A transthoracic echocardiogram (TTE), often called an “echo” or a cardiac ultrasound, is a non-invasive diagnostic procedure. It uses high-frequency sound waves to generate moving pictures of the heart’s structure and function. A device placed on the chest wall transmits and receives these sound waves. The echoes that bounce off the heart tissue are processed by a computer to create real-time images, providing a detailed assessment without the use of X-rays or radiation.
Why the Test is Performed
The TTE provides a clear picture of the heart’s overall health and is ordered for various indications. The procedure determines how effectively the heart is pumping blood, a function quantified by the left ventricular ejection fraction (LVEF). It measures the size and shape of the heart’s four chambers, detecting conditions like enlargement or wall thickening caused by high blood pressure or other diseases.
The test also evaluates the condition of the heart’s four valves, which control the direction of blood flow. It identifies structural abnormalities, such as narrowing (stenosis) or leakage (regurgitation), by observing valve movement. Additionally, the TTE can detect masses inside the heart, like blood clots or tumors, or fluid accumulating around the heart (pericardial effusion). This comprehensive assessment helps diagnose symptoms such as chest pain, shortness of breath, or heart murmurs.
Preparing for Your Appointment
The TTE procedure requires very little special preparation. There is typically no need to fast, and you can eat, drink, and take prescribed medications as you normally would, unless your doctor provides specific instructions. Patients should wear comfortable, two-piece clothing so they can easily undress from the waist up for the examination.
You will be provided with a gown for privacy and comfort during the procedure. It is recommended to arrive about 15 minutes before your scheduled time to complete any necessary check-in paperwork.
What Happens During the Examination
Upon entering the examination room, you will undress from the waist up and lie on the table, typically on your left side. This positioning shifts the heart closer to the chest wall, allowing the technician to obtain clearer images. Electrodes will be placed on your chest and connected to an electrocardiogram (ECG) machine to monitor your heart’s electrical activity during the scan.
The cardiac sonographer, the professional performing the test, will apply a clear, cool, water-soluble gel to your chest. This gel eliminates air pockets and ensures the sound waves from the transducer travel efficiently to the heart and back. The sonographer presses a wand-like device called a transducer firmly against your chest, moving it to capture images from different angles of the heart.
During the scan, you may be asked to hold your breath or move slightly to improve visibility. The machine may emit swishing sounds, which are the acoustic coding of blood flow processed by Doppler technology. Doppler measures the speed and direction of blood moving through the chambers and valves. The procedure is painless, though you may feel slight pressure, and typically takes 30 to 60 minutes to complete. Once finished, the gel is wiped away, and you can immediately resume normal activities.
Interpreting the Findings
The cardiac sonographer acquires high-quality images but does not provide a diagnosis or share the results immediately. The captured images are recorded digitally and sent for review by a cardiologist, a physician specializing in heart conditions. The cardiologist systematically analyzes the data, including precise measurements of the heart’s anatomy and performance.
Specific measurements analyzed include the thickness of the heart muscle walls, chamber volume, and the velocity of blood flow across the valves. The cardiologist calculates the LVEF, which indicates the heart’s pumping efficiency. Once the analysis is finished, the cardiologist generates a report and sends it to the physician who requested the test. Your referring doctor will then schedule a follow-up consultation to discuss the results and outline any next steps.