How you prepare for an echocardiogram depends entirely on which type you’re getting. A standard echocardiogram requires almost no preparation at all, while a transesophageal or stress echocardiogram involves fasting, caffeine restrictions, or medication changes. Your scheduling paperwork or provider should tell you which type you’re having, and that determines what you need to do beforehand.
Standard (Transthoracic) Echocardiogram
A standard echocardiogram, called a transthoracic echo or TTE, is the most common type. A technician places an ultrasound probe on your chest to capture images of your heart. It requires no fasting, no sedation, and no special preparation.
The one practical thing to plan for is your clothing. You’ll remove everything from the waist up and put on a hospital gown, so wearing a loose-fitting top that buttons or zips makes things easier. You can eat, drink, and take your medications as normal beforehand. You can also drive yourself to and from the appointment.
Transesophageal Echocardiogram (TEE)
A TEE captures images from inside your esophagus rather than through your chest wall. Because a flexible probe is guided down your throat, this type involves sedation and requires more preparation than a standard echo.
Fasting Requirements
You’ll need to stop eating by midnight the night before the procedure. You can still drink clear liquids, but stop drinking anything two hours before your scheduled arrival time. An empty stomach reduces the risk of nausea during sedation and while the probe is in your throat.
Arrange a Ride Home
This is the preparation step that catches people off guard. Because you’ll be sedated, you cannot drive yourself home. Most facilities follow a 24-hour restriction on driving after sedation, even though newer sedation drugs wear off faster than older ones. If you show up without a driver arranged, some facilities will admit you to an observation unit overnight rather than let you leave alone. Have a specific person confirmed as your ride before the day of the procedure.
What to Expect Afterward
Before the procedure, you’ll gargle with a numbing solution to suppress your gag reflex. That numbness lasts about an hour after the test is done. Don’t eat or drink anything until it fully wears off, because you could choke without the normal sensation in your throat. Once the numbness fades, a sore throat is normal and can last anywhere from a few hours to a few days.
Stress Echocardiogram
A stress echo combines exercise (or a medication that simulates exercise) with ultrasound imaging to see how your heart performs under strain. The preparation is more involved than a standard echo and starts the day before.
Caffeine and Tobacco
Avoid all caffeine for 24 hours before the test. That includes coffee, tea, energy drinks, chocolate, and decaf coffee (which still contains small amounts). Caffeine affects heart rate and can interfere with the accuracy of results. Stop smoking or using any tobacco products on the day of the test as well.
Medications
Certain heart medications can mask the very responses the stress test is designed to measure. Beta-blockers and calcium channel blockers in particular need to be stopped 48 hours before the test. If you continue taking them, the test may need to be postponed entirely. That said, never stop any medication on your own. Your provider will tell you exactly which ones to pause and which to keep taking.
Clothing and Food
If your stress echo involves exercise on a treadmill or stationary bike, wear comfortable, supportive shoes and clothes you can move in. Your provider may also ask you to avoid eating for a few hours beforehand, since exercising on a full stomach can cause nausea. Light meals are generally fine earlier in the day.
General Tips for Any Type
Regardless of which echocardiogram you’re having, a few things make the appointment go more smoothly. Bring a list of your current medications, including doses, since the technician or provider will want to review them. If you wear a bra, you’ll likely need to remove it for any type of echo, so plan accordingly. Leave necklaces and chest jewelry at home.
Arrive a few minutes early to fill out paperwork and change if needed. A standard TTE is typically the shortest appointment. Stress echos take longer because of the exercise component and recovery imaging. A TEE adds time for sedation, the procedure itself, and a recovery period while the sedation wears off. For a TEE, plan to be at the facility for a few hours total, even though the imaging itself is relatively quick.
If you’re unsure which type of echocardiogram you’ve been scheduled for, call your provider’s office and ask. The preparation differences are significant enough that it’s worth confirming, especially the fasting and medication changes required for TEE and stress echo.