Getting an echocardiogram typically starts with a referral from your primary care doctor or a cardiologist. In most cases, you’ll need a medical reason for the test, such as symptoms like shortness of breath, chest pain, or an abnormal heart sound detected during a physical exam. The process from initial visit to completed test can take anywhere from a few days to a few weeks, depending on urgency and scheduling availability.
Who Needs an Echocardiogram
An echocardiogram isn’t a routine screening test. It’s ordered when your doctor suspects a specific heart problem or needs to monitor a known condition. Common reasons include evaluating heart murmurs, assessing valve problems, checking how well your heart pumps after a heart attack, investigating unexplained shortness of breath or leg swelling, and monitoring conditions like high blood pressure that can damage the heart over time.
If you’ve had heart surgery or a valve replacement, periodic echocardiograms are standard follow-up. The test is also used to evaluate congenital heart defects, check for fluid around the heart, and look for blood clots or tumors inside the heart chambers. For insurance to cover the test, there generally needs to be a documented medical indication, not just a desire for reassurance.
Steps to Get One Scheduled
The most straightforward path is to bring up your symptoms or concerns with your primary care doctor. If they hear something abnormal with a stethoscope, notice signs of heart trouble on an EKG, or your symptoms point toward a cardiac cause, they can order an echocardiogram directly or refer you to a cardiologist who will order it. A cardiologist referral adds a step but may be required by your insurance plan.
Once the order is placed, the imaging center or hospital scheduling department will contact you (or you’ll call them) to set up an appointment. Wait times vary by location and urgency. If your doctor flags the request as urgent, you may get in within days. For routine monitoring, expect to wait one to three weeks in most areas.
Can You Get One Without a Referral?
Some private, for-profit companies market heart screenings directly to consumers, often at community centers or in mobile vans. These don’t require a doctor’s order, but they come with significant limitations. The screening is done without context about your personal risk factors, and results can produce false positives that lead to unnecessary follow-up testing, added cost, and anxiety. False negatives are also possible, giving you unwarranted reassurance. Harvard Health experts caution that screening is “all about the context,” and a test that makes sense for one person may not be appropriate for another. If you’re concerned enough to want an echocardiogram, seeing a doctor first will get you a more reliable and useful result.
Types of Echocardiograms
Your doctor will order one of a few types depending on what they need to see.
Transthoracic echocardiogram (TTE) is by far the most common. It’s completely noninvasive. A technician applies gel to your chest and moves a handheld probe across the skin to capture images of your heart using sound waves. No needles, no sedation.
Transesophageal echocardiogram (TEE) involves guiding a small ultrasound probe down your throat into your esophagus. Because the esophagus sits right behind the heart, this produces sharper images without interference from ribs, skin, or lung tissue. It’s used when a standard echo doesn’t provide clear enough pictures, or when your doctor needs high-resolution views of specific structures like the heart valves or left atrium. You’ll be sedated for this one.
Stress echocardiogram combines a standard echo with exercise. The technician takes images of your heart at rest, then again after you’ve worked out on a treadmill or stationary bike. If you can’t exercise, a medication is given through an IV to raise your heart rate instead. This test reveals how your heart performs under strain, which can expose problems like blocked arteries or valve issues that don’t show up at rest.
How to Prepare
For a standard transthoracic echo, preparation is minimal. You can eat, drink, and take your medications as usual. You’ll be asked to remove clothing from the waist up and change into a hospital gown. That’s about it.
A transesophageal echo requires more planning. You’ll typically need to stop eating and drinking for several hours beforehand. Because sedation is involved, you’ll need someone to drive you home afterward. For a stress echo, your doctor may ask you to temporarily stop certain heart medications, like beta blockers, that would prevent your heart rate from rising during exercise. Always confirm medication instructions with your doctor’s office before the test day.
What Happens During the Test
A standard TTE takes about 30 minutes to an hour. You’ll lie on an exam table, usually on your left side. The sonographer attaches small adhesive patches to your chest to monitor your heart rhythm, then applies a warm gel to your skin. They press a wand-like probe against your chest and move it to different positions. You may feel mild pressure but no pain. At various points, you’ll be asked to hold still, shift positions, or take specific breaths so the sonographer can capture different angles.
Sometimes the initial images aren’t clear enough, particularly if you have a larger body frame or lung disease. In those cases, the technician may inject a contrast agent through an IV in your arm. These are tiny microbubbles that show up brightly on the ultrasound, helping outline the heart chambers and reveal structures that were hard to see. This is painless and adds only a few minutes to the procedure. Once all the images are captured, the gel is wiped off, the patches are removed, and you can go about your day immediately.
Getting Your Results
The sonographer captures the images, but a cardiologist interprets them. Most results are available within 24 hours. Your ordering doctor will typically call or send a message through your patient portal to discuss the findings.
One of the key numbers on your report is your ejection fraction, which measures how much blood your heart pumps out with each beat. A normal ejection fraction falls between 50% and 70% (slightly higher in women, ranging from 54% to 74%). A mildly reduced ejection fraction, around 41% to 51%, means your heart’s pumping ability is slightly below normal, though you may not notice any symptoms. Below 40% indicates a more significant problem and is classified as heart failure with reduced ejection fraction. Your report will also describe the size of your heart chambers, how your valves are opening and closing, and whether any abnormal masses or fluid collections are present.
If the results are abnormal, your doctor may order additional testing, adjust your medications, or refer you to a cardiologist if you aren’t already seeing one. A single echocardiogram often becomes a baseline for future comparisons, so your doctor may recommend repeat studies at regular intervals to track changes over time.
What It Costs
The sticker price for an echocardiogram averages around $3,400, but what you actually pay depends heavily on your insurance, your deductible status, and where the test is performed. Real out-of-pocket costs reported by patients range from about $337 to over $4,000. An echo done at a hospital-based outpatient center generally costs more than one performed at an independent imaging facility. If cost is a concern, call ahead and ask the facility for a price estimate, and check with your insurer to confirm the location is in-network. With a valid medical indication and a doctor’s order, most insurance plans cover diagnostic echocardiograms, though you’ll still be responsible for any copay or coinsurance your plan requires.