An echocardiogram is an ultrasound of your heart. It uses high-frequency sound waves to create moving pictures of your heart as it beats, showing its structure, pumping ability, and blood flow through each valve. A standard echocardiogram takes about an hour from start to finish, though the time varies depending on the type.
What an Echocardiogram Shows
Unlike an EKG, which records your heart’s electrical signals on a graph, an echocardiogram produces a real-time video of your heart in motion. This lets your doctor see the size of each of your heart’s four chambers, how well the left ventricle (the main pumping chamber) is working, and whether blood is flowing normally through the valves.
One of the most important numbers from an echo is your ejection fraction, which measures the percentage of blood your left ventricle pumps out with each beat. A normal ejection fraction is 50% to 70% (slightly higher in women, at 54% to 74%). An ejection fraction of 40% to 49% is considered mildly reduced, and anything below 40% indicates heart failure with reduced pumping ability. Your doctor uses this single number, along with the rest of the echo images, to gauge how well your heart is functioning overall.
How Long Each Type Takes
There are several types of echocardiograms, and each one has a different time commitment.
Transthoracic Echocardiogram (TTE)
This is the standard version and the one most people get. A sonographer applies gel to your chest and moves a small handheld probe across it to capture images. The whole appointment takes about an hour. There’s no sedation, no needles, and no special preparation. You can eat, drink, and take your medications normally beforehand, and you can drive yourself home afterward.
Transesophageal Echocardiogram (TEE)
A TEE captures images from inside the esophagus, which sits directly behind the heart. This gives a clearer view of certain structures, especially the valves and the back chambers, that can be harder to see through the chest wall. You’ll receive sedation and a numbing spray for your throat before a thin, flexible probe is guided down your esophagus. The actual image-taking portion typically lasts about 15 minutes, but the full appointment, including preparation and recovery, can take up to 90 minutes. You’ll need to stop eating and drinking at least six hours before the test, your throat will feel numb for about an hour afterward, and you won’t be able to drive for 24 hours because of the sedation.
Stress Echocardiogram
A stress echo combines a standard echo with exercise, usually on a treadmill. Images are taken before and immediately after you exercise so your doctor can compare how your heart performs at rest versus under strain. The actual exercise portion lasts about 10 to 15 minutes, and the full test takes roughly an hour. If you can’t exercise, medication can be used to raise your heart rate instead.
Fetal Echocardiogram
This is a specialized ultrasound of a baby’s heart during pregnancy. It works the same way as a standard echo, with a probe placed on the mother’s abdomen, and typically takes 45 to 60 minutes for a single baby.
What the Experience Feels Like
For a standard transthoracic echo, you’ll change into a gown and lie on your left side on an exam table. The sonographer applies a water-based gel to your chest (it’s cool but not cold) and presses the ultrasound probe against different areas to get views from multiple angles. You may be asked to hold your breath briefly at certain points, which helps the sonographer get clearer images. The probe applies light to moderate pressure, but the test is painless. There’s no radiation involved, and you can return to normal activities immediately.
A TEE is more involved because of the sedation and the probe in your throat. Most people don’t remember much of the imaging portion. The recovery period is mainly about waiting for the sedation to wear off and for the feeling in your throat to return.
How Quickly You Get Results
A cardiologist typically reads the results within 24 hours of the test. You should expect to hear from your provider within three days. If the sonographer sees something of immediate concern during the procedure, you’ll be asked to stay while a cardiologist reviews the images right away. In that case, you may get preliminary results the same day.
Why Your Doctor Ordered One
Echocardiograms are one of the most commonly ordered heart tests because they’re noninvasive and provide a wide range of information in a single appointment. Doctors typically order them to evaluate symptoms like shortness of breath, chest pain, lightheadedness, or an irregular heartbeat. They’re also used to monitor known conditions like heart valve disease or heart failure over time, to check heart function before or after surgery, or to investigate an abnormal finding on a chest X-ray or EKG. If your doctor ordered an echo, it doesn’t necessarily mean something is wrong. It’s often a first-line screening tool to rule things out or establish a baseline of how your heart looks and functions.