What is an Echocardiogram and Why Might I Need One?

An echocardiogram uses high-frequency sound waves, similar to the ultrasound scans used during pregnancy. A small handheld device called a transducer is placed on your chest, sending sound waves through the skin. These waves bounce off the heart’s structures and are converted into live images on a monitor. The test provides detailed information about the size and shape of your heart, how well the chambers and valves are working, and how efficiently the heart is pumping blood. There are different types of echocardiogram: the most common is a transthoracic echocardiogram (TTE), performed on the chest. Sometimes, a transoesophageal echocardiogram (TOE) may be needed, where a small probe is passed down the throat for clearer images – this is done under sedation. A stress echocardiogram can assess how your heart copes with exercise or medication that mimics exercise.

Your doctor may recommend an echocardiogram for several reasons. It is a key tool for investigating symptoms such as breathlessness, chest pain, palpitations, or swelling in the ankles. It can help diagnose conditions like heart valve problems, heart muscle disease (cardiomyopathy), fluid around the heart, or damage following a heart attack. After a stroke or transient ischaemic attack (TIA), an echocardiogram is often used to look for a cardiac source of clots that may have travelled to the brain.

An echo is also used to monitor existing heart conditions. If you have been diagnosed with a murmur, high blood pressure, or heart failure, regular echoes can track changes over time and guide treatment. Additionally, it can be used before certain treatments, such as chemotherapy, to check the heart’s baseline function.

The echocardiogram is performed by a cardiac physiologist or your cardiologist. You will be asked to undress to the waist and lie on a couch. Small sticky electrodes are attached to your chest to monitor your heart’s electrical activity. A clear gel is applied to the skin to help the transducer make good contact.

The probe is moved across your chest and sometimes under the ribcage to obtain different views. You may be asked to change position or hold your breath briefly. The procedure is painless, though you may feel slight pressure. It usually takes between 20 and 40 minutes. Once finished, you can get dressed and resume your normal activities immediately. The images are then analysed, and the results will be explained to you in a follow-up appointment.

An echocardiogram is extremely safe. It does not use ionising radiation, so there is no risk of radiation exposure. The gel may feel cold, but it is harmless. If you are having a TOE, there is a small risk of sore throat or, very rarely, damage to the oesophagus – your cardiologist will discuss this with you in detail if it is recommended.

This article is for general information only and should not be taken as individual medical advice. If you experience symptoms such as severe chest pain, sudden breathlessness, or fainting, you should seek urgent medical help by calling 999 or visiting your nearest emergency department.

The information in this article draws on guidance from the National Institute for Health and Care Excellence (NICE), the British Heart Foundation, and the NHS. These organisations offer comprehensive resources for patients wishing to learn more about heart tests and conditions.