Cardiac Ultrasound (Echocardiography): What It Shows and How It Is Performed

You have been given a referral for a cardiac ultrasound — and you want to understand why these 30–40 minutes in the exam room matter and what exactly the doctor will see. Let's break it down step by step: echocardiography uses ultrasound, not X-rays, and it shows the heart in motion rather than in a static image.

What a cardiac ultrasound and echocardiography are

Echocardiography (EchoCG) is the same thing as a cardiac ultrasound: an ultrasound method that assesses the structure and function of the heart and its valve apparatus. The physics is simple: ultrasound reflects off media with different acoustic densities, the transducer picks up the reflected signal, and the machine converts it into an image.

The transducer is moved by a sonographer — a specially trained technician — and the results are interpreted by a cardiologist. There is no radiation, and the picture is more detailed than a standard X-ray; the image can be two- or three-dimensional, and Doppler mode shows the movement of blood through the heart.

What a cardiac echo shows

A cardiac echogram shows the thickness of the walls, the volume of the chambers, the condition of the valves, the contractile activity of the myocardium, and the speed and pattern of blood flow in the atria and ventricles.

What it helps detect: valve abnormalities, congenital defects, muscle damage after a heart attack, heart murmurs, inflammation or fluid in the cavity around the heart, infective endocarditis, pulmonary hypertension, pump function in heart failure, and the source of a thrombus after a stroke or transient ischemic attack.

When echocardiography is ordered

There are two goals: to check whether your symptoms are caused by heart disease, and to assess heart function if a problem is already known — for example, after a heart attack.

Indications: coronary heart disease, chest pain of unclear origin, congenital and acquired defects, ECG changes, murmurs, rhythm disorders, hypertension, and signs of heart failure. Complaints can also be a reason:

• shortness of breath;
• dizziness and weakness;
• loss of consciousness;
• rapid heartbeat, "skipped beats," chest pain.

In children, echocardiography is performed for diagnostic purposes — during periods of growth and development, complaints often arise. There are no absolute contraindications; the scan may be more difficult with respiratory diseases, chest deformities, pronounced hairiness, or skin inflammation on the chest.

How a cardiac ultrasound is performed in adults and children

The most common option is transthoracic echocardiography (TTE). No preparation is needed: you eat and drink as usual. In the exam room, you undress to the waist, put on a gown, and lie down; sticky electrodes are placed on the chest to monitor the pulse, and gel is applied to the skin. The sonographer slowly moves the transducer over the chest and upper abdomen: you feel light pressure, and the machine makes loud noise. You may be asked to breathe in a certain way or turn onto your left side. The procedure takes 30–40 minutes. If the image is obscured by the lungs, ribs, or tissues, a small amount of contrast is injected into a vein and you are asked to wait up to 30 minutes.

There is also stress echo: a scan before and after exercise on a treadmill or stationary bike — this shows how the heart works under stress. In children, the transducer is placed in the same way; you can ask for a close person or a healthcare worker to be nearby in the exam room.

Transesophageal echocardiography: how it differs

Transesophageal EchoCG: a thin tube with an ultrasound transducer at the end is inserted through the mouth into the esophagus — closer to the heart, giving a more detailed picture. It is not painful but is uncomfortable: the back of the throat is numbed with a spray, and a sedative is given if desired — you are not asleep but very drowsy. For several hours before the test, you must not eat or drink.

It is ordered when TTE gives an unclear picture (chest shape, lung disease, excess weight) or when detail is needed: signs of endocarditis, thrombi, or other abnormal structures. Risks: reaction to the sedative, damage to the esophagus — more often if there have already been esophageal problems. Afterward — no driving for 24 hours, someone else takes you home, and your throat may hurt for 1–2 days.

How to understand the echogram result and when to see a doctor

Normal: normal valves and chambers, normal wall motion. Abnormalities vary — minor ones without serious risk, and signs of serious disease (valve defect, cardiomyopathy, pericardial effusion), where further evaluation by a specialist is needed.

The result is sometimes discussed the same day, more often at a separate appointment with an explanation: what was found and what tests are still needed. If you do not understand a wording — ask. If you hear nothing for several weeks — call the doctor who referred you for the scan.

A referral for a cardiac ultrasound is not in itself a reason to call an ambulance; 103 or 112 — if signs of a heart attack or stroke appear.

This material is for reference: it explains the logic of the examination but does not replace a doctor's consultation — discuss the numbers and conclusions from your echogram with a cardiologist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer