakage of blood backward through a heart valve. |
| Valve stenosis | Refers to a narrowing or restriction in the opening of a heart valve. |
| Diastolic function | Refers to functions related to the relaxation of the heart muscle and the filling of the heart with blood. |
| Pericardial effusion | Means the accumulation of fluid within the membrane surrounding the heart. |
A single value in the Echo report being outside the normal or reference range does not constitute a definitive diagnosis on its own. Findings must be evaluated together.
What is the EF (Ejection Fraction) Value on an Echo?
EF (ejection fraction) is the measurement that shows, as a percentage, how much of the blood contained in the left ventricle of the heart is pumped out with each contraction. It is one of the primary indicators used in evaluating the pumping function of the heart.
In adults, the left ventricular EF range of %55–70 is generally considered normal. However, reference ranges may vary depending on the measurement method used and clinical characteristics.
When the EF value is low, it is considered that there may be a decrease in the contraction function of the heart. However, a normal EF value does not rule out all heart diseases, including heart failure.
For example, in a person with an EF value of 60%, the left ventricle pumps out approximately 60% of the blood inside it with each contraction. This value alone does not show the overall health status of the heart.
What Does a Normal Echo Result Mean?
A normal Echo result means that no significant abnormality was detected in terms of the structure and functions of the heart during the examination.
In a normal Echo, generally the dimensions of the heart chambers, contraction movements of the heart muscle, valve structure, and blood flow can be found appropriate for the individual's characteristics.
However, a normal Echo result does not definitively prove the absence of any heart disease. Particularly, rhythm disorders and certain coronary artery diseases may not create prominent findings on a standard Echo.
What Does an Abnormal Echo Result Mean?
An abnormal Echo result indicates that a finding differing from expected values was detected in the structure, valves, contraction, or relaxation functions of the heart.
The following findings may be observed in abnormal Echo results:
- Enlargement of the heart chambers or thickening of the walls
- Decrease in the contraction movements of the heart muscle
- Low EF value
- Narrowing or regurgitation in heart valves
- Changes in the relaxation and filling functions of the heart
- Fluid accumulation in the pericardium
Every abnormal Echo finding does not mean a serious heart disease. Some changes may be mild or related to the person's age and other clinical characteristics.
The significance of abnormal results is evaluated in conjunction with the person's symptoms, physical examination findings, and other test results when necessary.
What Are the Types of Echo?
Echocardiography can be performed using various methods to evaluate different features of the heart. The most commonly used method is transthoracic echocardiography (TTE). Other methods can be utilized in cases where more detailed imaging is required or when investigating the heart's function under specific conditions.
Transthoracic Echocardiography (TTE)
Transthoracic echocardiography is the standard Echo method performed by moving an ultrasound probe over the chest wall.
The heart chambers, heart valves, and movements of the heart muscle are evaluated. The procedure generally does not require special preparation, fasting, or sedation.
TTE is a non-invasive examination. Pressing the probe against the chest area may cause a temporary feeling of discomfort in some individuals.
Transesophageal Echocardiography (TEE)
Transesophageal echocardiography (TEE) is an Echo method performed by advancing a specialized device with an ultrasound probe at its tip through the mouth into the esophagus.
Because the esophagus is close to the heart, it can be used particularly to evaluate heart valves, certain intracardiac structures, and specific suspicions of blood clots.
Unlike a standard Echo, TEE requires special preparation:
- Fasting for a few hours is usually requested before the procedure; many applications use a fasting period of approximately 6 hours.
- A local anesthetic spray may be applied to the throat, and sedation can be administered in deemed appropriate cases.
- You should not eat food or drink liquids after the procedure until the numbness in the throat subsides.
- If sedation was administered, you may need to avoid driving for a certain period and return home accompanied by an escort.
Temporary sore throat or discomfort during swallowing may occur after TEE. More rarely, bleeding, injury to the esophagus, aspiration, or undesirable effects related to the medications used may occur.
The suitability of the procedure is evaluated by the physician based on the individual's health status and existing diseases.
Doppler Echocardiography
Doppler echocardiography is an ultrasound technique used to evaluate the direction and velocity of blood flow inside the heart.
It helps examine whether there is narrowing or regurgitation in the heart valves and certain characteristics of blood flow.
Doppler is often performed as part of a standard transthoracic Echo. It does not require a separate intervention route or sedation on its own; preparation conditions depend on the Echo method it is performed with.
Stress Echocardiography
Stress echocardiography is an examination in which the functions of the heart at rest and under increased workload are compared.
The workload of the heart can be increased through exercise or, when deemed necessary, with the help of medication. During this time, the movements of the heart muscle and certain functional changes are evaluated.
Stress Echo can be used particularly in investigating issues that may be related to the blood supply of the heart muscle and in evaluating certain heart diseases.
Depending on the method to be applied before a Stress Echo, you may be asked to remain fasting for a certain period, avoid caffeine, or regulate the use of certain medications. These conditions are not the same for every patient and are determined according to the instructions of the healthcare team.
Palpitations, dizziness, shortness of breath, or chest pain may occur during a Stress Echo. Rarely, serious rhythm disorders and other cardiac issues can be observed. Therefore, the test is performed with appropriate patient selection and under the supervision of medical personnel.
3D Echocardiography
Three-dimensional echocardiography (3D Echo) is an ultrasound imaging technique that allows certain anatomical structures of the heart to be evaluated with three-dimensional images.
It can provide additional information, particularly in examining the structure of heart valves, volumes of heart chambers, and specific anatomical features.
3D Echo can be performed using transthoracic or transesophageal methods. Therefore, preparation, fasting, sedation, and risk conditions depend on the method by which 3D imaging is performed.
What is the Difference Between an Echo and an ECG?
An Echo and an ECG are two separate diagnostic methods that evaluate different characteristics of the heart. While an Echo images the structure and movements of the heart, an ECG records the electrical activity of the heart.
| Feature | Echo (Echocardiogram) | ECG (Electrocardiogram) |
| Primary method | Ultrasound waves | Electrical signal recording |
|
Evaluated features | Heart structure, valves, contraction power, and blood flow | Heart rhythm, rate, and electrical conduction |
| Application | Ultrasound probe over the chest in the standard method | Electrodes placed on the chest, arms, and legs |
| Primary use | Structural and functional heart evaluation | Rhythm and electrical activity evaluation |
An Echo and an ECG are not interchangeable tests. Both methods can be utilized together when investigating a health problem related to the heart.
Is Echocardiography Safe?
Echocardiography is an imaging method that does not use ionizing radiation. However, safety evaluation varies depending on the Echo method used.
Standard transthoracic Echo (TTE) is generally a safe and non-invasive examination. A mild pressure may be felt while the ultrasound probe is applied to the chest area.
Transesophageal Echo (TEE) requires advancing a probe into the esophagus and administering sedation in some patients. Therefore, it carries different risks compared to a standard Echo.
Stress Echo, on the other hand, involves increasing the workload of the heart through exercise or medication. Due to potential complaints and possible cardiac risks that may arise, it is performed under the supervision of a healthcare team.
The risks of 3D and Doppler imaging techniques are evaluated based on the Echo method they are used with and any additional applications, if applicable.
Which Doctor Should You Visit for an Echo?
An Echo is an examination used to evaluate the structural and functional properties of the heart. For evaluations related to heart diseases, it is generally requested by a Cardiology specialist.
An Echo may be deemed necessary following a cardiological evaluation in conditions such as shortness of breath, fatigue easily, heart murmur, swelling in the legs, or the follow-up of known heart diseases.
Which Echo method will be used is determined based on the patient's health status and the clinical problem being investigated.
