Echocardiogram: Types and What They Show (2024)

How is a transthoracic echocardiogram done?

A transthoracic echo is the type most people think of when they hear “heart echo.” It’s also the type most often used. It’s performed outside your body.

A sonographer places a hand-held wand (called a transducer) on the outside of your chest to send sound waves to your heart. These sound waves bounce off the different parts of your heart.

These “echoes” then appear as pictures on the sonographer’s computer screen. These pictures can also be saved for your cardiologist and physician to review later.

Preparing for a transthoracic echo

There’s not much you need to do to prepare for this type of echo. In general:

You don’t need to avoid eating or drinking before a transthoracic echo.
Take your medications as you usually do.
Wear anything you’d like.
Leave anything valuable at home. You’ll be given a storage locker to use during the test.

What to expect during a transthoracic echo

A transthoracic echo includes the following steps:

You’ll be asked to remove your clothing from the waist up. You’ll put on a hospital gown.
Your sonographer will place several electrodes on your chest. These are small, flat, sticky patches. The electrodes are attached to an electrocardiograph (EKG) monitor. The EKG records your heart’s electrical activity during the test.
You’ll lie down on an exam table. Your sonographer will ask you to lie on your left side if possible.
Your sonographer will place a sound-wave transducer (wand) on several areas of your chest. There’s a small amount of gel on the end of the wand, which won’t harm your skin. This gel helps produce clearer pictures.
You may hear swishing sounds throughout the test. This is normal. It means you’re hearing blood flowing through your heart as the wand picks up the sound.
Throughout the test, your sonographer may ask you to hold your breath for several seconds at a time. You may also need to move into a different position.

You should feel no major discomfort during the test. You may feel a coolness on your skin from the gel on the wand. You may also feel a slight pressure of the wand against your chest.

How is a transesophageal echocardiogram done?

A transesophageal echo takes pictures from inside your chest, rather than from the outside. It can show your heart and valves in greater detail than a transthoracic echo. That’s because your body’s bones and tissues aren’t in between the transducer and your heart.

For this test, the sonographer guides a small transducer down your throat and esophagus (food tube) using a long, flexible tube. This minimally invasive procedure may cause mild, temporary discomfort. But it has a low risk of serious problems.

This type of echo may be used:

When your provider needs a detailed look at your aorta or the back of your heart (especially your left atrium or left ventricle).
To check for blood clots.
To evaluate your mitral valve or aortic valve.
If you have obesity or lung disorders.
If a transthoracic echo isn’t possible for various other reasons.

Preparing for a transesophageal echo

As you prepare for your echo, tell your doctor if you have:

Problems with your esophagus, like a hiatal hernia.
Problems swallowing.
Sleep apnea.
IV drug use.

It’s also important to share if you take medication for:

Sleep issues.
Anxiety.
Pain.

Preparations for the day of your test include:

Find someone to drive you home from your test. This is because you’ll be sedated for the test, and you won’t be able to drive for 24 hours.
Don’t eat or drink anything for at least six hours before your test. Your provider may give you more specific instructions for eating and drinking. It’s essential you follow these closely.
Ask your provider about when to take your usual medications. You may be able to take them at your usual time with a small sip of water.
Ask your provider about when and how to take your diabetes medication, if this is relevant to you.
Plan to leave any valuable personal items at home. You’ll have access to a storage locker for your belongings during the test.
Plan to wear whatever’s most comfortable for you. You’ll change into a hospital gown before the echo begins.

What to expect during a transesophageal echo

A transesophageal echo includes the following steps:

You’ll remove your clothing from the waist up and put on a hospital gown.
Your provider will place electrodes (small stickers) on your chest. The electrodes allow your sonographer to monitor your heart’s electrical activity during the test.
Your provider will place a blood pressure cuff on your arm and a pulse oximeter on your finger.
You’ll gargle with a solution that numbs your throat. Your provider will also spray your throat with pain-relieving medication.
To make you more comfortable, you’ll be hooked up to an IV and sedated. You’ll soon start to feel sleepy.
You may have a tube in your nose that provides oxygen.
You’ll lie on your left side on the exam table.
The provider will insert an endoscope into your mouth. This is a long, thin, flexible tube that has a transducer on the tip. The tube travels into your throat and esophagus. It’s lubricated to help it slide down more easily. While this may feel uncomfortable, it won’t harm you. You may need to swallow to move the transducer into the right spot (just behind your heart).
Your provider will take pictures. You won’t feel anything while this happens.
After your provider has the pictures they need, they’ll remove the tube from your throat. You’ll soon be able to get dressed and get ready to leave.

How is an exercise stress echocardiogram done?

An exercise stress echo, sometimes simply called a stress echo, shows how your heart works when it’s taxed. The test resembles a traditional exercise stress test. A technician will monitor your heart rate and rhythm as well as your blood pressure (this is standard during a stress test). But they’ll also use echo imaging (which isn’t normally used during a stress test).

This test shows how well your heart can withstand activity. Your sonographer takes pictures before you start exercising and then right after you’re done.

In some cases, you won’t exercise. Instead, your provider will give you medication to make your heart work harder as if you were exercising. The goal is to force your heart to need more oxygen.

When your heart is under stress, your sonographer can see details they might not be able to see if you were lying on the exam table. These include problems with your coronary arteries or the lining of your heart.

Preparing for an exercise stress echo

Your provider will give you detailed instructions on how to prepare for your test. An exercise stress echo needs more preparation than other types of echo testing. These include:

Not eating or drinking anything except water for at least four hours before your test.
Not smoking on the day of your test.
Avoiding caffeine for 24 hours before your test. This includes caffeine in any form (coffee, tea, decaf drinks and some over-the-counter pain medicines).

Ask your provider when and how to take your usual medications. You may need to avoid taking certain heart medications on the day of your test. You may also need to change your dose of diabetes medication. Closely follow your provider’s guidance.

You won’t be sedated, but you still may want to ask someone to drive you to and from the appointment. You may feel tired after the test.

Plan to wear comfortable clothes and shoes. You’ll need to walk or ride a stationary bike during the test, so wear what feels good for you.

What to expect during an exercise stress echo

The exercise stress echo will include the following steps:

Your sonographer will place electrodes (small stickers) on your chest. These stickers are hooked up to an EKG monitor to check your heart rate and rhythm during the test.
Your provider will measure your heart rate, heart rhythm and blood pressure before you start moving.
You’ll lie on an exam table so your sonographer can take pictures of your heart. They’ll place a hand-held wand (the kind usually used for echo tests) on the outside of your chest in various spots.
Then, it’s time to start moving. You’ll walk on a treadmill or pedal on a stationary bike. The intensity will gradually increase. You’ll keep going until you’re exhausted. This usually takes seven to 12 minutes.
As you’re exercising, a technician will ask how you’re feeling. Tell them any and all symptoms you notice. They’ll also watch your heart on the EKG monitor.
You’ll stop moving, and you’ll have another echo test done.
You’ll then do a short cool-down (slow walking or cycling), and your provider will monitor your vitals until they’re back to normal.

If you were given medication to stress your heart, the process will be a bit different. You won’t be on a treadmill or bike. Talk to your provider to learn what to expect and how you might feel during this type of test.