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An echocardiogram (ECHO) uses ultrasound waves to produce images of your heart. This commonly used test allows your doctor to see your heart beating and pumping blood. Your doctor can use the images from an echocardiogram to identify heart disease.

Your doctor may suggest an echocardiogram if he or she suspects problems with the valves or chambers of your heart or if heart problems are the cause of symptoms, such as shortness of breath or chest pain. An echocardiogram can also be used to detect congenital heart defects in unborn babies.
Depending on what information your doctor needs, you may have 1 of these 3 echocardiograms:

  1. Transthoracic Echocardiogram: This is a standard, non-invasive echocardiogram. A technician (sonographer) spreads gel on your chest and then presses a device known as a transducer firmly against your skin, aiming an ultrasound beam through your chest to your heart. The transducer records the sound wave echoes from your heart, and a computer converts the echoes into moving images on a monitor.If your lungs or ribs block the view, you may need a small amount of liquid (contrast agent) injected through an IV to improve the images of your heart’s structure on a monitor.
  2. Doppler Echocardiogram: When sound waves bounce-off blood cells moving through your heart and blood vessels, they change pitch. These changes (Doppler signals) can help your doctor measure the speed and direction of the blood flow in your heart. Doppler techniques are used in most transthoracic and transesophageal echocardiograms, and they can be used to check blood flow problems and blood pressures in the arteries of your heart that traditional ultrasound might not detect. Sometimes the blood flow shown on the monitor is colorized to help your doctor pinpoint any problems.

No special preparations are necessary for a standard transthoracic echocardiogram. You can eat, drink and take medications as you normally would. If you’re having a transesophageal or stress cardiogram, your doctor will ask you not to eat for a few hours beforehand. If you have trouble swallowing, let your doctor know, as this may affect his or her decision to order a transesophageal echocardiogram.
If you’ll be walking on a treadmill during a stress echocardiogram, wear comfortable shoes. If you’re having a transesophageal echocardiogram, be sure to arrange a ride home, as you’ll likely receive sedating medication

Your technician will attach sticky patches (electrodes) to your body to help detect and conduct the electrical currents of your heart. He/she will then apply a special gel to your chest that improves the conduction of sound waves and eliminates air between your skin and the transducer (a small, plastic device that sends out sound waves and receives those that bounce back).
The technician will move the transducer back and forth over your chest. The sound waves create images of your heart on a monitor, which are recorded for your doctor to review.
If you have a transesophageal echocardiogram, your throat will be numbed with a spray or gel to make inserting the transducer into your esophagus more comfortable. You’ll likely be given a sedative to help you relax.
Most echocardiograms take less than an hour, but the timing may vary depending on your condition. During a transthoracic echocardiogram, you may be asked to breathe in a certain way or to roll onto your left side. Sometimes the transducer must be held very firmly against your chest. This can be uncomfortable, but it helps the technician produce the best images of your heart.

You can usually resume your normal daily activities after an echocardiogram. If your echocardiogram is normal, no further testing may be needed. If the results are concerning, you may be referred to a doctor trained in heart conditions (cardiologist) for more tests.
Treatment depends on what’s found during the exam and your specific signs and symptoms. You may need a repeat echocardiogram in several months or other diagnostic tests, such as a cardiac computerized tomography (CT) scan or coronary angiogram.

2D Color Doppler

This is a non-invasive, painless and risk-free heart scan using high frequency ultrasound waves reflecting off various structures of the heart to obtain real-time images (in one and two dimensions) of your beating heart.  When combined with the Doppler technique, which records changes in frequency of sound waves, echocardiography can be used to measure blood flow through various chambers of the heart and heart valves and calculate pressure difference across valves.

Doppler signals can be colour-coded to enhance visualisation of blood flow (termed Doppler colour-flow mapping) and is the best way to determine the degree of narrowing, calcification or leakage of a valve.
2D Echo/Doppler study is one of the most important non-invasive investigations used in the diagnosis of heart disease today.

Your heart specialist can obtain very valuable information from this test which include:

  1. Assessment of the pumping function of the heart
  2. Assessment of wall motion of the heart muscles in various chambers
  3. Measurement of the dimensions of the heart chambers and the heart muscle thickness
  4. Assessment of the structure and function of the heart valves
  5. Looking for congenital abnormalities of the heart (e.g. hole in the heart, abnormal malposition of vessels and chambers of the heart)
  6. Other structural and functional problems (e.g. clots in the heart chambers, fluid collection around the heart, heart tumour, etc)

Contrast Echo

Contrast echocardiography is a technique for improving echocardiographic resolution and providing real time assessment of intracardiac blood flow. Agitated saline contrast provides contrast in the right heart and enables detection of right to left shunts. Opacification of the left ventricular (LV) cavity by contrast agents developed to traverse the pulmonary vasculature permits improved endocardial border detection

Stress Echo

Echocardiography is a test that uses ultrasound to make a picture of your heart. Ultrasound uses sound waves, or echoes, to make the picture. This test is used to determine if you have enough blood flowing to your heart and how well your heart is pumping.
Pictures of your heart will be taken before and after you exercise.

The purposes of this test are to:

  1. Diagnose if you have coronary artery disease or are at risk of getting coronary artery disease.
  2. Determine how likely it is that your condition will get worse.
  3. Determine if you have any other conditions related to your heart and blood flow.

How to Prepare for Your Test

  • Do not eat or drink for three hours before the test.
  • Do not drink or consume anything with caffeine in it (such as coffee) 24 hours before the test.
  • Specific heart medicines (such as beta blockers) may need to be stopped 24-48 hours before the test. Check with your doctor about specific instructions regarding medications before the test. Do not stop taking medications without consulting your doctor.
  • Wear comfortable clothing and shoes that are suitable for exercising on a treadmill or bike.

What to Expect During the Test

  • During the test you will exercise by walking or running on a treadmill.
  • If you are not able to exercise, a drug called Persantine will be used to open up your veins and arteries allowing the doctor to examine the flow of blood to your heart as if you were exercising.
  • The test will take approximately 1.5 to 2 hours

Contrast Stress Echo

A contrast stress echocardiogram is a non-invasive cardiac test that combines a stress test and echocardiogram. Ultrasound images of your heart are taken before and immediately after you walk on a treadmill to determine how well your heart and blood vessels are working. A substance called a contrast agent is used to help improve the quality of the images collected. The contrast is administered by a technologist or nurse using an intravenous (IV) line.

Contrast stress echocardiogram to:

  • Assess the wall motion of your heart in response to physical stress (on the treadmill).
  • To diagnose the presence or absence of coronary artery disease.


  • Avoid oily or greasy skin creams and lotions the day of the test, as the cream can interfere with the electrode-skin contact.
  • Take your usual medications unless otherwise directed by your physician.
  • You can eat, drink and take medications as you normally would.


  • Wear comfortable clothes and shoes that are suitable for walking on a treadmill, and bring a water bottle.


  • A technologist (sonographer) will explain the test to you, take a brief medical history, and answer any questions you may have. You will be asked to sign a consent form.
  • Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
  • You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front, and lie down on an examination table.
  • Adhesive stickers called electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
  • A contrast stress echo scan requires the use of a substance called a contrast agent. The contrast agent helps to improve image quality. A technologist or nurse will insert an intravenous (IV) line into a vein in one of your arms.
  • The sonographer will apply some gel to a small ultrasound probe called a transducer, they will then position it on your chest, and take several resting images of your heart. You may feel some discomfort from the transducer against your chest as the sonographer may need to apply some mild pressure to obtain the best images of your heart.
  • The sonographer may guide you to breathe in and out at certain times and may ask you to roll onto your left side.
  • Next, you will undergo an exercise stress test. To do this, you will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increase at set times. This usually takes about 10 minutes. Ultrasound images are collected again immediately after exercise.
  • You will be monitored throughout the test. If a problem occurs, the technologist will stop the test immediately. It is very important for you to tell the technologist if you experience any symptoms.
  • It takes about 45 minutes to complete the test.
  • Your contrast stress echocardiography test will be kept on file for comparison with future contrast stress echocardiography tests.


  • People can resume their normal daily activities, including driving, after the test. The data will be reviewed by a cardiologist and the results will be reported to your doctor. If necessary, you may be referred for additional testing or a consultation with a physician