A good echocardiogram shows a heart that pumps efficiently, with chambers that are normal in size, valves that open and close properly, and walls that contract evenly. The single most important number on the report is your ejection fraction, which should fall between 50% and 70%. If your results come back in these ranges with no structural abnormalities, your heart is functioning well.
Ejection Fraction: The Key Number
Ejection fraction measures the percentage of blood your left ventricle pushes out with each beat. A normal reading is 50% to 70%, meaning your heart sends more than half its blood volume into your body every time it contracts. Below 50% signals that your heart isn’t pumping as effectively as it should, which can be an early sign of heart failure. Interestingly, a number above 75% isn’t necessarily better. Very high ejection fractions can indicate a condition where the heart muscle is abnormally thick, which also requires medical attention.
The lower normal limit differs slightly by sex: about 51% for women and 50% for men. So if your report shows an ejection fraction of, say, 58%, that’s solidly normal. Your report will likely describe this as “preserved left ventricular systolic function,” which is exactly the phrase you want to see.
Normal Chamber Size
The echocardiogram measures all four chambers of your heart. Enlarged chambers can signal that the heart is working harder than it should, often due to high blood pressure, valve disease, or other conditions that force the heart to compensate over time. A good report describes the chambers as normal in size or “within normal limits.”
The left atrium (the upper-left chamber that receives blood from your lungs) is one of the most closely watched measurements. Its volume is indexed to your body surface area, and the upper normal limit ranges from about 44 to 53 milliliters per square meter depending on how the measurement is taken. The right ventricle, which pumps blood to your lungs, normally measures up to about 43 to 53 millimeters across at its widest point. You don’t need to memorize these numbers. What matters is whether your report says the dimensions are normal, mildly enlarged, or significantly enlarged.
Valve Function
Your heart has four valves, and the echocardiogram checks each one for two problems: stenosis (a valve that doesn’t open wide enough) and regurgitation (a valve that leaks backward). A good result shows all four valves opening and closing properly, with no significant narrowing and no meaningful leakage.
Here’s something that catches many people off guard: mild regurgitation, particularly in the tricuspid valve (the valve between your right-side chambers), is extremely common and not a cause for concern. Your report might note “trace” or “mild” regurgitation, and that’s still considered a normal finding. It’s moderate or severe regurgitation, or any degree of stenosis, that warrants closer attention.
Wall Motion and Thickening
During each heartbeat, your heart muscle should thicken and contract evenly across all segments of the ventricle. A good echocardiogram shows normal wall motion throughout, with each segment thickening by at least 30% when it contracts. The report will describe this as “normal wall motion” or note that there are “no regional wall motion abnormalities.”
When part of the heart wall doesn’t move properly, it can indicate damage from a previous heart attack or reduced blood flow to that area. Mild hypokinesia means a segment is moving less than it should (thickening only 20% to 29%). Akinetic means a segment isn’t moving at all. These findings on a report are red flags that prompt further testing. Their absence is one of the clearest signs of a healthy heart.
What the Report Language Means
Echocardiogram reports use specific terminology that can feel intimidating when you first read them. A few key phrases signal good news:
- Preserved systolic function: Your heart’s pumping ability is normal.
- Normal chamber dimensions: No enlargement of the heart’s cavities.
- No significant valvular abnormality: Your valves are working properly (trace leakage may still be noted, which is fine).
- No pericardial effusion: There’s no abnormal fluid collection around the heart.
- Normal wall motion: All segments of the heart muscle are contracting as expected.
If your report contains mostly these phrases, your echocardiogram looks good. Reports that flag problems will typically use words like “dilated,” “reduced,” “moderate” or “severe” regurgitation, or “wall motion abnormality.”
What Affects Image Quality
Not all echocardiograms produce equally clear images, and a technically limited study doesn’t mean anything is wrong with your heart. The ultrasound probe needs a clear path to the heart through what’s called an “acoustic window.” Technicians use four main windows: the left side of the chest near the breastbone, the apex of the heart near your left armpit, below the ribcage, and above the collarbone. You’ll be positioned on your left side for most of the exam, which shifts the heart closer to the chest wall for better images.
Body habitus, lung disease, and rib spacing can all make it harder to get clear pictures. The technician constantly balances image sharpness against the depth needed to see deeper structures. They’ll also use Doppler imaging, which adds color to show the direction and speed of blood flow through your valves. If you’ve ever seen the red and blue patterns on an echo image, that’s Doppler showing blood moving toward and away from the probe. A clean Doppler signal with no turbulent jets of color shooting backward through a valve is another visual hallmark of a healthy heart.
The Test Itself and Getting Results
A standard transthoracic echocardiogram (the most common type, done from outside the chest) takes 45 to 60 minutes for image capture. Complicated cases can take up to 90 minutes. The test is painless, though the pressure of the ultrasound probe between your ribs can be mildly uncomfortable.
After the sonographer collects the images, a cardiologist reviews them and writes the final report. Most doctors have results within 24 hours. If you haven’t heard anything within a few days, it’s reasonable to call your doctor’s office and ask. In many health systems, the report also becomes available through your patient portal, where you can review the specific numbers and terminology covered here.