All You Need To Know About An Echocardiogram: Purpose, Types, And More

A male patient is undergoing an echocardiogram with a sonographer holding the transducer on his chest.

Why is an Echocardiogram Performed

An echocardiogram is a test performed on the heart using sound waves to look for any underlying cardiac issues. It is commonly used to measure the size and function of the heart’s chambers, analyse the behaviour of the heart’s valves, and measure heart muscle contraction and blood flow.

The test results provide valuable data that help cardiologists do the following:

Assess why a patient experiences symptoms of cardiovascular conditions.
Track the progression of a heart condition you may have been diagnosed with.
Evaluate the effectiveness of ongoing or prescribed treatment.

Although echocardiograms are primarily diagnostic tests used to assess the structure and function of the heart in patients with symptoms, they can also be used as a screening tool in some cases. Therefore, your cardiologist may recommend that you undergo an echocardiogram even if you do not have symptoms of heart conditions.

Who May Need an Echocardiogram

People with one or more of the following symptoms may require an echocardiogram:

Shortness of breath
Chest pain or discomfort
Irregular heartbeats
Abnormal sounds—such as a whooshing, swishing, or humming—heard during a heartbeat
Swelling in the legs, ankles, or feet
Fatigue or weakness
Fainting

Additionally, patients with one or more of the following suspected or known conditions may require an echocardiogram:

Heart valve diseases
Coronary artery disease
Hemodynamic instability or structural heart disease
Heart failure or heart attack
Congenital heart disease

At Capital Heart Centre, Dr Joshua Loh, our experienced cardiologist in Singapore, will thoroughly assess your condition to help you determine if an echocardiogram is suitable for you. In addition to echocardiograms, a wide variety of other tests are also available. This ensures you will undergo the right test(s) for your cardiovascular condition.

What are the Types of Echocardiograms

1. Non-Invasive Transthoracic Echocardiogram Test

The most commonly performed echocardiogram is the transthoracic echocardiogram (TTE), a type of ultrasound scan. In TTE, a small, handheld device known as an imaging probe is positioned on the chest by your cardiologist or technician, emitting sound waves that pass through the chest cavity. As these waves encounter the heart and nearby organs, they reflect as echoes. These are captured and transformed into images of the heart in motion.

Since no imaging equipment enters the body during a TTE, it is considered a safe, non-invasive procedure.

2. Minimally Invasive Transoesophageal Echocardiogram Test

A transoesophageal echocardiogram is performed when a transthoracic echocardiogram cannot provide sufficient quality data, and better image definition is required for certain structures within the heart.

A transoesophageal echocardiogram (TEE) is done to examine the heart from inside the body. A small flexible imaging probe (a tube equipped with a sound wave emitter) is placed inside the oesophagus. The sound waves bounce off different areas of your heart, sending echoes to a computer to be turned into pictures. These pictures show the structure and function of your heart in greater detail.

3. Stress Echocardiogram Test

Patient undergoing treadmill exercise ECG test 2

Usually performed when we suspect coronary artery disease based on a patient’s symptoms and signs. Exercise stress echocardiography combines an echocardiogram with a treadmill exercise ECG test to check how the heart responds to physical activity or stress. Ultrasound images of the heart are taken before and after exercising on the treadmill. During exercise, blood pressure and ECG is continuously being monitored. If you cannot exercise, you may be given some medication to make your heart work harder.

How the Cardiologist Decides Which Echocardiogram You Need

When a cardiologist determines which type of echocardiogram you need, they’ll base their decision on your symptoms, medical history, and the suspected heart condition. Here’s how they approach this:

Symptom Discussion: The doctor will ask about symptoms such as shortness of breath, leg swelling, chest pain, or heart murmurs.
Medical History: Reviewing your past heart conditions, such as heart valve disease or heart failure, is essential in selecting the proper test.
Physical Examination: The doctor may listen to your heart for abnormal sounds or check for signs of fluid retention that could suggest heart function issues.
Reason for Test: The goal is to determine how well your heart and valves function. A different type of echocardiogram may be needed depending on whether the issue is structural, functional, or related to blood flow.
Risk Factors: Risk factors like hypertension, congenital heart disease, or previous heart surgery will influence the type of echo they choose.

How to Prepare for the Procedure

Food, Medications, and Other Preparations

Before an echocardiogram, you should let your cardiologist know if you are taking any medication, including aspirin, blood thinners, and mineral supplements. Here is a general guideline：

TTE:
Eat or drink normally before this test. You can generally take your regular medications before the test.
Wear comfortable, loose-fitting clothing. It is advisable to dress in a way that allows easy removal of your top, as the test involves placing electrodes and a probe on your chest.
TEE:
Before the procedure, you usually need to fast for 4 to 6 hours to prevent vomiting or aspiration during the procedure. This includes avoiding both food and drinks, except for a small sip of water with prescribed medications.
Remove all jewellery and wear comfortable clothing. Before the procedure, it is recommended that you take a bath or shower.
Stress Echocardiogram:
Exercise stress echocardiography:
To reduce the risk of nausea during exercise, avoid eating a heavy meal before. Opt for light meals instead.
Do not consume caffeine for at least 3 hours before the test, as it can affect heart rate and blood pressure
It is advisable to wear comfortable shoes and workout clothes, as you will be walking on a treadmill or pedaling a stationary bike.
Dobutamine stress echocardiography:
You may need to avoid food and drinks, except water, typically up to 4 hours before the test.
Wearing comfortable clothes allows electrodes to be placed easily.

Important Note: The information above is meant as a general guide. Since every patient is different, it’s always best to check with your cardiologist about whether you need to adjust your medications before your scheduled echocardiogram test.

At Capital Heart Centre, a cardiology clinic in Singapore, Dr Joshua Loh will give you personalised advice on how to prepare for your tests.

What to Expect

What Would Happen During the Procedure?

Transthoracic Echocardiogram (TTE)

Procedure: A TTE typically takes 30 to 60 minutes to complete. Small patches (electrodes) are placed on the chest before an imaging probe (ultrasound wand) is pressed against the chest to send high-frequency sound waves and pick up echoes.
Comfort Level: You might experience some discomfort during the transducer placement. However, do not worry; the discomfort is typically mild and temporary.

Transesophageal Echocardiogram (TEE)

Procedure: The procedure will last slightly longer, estimated at around 10 to 30 minutes. Your echocardiographer may also ask you to swallow a few times to shift the imaging probe into the oesophagus.
Comfort Level: You should not experience any significant pain during a TEE. For a TEE, you will be sedated before the procedure to numb your throat. Thus, you will not feel much during the procedure aside from mild discomfort caused by the anaesthetic being administered and the movement of the tube.

Stress Echocardiogram

Procedure: A stress echocardiogram takes about 45 to 60 minutes. Initially, baseline images of your heart are taken while you are at rest. Then, to raise your heart rate, you will be asked to exercise, either by walking on a treadmill or riding a stationary bike. After the exercise, more images of your heart are captured to see how it functions under stress. In cases where you cannot exercise, medication may be administered to simulate the effects of physical exertion.
Comfort Level: If you are exercising, it may feel strenuous, especially if you’re not accustomed to it. If medication is used instead of exercise, you may feel some side effects, such as a flushed feeling, but this generally resolves quickly. There should be no pain during the test, though mild discomfort from exertion is common.

What the Echocardiogram Data May Show

Heart Defects

Echocardiogram data can reveal irregular linkages between your heart and blood vessels or between the four chambers of your heart. These are usually related to congenital heart defects.

Damages to the Heart Muscles

Images from an echocardiogram may show damage to your heart tissue, which could be a sign of a past heart attack.

Various Heart Valve Problems

An echocardiogram may show any thickening or blockages inside your heart’s walls, signalling possible heart valve conditions such as stenosis (narrowing of the heart valves).

Extra tissue on your heart valves will also appear on the images, which could suggest infection or cancer.

Pump Strength

Since a TTE and TEE can accurately measure blood flow, suboptimal pump strength can be detected.

An echocardiogram will also detect if blood regurgitates back into the heart after each pump.

Changes in Heart Size

Echocardiogram data can help your cardiologist notice heart enlargement, indicating coronary artery disease and chronic high blood pressure.

Summary

Section	Summary
Purpose	Echocardiograms are a group of non-invasive or minimally invasive tests that rely on sound waves to assess heart structure and function, identify conditions, and monitor treatment progress.
Who May Need It	People with symptoms like chest pain, shortness of breath, irregular heartbeats, or known heart conditions like valve disease, coronary artery disease, and heart failure.
Types of Echocardiograms	Transthoracic (TTE): Uses an imaging probe on the chest to capture heart images. Transesophageal (TEE): Uses an imaging probe in the oesophagus for clearer images. Stress Echocardiogram: Monitors heart function under stress or exercise.
Preparation	Guidelines depend on the test type (TTE, TEE, Stress); they may involve fasting or avoiding certain foods/medications.
Procedure Experience	Generally painless, though some discomfort may occur. Stress echocardiograms may cause mild exertion discomfort.
Post-Procedure	Normal activities can usually be resumed after the test. Further tests may be needed based on the results
Results	Detects heart defects, valve issues, muscle damage, changes in heart size, and blood flow abnormalities.

Visit Capital Heart Centre

Patient speaking to a doctor at Capital heart Centre

Clear echocardiogram results can be crucial in helping cardiologists determine a correct diagnosis. Schedule an appointment with Dr Joshua Loh, Senior Consultant Interventional Cardiologist at Capital Heart Centre, which is conveniently located at Singapore’s Mt Elizabeth Novena Hospital. With more than 15 years of experience in the field of cardiology, Dr Loh is an expert in conducting detailed cardiac diagnostic and screening tests as well as executing complex coronary interventional procedures.

References

Echocardiogram. Mayo Clinic
https://www.mayoclinic.org/tests-procedures/echocardiogram/about/pac-20393856
Transesophageal Echocardiogram. Healthline
https://www.healthline.com/health/tee-procedure

How can we help you?

We offer consultation for a comprehensive range of cardiac diagnostic tests and treatment plans.

Dr Joshua Loh

Senior Consultant Interventional Cardiologist

Medical Director at Capital Heart Centre, Dr Joshua Loh has more than 20 years of experience in the field of cardiology.

He is experienced in the treatment of complex coronary and interventional procedures.