A non-invasive ultrasound scan used to assess the heart chambers, valves, muscle and pumping function.
An echocardiogram, often called an echo or transthoracic echocardiogram (TTE), uses ultrasound to produce moving images of the heart. It is performed by placing an ultrasound probe on different areas of the chest.
The test shows how the heart chambers, valves and muscle are working at the time of the examination. Doppler ultrasound also assesses blood flow through the heart. It may be requested for a heart murmur, unexplained breathlessness, possible heart failure, valve disease, high blood pressure, an abnormal ECG, cardiomyopathy or monitoring of an established heart problem.
Dr Mark Cassar personally performs and interprets transthoracic echocardiography, allowing the images to be considered alongside the symptoms, examination findings and clinical question.
For more specialised questions, related tests include transoesophageal echocardiography and dobutamine stress echocardiography.
TTE assesses heart-chamber size, left and right ventricular contraction, relaxation and filling, valve structure and function, heart-muscle thickness and movement, the sac around the heart and estimated pressures within the pulmonary circulation.
It is the main initial imaging test for valve narrowing or leakage. A murmur does not automatically mean significant valve disease, and the importance of a valve abnormality cannot be judged from a single measurement. Symptoms, Doppler measurements and the effect on the heart must be considered together.
The scan assesses chamber size, pumping function, filling, wall thickness and movement. Ejection fraction is useful, but it is only one part of the examination.
Doppler imaging assesses valve narrowing, leakage and pressure changes. Findings are interpreted with symptoms and the effect on the heart chambers.
No needles, injections or radiation are normally involved. You will usually remove clothing from the upper body and lie partly on your left side. ECG stickers may be attached, ultrasound gel is applied, and the probe is moved across several positions on the chest. Gentle pressure and brief breath-holding may be needed to obtain clear views.
Image quality varies because the heart lies behind the ribs and lungs. Measurements may differ slightly with image angle, heart rate, blood pressure and technical conditions. A normal TTE is reassuring about many structural problems, but it does not exclude coronary artery disease, intermittent rhythm disturbances or every cause of breathlessness, dizziness or chest pain.
Dr Cassar interprets the study as part of the clinical assessment rather than as a stand-alone result. Comparison with previous studies can be as important as a single current measurement.
Provides closer views of selected valves and structures when chest-wall imaging does not answer the question.
Detailed assessment of heart-muscle structure and tissue characteristics.
Useful for coronary arteries, the aorta and detailed three-dimensional anatomy.
Assesses the heart under controlled stress and answers a different question from resting TTE.
No. An ECG records electrical activity. An echocardiogram uses ultrasound to show the heart’s structure and movement.
Most people find it straightforward. Some pressure is needed between the ribs and can be mildly uncomfortable if the chest is tender.
There is usually no special preparation. You can generally eat, drink and take usual medicines unless advised otherwise.
A resting TTE does not show most coronary narrowings directly and cannot rule out coronary artery disease.
Not necessarily. Valve disease, filling abnormalities, right-heart problems and other conditions may be present despite preserved ejection fraction.
The report should state any limitations. Repeat imaging, contrast echocardiography, TOE, MRI or CT may be considered when an important structure cannot be assessed reliably.
Dr Mark Cassar can review your symptoms, examination findings and previous results, and arrange or perform echocardiography where clinically appropriate.
