Echo - transthoracic echocardiogram

Ultrasound imaging of the cardiac structures

Basics of echo

This is a test that uses inaudible ultrasound waves to create images of your heart to determine its structure and function. The ultrasound beam passes out from the probe and is reflected from the cardiac structures. It provides the doctor with information about the size and shape of your heart and how well the cardiac chambers and valves are working. A part of the echocardiogram is a Doppler analysis of blood flow across heart valves allowing assessment of valvular disease. An echo is particularly useful in the investigation of breathlessness and murmurs. During transthoracic echocardiography (TTE), ECG leads will be attached to your chest, and an ultrasound probe will be placed on the chest wall in various positions to allow the acquisition of images. The whole test takes about 20-30 minutes and is not painful. Images are then stored in an electronic archive, and a report is produced.

Echocardiography allows measurements of the heart structures, assessment of the pumping function of the heart (contractility, systolic function) using parameters such as ejection fraction (EF) and the relaxation of the heart (diastolic function). In combination with Doppler analysis, it is possible to evaluate the presence and degree of valve disease (aortic stenosis/regurgitation, mitral stenosis/regurgitation, tricuspid stenosis/regurgitation, pulmonary stenosis/regurgitation) or congenital heart disease (e.g. atrial or ventricular septal defect, pulmonary and aortic stenosis, coarctation of the aorta, tetralogy of Fallot, transposition of the great arteries).

Echo will be often required following the first appointment with Dr Ruzicka. Echo may need to be repeated in regular intervals in patients with valve disease and heart failure.


  • Murmurs of unknown cause with suspicion on valve disease or congenital heart disease
  • Patients who are being investigated for chest pain, breathlessness, palpitations, dizziness and blackouts (syncopes)
  • Patients with abnormal ECG (e.g. suspicion on left ventricular hypertrophy, i.e. thickening of heart walls, usually due to hypertension)
  • The screening of patients with established ischaemic heart disease, i.e. a history of heart attack (myocardial infarction), revascularization with PCI (angioplasty/stenting) or CABG (bypass surgery)
  • Patients with heart rhythm problems such as atrial fibrillation or atrial flutter
  • Screening relatives of patients with cardiomyopathies (diseases leading to abnormal structure and function of the heart muscle)
  • Previous valve replacement or valve repair
  • Known congenital heart disease

    Risks and complications

There are no known side effects or risks in using ultrasound for diagnostic assessments. A firm contact of the ultrasound probe with the chest wall is necessary to get good quality images. Sometimes this can be a little uncomfortable, but it will not be painful. The gel used for the test is suitable even for people with sensitive skin.

Before the procedure

The echocardiogram will normally be performed by Dr Ruzicka or one of the cardiac physiologists. The procedure will be explained, and you will be offered the opportunity to ask any questions about the test. Since direct access to the chest is needed, women are advised to wear trousers or a skirt rather than a dress. You will be asked to remove all your clothing above the waist, including your bra and to lie on a couch on your left side so that your lungs drop out of the way of the ultrasound beam. Your privacy will be protected by a gown that only exposes the necessary area. Three electrodes (plastic stickers) will be placed on your right side, left and right shoulder, and attached, leading to the echo machine.

During the procedure

The ultrasound probe with gel will be placed on your chest and moved as the heart is visualized from different angles. Images will be acquired and stored electronically in the echo machine. You will hear Doppler sounds from the machine; these are not real sounds produced by the heart but represent acoustic coding of blood flow volume and velocity. Once your assessment is complete, the gel will be wiped off your skin, and you can get dressed. The procedure takes approximately 20-30 minutes.

After the procedure

The echo report will be discussed with you during the initial appointment, and depending on the result, appropriate action will be taken.

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