What is an Echocardiogram?

What is an Echocardiogram?

An echocardiogram (or "echo") is a test that uses sound waves to create detailed pictures of your heart. We use this test to check how well your heart pumps blood, how your heart valves are working, and whether there are any problems like weak heart muscles, leaky valves, or blocked blood flow. The test is painless and non-invasive. A technician places a small probe on your chest, which sends sound waves into your body. These waves bounce off your heart and create real-time images on a screen.

An Echocardiogram is like a Home Inspection

Think of your heart like a house, and an echocardiogram as a home inspection that helps check if everything is in good working order.

Walls & Rooms (Heart Chambers)

A house has rooms and walls that keep everything structured. Similarly, your heart has four chambers (two atria and two ventricles). The echocardiogram checks if these "rooms" are the right size, if the walls are strong, and if there's any damage or unusual thickening. One critical aspect of the “home inspection” is calculating a left ventricular (the main chamber of the heart) ejection fraction (EF).

Before the heart contracts, it fills up with blood. When it squeezes, it pushes blood out to the body. But the heart never empties completely – some blood always stays behind. Ejection fraction tells us what percentage of blood is pushed out with each heartbeat.

Normal EF is considered 55-70%; Borderline EF is considered 50-54%
Mildly reduced (or mid-range) EF is considered 40-49%
Moderately reduced is considered 30-39% and severely reduced less than 30%

A normal EF, however, does not necessarily mean a normal heart. The heart muscle can be stiff and not relax properly. This is something we can assess with an echocardiogram, as well.

Doors (Heart Valves)

In a house, doors open and close to let people move from one room to another. In your heart, valves act like doors, making sure blood flows in the right direction. If a door in your house is stiff, it might not open all the way, making it hard for people to walk through. In the heart, if a valve is too stiff, we call this stenosis. And blood has trouble passing through the valve.

The categories of stenosis are mild, moderate or severe. Mild stenosis is unlikely to cause any significant issue for the heart or symptoms.

Now, imagine a door in your house, like your front door. Let’s say the door doesn’t shut all the way. Air might come back in when you’re trying to keep it out. In the heart, valve regurgitation happens when a heart valve doesn’t close properly, letting blood leak backward instead of moving forward like it should. We typically describe the degree of regurgitation as trace, mild, moderate or severe. It is common for individuals to have trace or mild valvular regurgitation, and it does not cause any symptoms or become an issue over someone’s lifetime, because the valves do not close perfectly in many patients.

An echocardiogram is especially helpful for assessing heart valves and if there is any stenosis or regurgitation and the mechanism for why the valve became “stiff” or “leaky.”

Plumbing & Pipes (Blood Flow & Blood Vessels)

A home inspector checks the plumbing to ensure water flows smoothly through the pipes. In the heart, the plumbing would be the coronary arteries. On an echocardiogram, we cannot directly look at the coronary arteries and see if there are any clogged pipes. However, we know the coronary arteries supply specific walls of the heart. If those specific walls are not pumping as strong or look thinner, we can infer that the artery supplying that area may have blockage in it (or clogging).

Electrical System (Heart Function & Pumping Strength)

A house needs a working electrical system to power lights and appliances. Your heart also has an electrical system that controls how it beats. Like the heart arteries, the echocardiogram cannot look directly at the electrical system of the heart. However, it provides valuable information on how to best treat electrical issues of the heart by giving us all the other information above.

Why Might You Need an Echocardiogram?

There are many reasons, your cardiologist may order an echocardiogram. Common reasons include:

Chest pain or shortness of breath
Irregular heartbeats (arrhythmias)
High blood pressure or heart murmurs
Swelling in your legs or fluid buildup
A history of heart disease

If we find anything unusual, we can recommend treatments or lifestyle changes to keep your heart "house" in great shape!

Dr. Karan Desai is a board-certified cardiologist with Virginia Heart. He is accepting new patients in the Loudoun Office.