An echocardiogram, commonly called an echo test, uses ultrasound waves to create a moving picture of your heart. It shows the size and shape of your heart chambers, how well your heart pumps blood, whether your valves open and close properly, and how blood flows through the heart. It’s one of the most widely used heart tests because it reveals so much without any radiation or needles.
Heart Structure and Size
The echo gives your doctor a real-time view of all four heart chambers: the left and right atria (the two upper chambers) and the left and right ventricles (the two lower chambers). It measures the thickness of the heart walls and the dimensions of each chamber. Thickened walls can signal high blood pressure or a condition called hypertrophic cardiomyopathy, while enlarged chambers often point to heart failure or valve disease.
The test also captures the four heart valves (aortic, mitral, tricuspid, and pulmonary) and the major blood vessels connected to the heart, including the aorta. If any structure looks abnormal in size, shape, or movement, it shows up clearly on the ultrasound image.
How Well Your Heart Pumps
One of the most important numbers from an echo is your ejection fraction, often abbreviated as LVEF on your report. This tells you what percentage of blood the left ventricle pushes out with each beat. A normal ejection fraction falls between about 50% and 70%. A mildly reduced ejection fraction sits between 41% and 49%, and anything at 40% or below is considered reduced.
A low ejection fraction means the heart isn’t pumping efficiently, which is the hallmark of heart failure. Tracking this number over time helps your doctor see whether your heart function is stable, improving with treatment, or getting worse.
Valve Problems
Echo is the primary tool for detecting two main types of valve disease. Stenosis means a valve has become stiff or narrow and doesn’t open fully, forcing the heart to work harder to push blood through. Regurgitation (sometimes called a “leaky valve”) means the valve doesn’t close completely, allowing blood to flow backward.
The test can grade how severe these problems are. For a narrowed aortic valve, the echo measures how fast blood accelerates through the opening. Speeds above 4.0 meters per second with a high pressure difference across the valve indicate severe narrowing. For a leaky valve, the echo measures the width of the backward blood jet and how much blood volume is lost in the wrong direction. These measurements help determine whether you need monitoring, medication, or surgery.
Blood Flow Patterns
A technique called Doppler is built into most echo machines. It works by bouncing ultrasound off moving red blood cells and measuring the change in frequency of the returning signal. When blood cells move toward the ultrasound probe, the frequency increases; when they move away, it decreases. This shift lets the machine calculate exactly how fast blood is traveling and in which direction.
Color flow imaging takes this a step further, painting the blood flow on screen in color so your doctor can instantly spot turbulence or backward flow. Areas of unusually fast or chaotic flow often indicate a narrowed valve, a hole between chambers, or another structural problem. The audio signal from the Doppler can also help, since turbulent flow produces a distinctive sound that sometimes reveals problems before they’re visible on the screen.
Conditions an Echo Can Diagnose
The range of conditions an echo can identify is broad:
- Cardiomyopathy: diseases of the heart muscle that make it too thick, too stiff, or too weak
- Congenital heart defects: structural problems present from birth, such as holes between chambers or malformed valves
- Pericarditis and pericardial effusion: inflammation of the sac surrounding the heart, or fluid buildup inside it
- Blood clots: clots that form inside the heart chambers, which can travel to the brain and cause a stroke
- Heart tumors: growths inside the heart, whether cancerous or benign
- Infective endocarditis: a serious infection of the heart valves
- Aortic aneurysm: a dangerous bulge in the wall of the aorta
- Pulmonary hypertension: elevated pressure in the blood vessels of the lungs
An echo can also reveal damage from a heart attack by showing sections of the heart wall that no longer contract normally.
Types of Echo Tests
The standard echo is a transthoracic echocardiogram, or TTE. A technician presses an ultrasound probe against your chest, and the sound waves pass between your ribs to reach the heart. It’s painless and takes roughly 30 to 60 minutes.
A transesophageal echocardiogram, or TEE, involves a thin probe guided down your throat into the esophagus, which sits directly behind the heart. Because there’s no lung or bone between the probe and the heart, the images are sharper, especially for structures at the back of the heart. TEE is typically reserved for specific situations: looking for blood clots in the left atrial appendage (a common hiding spot in people with atrial fibrillation), evaluating heart valve infections, checking prosthetic valve function, or diagnosing a tear in the aorta. It’s also used during certain heart surgeries and catheter-based procedures to guide the surgeon in real time.
A stress echocardiogram combines an echo with exercise or medication that makes your heart beat faster. You’ll either walk on a treadmill or receive a drug that mimics the effect of exercise. Images taken before and during the stress show whether parts of the heart muscle aren’t getting enough blood flow when demand increases, which suggests blocked or narrowed coronary arteries. If you can’t exercise due to joint problems, deconditioning, or frailty, the medication-based version provides the same diagnostic information.
Reading Your Echo Report
Echo reports are packed with abbreviations that can look intimidating. Here are some of the most common ones you’ll encounter:
- LVEF: left ventricular ejection fraction, the pumping percentage described above
- LVH: left ventricular hypertrophy, meaning the wall of the left ventricle is thicker than normal
- MR: mitral regurgitation, a leaky mitral valve
- AR: aortic regurgitation, a leaky aortic valve
- AS: aortic stenosis, a narrowed aortic valve
- LVEDD: left ventricular end-diastolic diameter, the size of the left ventricle when it’s fully relaxed and filled with blood
Most reports will grade any abnormality as mild, moderate, or severe. A “normal” or “unremarkable” echo means the heart’s size, function, and valves all looked healthy. If something is flagged as “trivial” or “trace,” it usually describes a tiny amount of valve leakage that’s common and not clinically significant.