What to Expect During an Echocardiogram

Medically Reviewed by Poonam Sachdev on November 27, 2023
11 min read

An echocardiogram is a test that uses ultrasound to show how your heart muscle and valves are working. These sound waves make moving pictures of your heart so your doctor can get a good look at its size and shape. You might hear your doctor call this test “echo” for short.

A specialist called a cardiac sonographer (or echocardiographer) will perform your echocardiogram. These medical professionals are trained to use the equipment that produces the image of your heart.

Both EKGs and echoes are tests that involve putting sensors called electrodes on your chest. During an echo, a cardiac sonographer will move a wand across this area.

An EKG checks your heart's electrical activity. It looks for patterns to figure out if your heart is beating normally, too fast, too slow, or in an irregular way. It's a good first test to spot issues linked with heart disease and can also reveal problems with your heart's shape or size. But it's not very accurate in judging how well your heart pumps.

An echocardiogram, on the other hand, shows a detailed view of the heart's internal structure and how blood flows through it. The test: 

  • Measures the size and shape of your heart
  • Shows how well the valves work
  • Checks communication between the left and right sides of your heart
  • Tests the speed of blood leaving the heart


Your doctor may order an echocardiogram to:

  • Look for heart disease
  • Track heart valve disease over time
  • See how well medical or surgical treatments are working

There are several types of these tests. Your doctor can tell you more about which is best for you.

Transthoracic echocardiogram

This is the standard echo test. It’s like an X-ray but without the radiation. Specialists use the same technology to check a developing baby's health before birth.

How to prepare for transthoracic echocardiogram. On the day of the test, eat and drink as you usually would. Take all of your medications at the regular times.

What to expect. You’ll undress from the waist up and put on a hospital gown. The cardiac sonographer will put three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an electrocardiograph monitor (EKG or ECG) that tracks your heart's electrical activity.

You’ll lie on your left side on an exam table. The sonographer will run a wand (called a sound-wave transducer) across several areas of your chest. There will be a small amount of gel on the end to help create clearer pictures. Changes in the sound waves, called Doppler signals, show the direction and speed of blood moving through your heart.

You may or may not hear these sounds during the test. The sonographer might ask you to move around so they can take pictures of different areas of your heart. They might also ask you to hold your breath sometimes.

You won’t feel anything during the test except coolness from the gel and slight pressure from the transducer.

The test will take about 40 minutes. Afterward, you can get dressed and go back to your routine.

Transesophageal echocardiogram (TEE)

For this test, the transducer goes down your throat and into your esophagus (the tube that connects your mouth to your stomach). Because it’s closer to your heart, it can create a clearer picture.

How to prepare for transesophageal echocardiogram (TEE). Tell your doctor beforehand if you have any problems with your esophagus, such as a hiatal hernia, swallowing problems, or cancer.

Don’t eat or drink anything for 6 hours before the test. Take all of your medications at the usual times with a small sip of water if necessary. If you use medicine or insulin for diabetes, ask your doctor or the testing center about it.

What to expect. Before the transesophageal echocardiogram, a nurse will put an intravenous line (IV) into a vein in your arm or hand so they can give you medication. A technician will stick EKG electrodes on your chest. They’ll also put a blood pressure monitor on your arm and a pulse oximeter clip on your finger to watch your vital signs.

You’ll get a mild sedative to help you relax.

A member of your medical team will pass the ultrasound probe into your mouth, down your throat, and into your esophagus. It won't affect your breathing. They might ask you to swallow to help the probe along. This takes a few seconds and may be uncomfortable. Once the probe is in place, it will take pictures of your heart. You won’t feel it.

The test takes about 10 to 30 minutes. Then, someone will take out the probe. Nurses will watch you for 20 to 30 minutes afterward.

Don’t eat or drink until the sedative wears off, which takes an hour after the test. You might still be drowsy or dizzy, so someone else should drive you home.

Stress echocardiogram

You have this test while exercising on a treadmill or stationary bicycle. It shows the motion of your heart's walls and pumping action when it’s working hard. It can also show a lack of blood flow that might not appear on other heart tests.

How to prepare for a stress echocardiogram. Don’t eat or drink anything but water for 4 hours before the test. Don’t drink or eat anything with caffeine (such as cola, chocolate, coffee, tea, or medications) for 24 hours before. Don’t smoke the day of the test. Caffeine and nicotine might affect the results.

Your doctor may tell you to stop taking certain heart medications on the day of your test. Ask what you should do if you take one of these drugs:

  • Beta-blockers such as atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol XL), and propranolol (Inderal LA, Inderal XL, InnoPran XL)
  • Isosorbide dinitrate (Dilatrate SR, Isordil)
  • Isosorbide mononitrate (Monoket)
  • Nitroglycerin (Minitran patch, Nitrostat, Nitro-Dur patch)

Talk to them if you have questions.

What to expect. For the procedure, a cardiac sonographer will stick EKG electrodes to your chest. They’ll chart your heart activity and take your pulse and blood pressure.

The sonographer will first do a transthoracic echocardiogram. Then, you’ll get on a treadmill or a stationary bicycle and start exercising. The medical team will slowly raise the intensity of the exercise machine. In the meantime, they’ll watch the EKG monitor for changes and ask about any symptoms.

You’ll exercise until you can’t do it anymore. The sonographer will quickly do another echocardiogram.

After the tests, you’ll exercise slowly to cool down. The team will watch your vital signs until they’re back to normal.

The appointment takes about an hour, but the test itself usually takes less than 15 minutes.

Dobutamine stress echocardiogram

This is another form of stress echocardiogram. But instead of exercising, you get a drug called dobutamine that makes your heart feel like it’s working hard.

This test checks your heart and valves when you can’t exercise on a treadmill or stationary bike. It can tell your doctor how well your heart handles activity. It also helps them figure out your risk of coronary artery disease and how well any cardiac treatments are working.

How to prepare for a dobutamine stress echocardiogram. Four hours before your test, stop eating and drinking everything except for water. But before this, most foods and drinks are OK. 

You'll also need to stop smoking the day you're scheduled to have the test since nicotine can skew the results.

Food and drinks with caffeine, such as soda, energy drinks, chocolate, coffee, and tea are off-limits 24 hours before the test. You should even avoid products that are decaffeinated or caffeine-free since they can still affect your test results.

Talk to your doctor about which medications are safe to take before a dobutamine stress test. You may need to stop taking some heart drugs a day ahead of the test.

What to expect. A technician will attach EKG electrodes to your chest. A nurse will put an intravenous line (IV) into a vein in your arm in order to give you the dobutamine.

The team will do a transthoracic echocardiogram, measure your resting heart rate, and take your blood pressure. Then, you’ll get the dobutamine. Your heart will begin beating faster and stronger. You might have a warm, flushed feeling and a mild headache.

Lab personnel will ask how you’re feeling. They’ll watch for changes on the EKG monitor and take out the IV once you’ve gotten all the dobutamine.

The appointment will take about an hour, but the IV usually lasts about 15 minutes. Plan to stay in the waiting room until any symptoms have gone away.

Intravascular ultrasound

During this test, your doctor threads the transducer into your heart's blood vessels through a catheter in your groin. It gives more detailed information about atherosclerosis (a buildup of plaque) inside your blood vessels.

How to prepare for an intravascular ultrasound. Your doctor will tell you what medications to take and what to eat or drink before the test. You'll likely need to avoid food and drinks after midnight on the day of your test. Your doctor may tell you to wear loose clothes and leave your jewelry at home.

What to expect. You’ll put on a hospital gown and lie on a special table. A nurse will attach EKG electrodes to your chest. They’ll put an IV line into your arm and give you a mild sedative so you can relax.

Your doctor will use a medication to numb your groin. They’ll make a small cut there, put a short tube called a plastic inducer sheath through it, and run a catheter (a long, narrow tube) through the cut and into the arteries of your heart. The catheter has a wire with an ultrasound tip inside. It will make pictures of your artery.

The test takes about an hour. After your doctor removes the catheter and sheath, a nurse will put a tight bandage on your groin to prevent bleeding. You probably won't need stitches to close the cut in your groin. You’ll lie flat with your leg straight for 3 to 6 hours. You might have to stay in the hospital overnight.

Fetal echocardiography

This test takes detailed pictures of your baby's heart before they're born. Doctors use it to diagnose heart problems present at birth (called congenital heart defects).

How to prepare for a fetal echocardiogram. Some ultrasounds carried out during pregnancy require a full bladder, but that's not the case for a fetal echocardiogram. You won't need to do anything special to get ready for the test. Expect it to take between 30 minutes and 2 hours.

What to expect. Your health care team can do a fetal echocardiogram in one of two ways:

  • Abdominal ultrasound. This is the usual way sonographers do this type of test. They'll apply a gel to your stomach, and then place a probe there to take pictures. You won't feel any pain and don't need to worry about the test hurting your fetus.
  • Endovaginal ultrasound. You're more likely to have this version of the test early in your pregnancy. The sonographer will place a small probe into your vagina to take pictures of your baby's heart.

A few components make up an echocardiogram. They include:

  • Two-dimensional (2D) or three-dimensional (3D) echocardiogram. A 2D echo is the standard test, which shows your doctor images of your heart's walls, valves, and some vessels. If they need more detailed pictures, especially of your heart's lower left chamber, you may get a 3D echo. 
  • Doppler echocardiogram. This component of the echo measures how fast blood flows in your heart and blood vessels, and in which direction. It works by using sound waves, which change pitch as they bounce off your blood cells. The signals can show your doctor if you have blocked or leaking valves and check the blood pressure in your heart's arteries.
  • Color flow imaging. This part of the test shows blood flowing in your heart in color. It helps your doctor more easily spot leaking heart valves as well as any other blood flow changes you may have.

The guidelines for an echocardiogram are a bit different if you have diabetes:

If you take insulin to control your blood sugar, ask your doctor how much of your medication you should take the day of the test. Often, your doctor will tell you to take only half of your usual morning dose and to eat a light meal 4 hours before the test.

If you take pills to control your blood sugar, don't take your medication until after the test is complete unless otherwise directed by your doctor.

Don't take your diabetes medication and skip a meal before the test.

If you have a glucose monitor, bring it with you to check your blood sugar levels before and after your test. If you think your blood sugar is low, tell the lab personnel immediately.

Plan to eat and take your blood sugar medication following your test.

It depends on the type of echo you're having. The test itself can take anywhere from 10 minutes to 2 hours. After the test, your doctor will want to keep an eye on you for at least half an hour. 

For some types, such as anintravascular ultrasound, your recovery time may be considerably longer.

The sound waves used during an echocardiogram aren't harmful. But there are some possible risks of the test:

  • Discomfort from pressure on your chest during a transthoracic echo
  • An allergic reaction to the contrast dye
  • Backache
  • Headache
  • Rash

After a transesophageal echocardiogram, you may have:

  • A sore throat
  • Trouble swallowing
  • Changes in your voice
  • Lung or throat muscle spasms
  • A small amount of bleeding in your throat
  • Tooth, gum, or lip wounds
  • A tear in the esophagus (esophageal perforation)
  • Changes to your heart rhythm (arrhythmias)
  • Queasiness from medicines used during the test

The drug you get during a stress echo could also cause side effects such as:

  • A hot feeling or flushing
  • Low blood pressure
  • Allergic reaction
  • It's very rare, but this type of echo could also trigger a heart attack

An echocardiogram can help your doctor diagnose several kinds of heart problems, including:

  • An enlarged heart or thick ventricles (the lower chambers of the heart)
  • Weakened heart muscles
  • Problems with your heart valves
  • Heart defects that you’ve had since birth
  • Blood clots or tumors

An echocardiogram is a test that uses sound waves to create pictures of your heart. You might need one if your doctor suspects you or your baby has problems like an enlarged heart, weak heart muscles, issues with heart valves, and even birth defects in the heart. There are different types of echocardiograms, depending on what your doctor needs to see. It's a safe way to diagnose and keep an eye on heart conditions.

What 5 abnormalities can be found on an echocardiogram?

An echocardiogram can reveal:

  1. An enlarged heart or thick ventricles
  2. Weakened heart muscles
  3. Problems with heart valves
  4. Heart defects present since birth
  5. Blood clots or tumors

Do you have to take your bra off for an echocardiogram?

For some echocardiograms, you'll need to take off all your clothes from the waist up and put on a hospital gown.

What should you not do before an echocardiogram?

Before an echocardiogram, you shouldn't eat or drink anything for a certain period of time, depending on the type of test. You may also need to avoid caffeine, smoking, and certain medications on the day of the test. Your health care team will tell you how to prepare.