Indian Academy of Echocardiography

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Patients Resources


Frequently asked questions:


  • Echocardiography (commonly referred to as echo or 2D echo)
  • Contrast echocardiography
  • Transesophageal echocardiography
  • Exercise stress echocardiography
  • Dobutamine stress echocardiography
  • Acknowledgement


Echocardiography (commonly referred to as echo or 2D echo)

Q : What is echocardiography?
A : It is ultrasound imaging, or in simple terms, the sonography of your heart. Sound waves are transmitted in to your body, from an instrument called a transducer or a probe. These sound waves reflect or echo off the heart to create pictures that can be seen on a screen.
Q : What are the different types of echocardiography?
A :

Echocardiography is the broad term which encompasses all different varieties of echo techniques. It can be classified depending on how the images are obtained, what specific techniques are used for creating the images and whether the examination was performed at rest or during some form of stress.


Echo is traditionally performed by placing a probe on the chest wall. This is the form of echo which we all are most familiar with. This is known as transthoracic echo or simply ‘echo’. Some people also call it ‘2D echo’, but this is not the most appropriate term (explained below). Alternately, echo can also be performed by inserting the probe in to the food-pipe just as endoscopy is done (known as transesophageal echo) or, less often, by inserting a catheter in to the heart (known as intracardiac echo).


Each echocardiographic examination involves use of 2D imaging and Doppler (including color Doppler) for visualizing the heart. No echocardiographic study will be complete without the use of these techniques. In addition, depending on the equipment, expertise of the echocardiographer and the clinical need, additional techniques such as 3D imaging, tissue Doppler and strain, contrast imaging, etc. may have to be used.


Echocardiography is mostly performed at rest, but in many clinical situations, it may be combined with some form of stress such as exercise or a medication to speed up the heart beating. This is known as stress echocardiography.


The subsequent discussion refers to traditional echo performed at rest.

Q : What information will I get after doing an echo?
A : Echo provides a lot of information about the structure and function of the heart. It tells about the pumping efficiency of the heart, size of the heart chambers, condition of the valves (narrowed or leaking), pressures inside the heart, any birth defects, fluid collection around the heart, any clots or tumors, etc.
Q : Can echo also show us the ‘blockages’ in the heart?
A :

No, a resting echo doesn’t show us the blockages, unless the blockages have already caused damage to the heart muscle. In other words, if a part of the heart muscle is damaged, it indicates blockage in the artery supplying blood to that part of the heart muscle. However, if there is no apparent damage to heart muscle, then the blockages may or may not be present.


Stress echocardiography (as discussed below) is the test specifically designed to detect blockages in the heart arteries.

Q :

How is the test performed? What will I experience during the test?

A : A cardiac sonographer will fix three small, sticky patches on your chest wall for recording your ECG while your echo is being done. You will then be asked to turn to your left side. An echo probe will be placed on several areas of your chest wall. The echo probe emits ultrasound beams which are used for visualizing the heart. A small amount of cool gel is applied on the end of the probe. This gel does not harm the skin; it helps to obtain clearer pictures. During the test, the echo probe is moved to different parts of the chest wall to take pictures of different areas of your heart. You may be asked to change positions during the exam and may also be asked to hold your breath at times. During the imaging, you will be able to hear the sounds of your blood passing through the different chambers of the heart.
Q : Is it painful?
A :

No, echo is not painful but you will feel slight pressure from the echo probe being placed on your chest wall. The pressure of the echo probe on your chest wall may cause slight discomfort. This discomfort is only mild and subsides on its own.


Echo is a completely non-invasive test, which means no needles, catheters, or dyes are used. However, on rare occasions, when ultrasound images are difficult to obtain because of body structure, contrast imaging may be needed. This will require an intravenous line to be placed which will cause slight pain.

Q : Does echo have any side-effects? Will repeated echo produce any damage to my heart?
A : Echo test has no side-effects. Unlike the x-rays, the ultrasound beams used for echo are completely harmless and do not cause any damage to the heart.
Q : Do I need to have any specific preparations before the test?
A : No specific preparation is required before the test.
Q : Do I need to be empty stomach for the test?
A : No. You may eat and drink as you normally would on the day of the echo test. You can take all your regular medications on the morning of the test.
Q : Do I need to drink a lot of water before the test, as we need to do for the ultrasound of the abdomen?
A : No.

Contrast echocardiography

Q : What is contrast echocardiography?
A : Contrast echocardiography is a technique that involves injection of either agitated saline (saline vigorously shaken to from small bubbles) or a special contrast solution during the echocardiography.
Q : Why is contrast echocardiography performed?
A : The use of contrast allows better visualization of heart structures when they are not very clearly seen otherwise. The agitated saline helps in assessment of certain types of heart defects that cause shunting of the blood within the heart.
Q :

What is contrast made of?

A :

The agitated saline, as mentioned above, is nothing but vigorously shaken saline solution (the clear liquid used for intravenous drips). Vigorous shaking traps air within the liquid, forming small bubbles.


The ultrasonic contrast agents are engineered microbubbles which have an outer shell (composed of a protein or a lipid) with small amount of gas inside.

Q : How is it performed?
A :

The procedure of contrast echocardiography is almost the same as any standard echocardiography test except that small amount of contrast solution is injected during the test. Of course, an intravenous line will have to be placed for injecting the contrast.

Q : Will I feel anything when contrast is injected?
A : No, you won’t feel anything.
Q : What are the possible side effects of contrast echo?
A : Contrast echocardiography has been proven to be extremely safe, except in certain rare cardiac conditions in which it should be avoided (your doctor will be able to decide that). The risk of any serious complications with the use of contrast is <1 per 10,000. Some non-serious side effects may occur but they are also quite infrequent and mild. These include headache, weakness, fatigue, palpitations, nausea, dizziness, dry mouth, altered sense of smell or taste, breathing difficulty, itching, back pain, chest pain, or rash, or a combination of these effects.

Transesophageal echocardiography

Q : What is transesophageal echocardiography?
A : Transesophageal echocardiography, or TEE, is a form of echocardiography which is performed by introducing an endoscope (a flexible tube) in to the food-pipe of the patient. The endoscope carries a transducer (i.e. ‘camera’) at its tip which is used for taking the pictures of the heart.
Q : Why is TEE performed?
A : There are several reasons why a TEE may be needed. First, there are certain structures of the heart which are best visualized by imaging from behind rather than through the chest wall; TEE is always preferred for these structures. Second, TEE generally provides much better visualization of the heart as compared to normal echo because the bones of the chest wall and lungs do not block the sound waves produced by the probe. For this reason, a TEE is often needed in patients in whom normal echo does not provide sufficient pictures, e.g. obese patients, ICU patients, etc.
Q : How is the test performed?
A :

The TEE test is performed under local anesthesia. In some patients who are quite anxious and are unable to tolerate the procedure, sedation may have to be used. For this, a medicine is given by injection which makes the patient sleepy. At some centres, sedation is used routinely.


Regardless of whether sedation is used or not, a local anesthetic will be sprayed to numb the back of your throat and you will also be asked to swallow one or two spoonsful of a local anesthetic liquid. In addition, a local anesthetic gel will also be applied to the tip of the transducer. Once the throat is adequately anesthetized, the TEE probe will be gently inserted into your mouth and directed into your food-pipe. If you are not sedated, you will be asked to swallow as the probe is inserted, which makes it easier to guide the probe in to proper position.


Once the probe is appropriately positioned, images of the heart will be taken from different angles and views, following which the transducer will be taken out. The entire process will take around 10-15 minutes only. Your heart rate, blood pressure and blood oxygen level will be monitored during the test.

Q :

Do I need any specific preparation for the test?

A :

Yes, several important precautions need to be taken-

  • You should not eat or drink anything for at least 6 hours before the test. Only clear liquids may be allowed up to 3 hours prior to the test.
  • If you have a loose tooth, you need to tell the doctor about it. If you use dentures or dental prostheses, they may need to be removed before the test.
  • You should also tell the doctor or nurse if you have a problem with swallowing or have a history of any disease related to your food-pipe or stomach of if you have any bleeding disorder. If you are taking any blood thinners, they may have to be stopped before the test.
  • Tell your doctor or nurse if you have any allergies to medicines, especially medicines that make you relax.
  • If you have diabetes and take medications to manage your blood sugar, ask your doctor how to adjust your medications on the day of your test.
  • If you are undergoing TEE under sedation, you will not be able to drive until the day after the procedure. Hence, you should bring someone with you to drive you home after the test.
Q : How will I feel during the test?
A :

The TEE test itself is not painful but if an intravenous line needs to be secured, that will hurt slightly.


The anesthetic sprayed into your throat may taste bitter and will make your tongue and throat feel numb and swollen. Some people report that they feel as if they cannot breathe at times because of the probe in their throat, but this is a false sensation caused by the anesthetic. There is always plenty of breathing space around the probe in your mouth and throat. Remember to relax and take slow, deep breaths.


You may gag and feel nauseous, bloated, or have mild belly cramps when the probe is moved. If the discomfort is severe, alert your doctor with an agreed-upon signal or a tap on the arm. Even though you won't be able to talk during the procedure, you can still communicate.


Sedation, if used, will of course make you feel sleepy. You may also feel heaviness of eyelids, trouble speaking, a dry mouth, or blurred vision. These effects may last for several hours after the test but you probably will not be able to remember much of the test.

Q : How will I feel after the test?
A :

You will be advised not to eat or drink for at least an hour after the procedure.


You may have a tickling sensation in the throat, dryness of the throat, slight hoarseness of the voice or a mild sore throat. These symptoms may last for 2 to 3 days. Throat lozenges and warm salt water gargles can help relieve these symptoms. Throat lozenges can be used by people age 4 or older. And most people can gargle at age 8 and older. If the symptoms do not improve with time or if you have too much discomfort, then contact your doctor immediately.

Q : How safe is the procedure?
A : In appropriately selected patients and when performed properly, the TEE test is very safe with the risk of any serious complication being as small as 2 per 1000 cases.

Exercise stress echocardiography

Q : What is exercise stress echocardiography?
A : As the name suggests, it is a test that combines echocardiography with exercise. During the test, echocardiography is performed first, following which the patient is made to perform exercise (usually on a treadmill). As soon as the patient finishes the exercise, echocardiography is performed again to collect the second set of images.
Q : Why is this test performed? How is it different from a normal echo?
A : Unlike a normal echo in which imaging is done only at rest, stress echocardiography allows evaluation of the heart’s ability to withstand stress. The most common purpose of doing stress echocardiography is to detect if there are any blockages in the heart arteries and if yes, then how badly they are compromising the blood supply to the heart muscle. Apart from this indication, stress echocardiography is also performed to assess some valve diseases and to evaluate one’s overall functional capacity.
Q : What specific preparations are needed for this test?
A :

You need to be fasting for roughly 3 hours before the test. You should wear comfortable two-piece clothing and shoes that you can walk rapidly in. You may be asked to change into an exam cape/ gown to wear during the procedure.


You should disclose all your medical details and medications that you are taking to the doctor performing the test. The doctor will advise you if any particular cardiac medicine needs to be stopped prior to the test and will also advise you what to do about the diabetes medicines. If you have a history of asthma and use an inhaler for breathing, bring it to the test.


In case of men, you will also be required to shave your chest because ECG electrodes will have to be placed on the chest wall.

Q : How is the test performed?
A :

Before the test, a cardiac sonographer will fix several ECG electrodes (small, sticky patches) on your chest wall. These are required for recording your heart rhythm during the test and for acquiring echo images. A resting ECG will then be performed and your heart rate and blood pressure will be recorded. If contrast is going to be used, then an intravenous access line will also be secured. A resting echocardiogram will then be performed.


Before you start exercising, the sonographer will demonstrate you how to walk on the treadmill and how to promptly return to the exam table once the exercise is over. You will then be asked to exercise on the treadmill under supervision. Your heart rate and blood pressure will be monitored and at regular intervals, the lab personnel will ask you how you are feeling. If you feel chest, arm or jaw pain or discomfort or become short of breath, dizzy or lightheaded, or have any other unusual symptoms, tell the lab personnel immediately.


When you feel you are not able to exercise any further, the treadmill will be stopped. The decision to end the test may also be taken by the supervising doctor if there are significant ECG changes of if it is felt that the sufficient level of exercise has been achieved.


As soon as the treadmill is stopped, you need to quickly get off the treadmill, return to the exam table and lie on your left side so that the repeat echocardiogram can be performed. Since the treadmill is stopped suddenly, it is normal to feel a little unsteady when getting off the treadmill and onto the exam table for the echo; you need not worry about these.


Your heart rate, blood pressure and ECG will continue to be monitored after stopping the exercise, until these parameters return to normal.

Q : What happens after the test?
A : Once the test is over, you can quickly resume your activities and can eat also, provided there were no significant problems during the test.
Q : What are the risks associated with the test?
A : The risk of causing any serious complication during the test is <1:10,000. However, several symptoms may develop during the test. The patients who have significant blockages in their heart arteries are likely to develop chest pain during the stress test because that is what is the goal of the test. This discomfort usually subsides within few minutes of stopping the exercise but if prolonged, appropriate medications may have to be administered. Very rarely, the test may precipitate very severe chest pain, which may require urgent intervention. The other infrequent complications include heart rhythm abnormalities, dizziness, fall, etc.
Q :

What is contrast stress echocardiography?

A : Just as with normal echo, contrast may have to be used during stress echocardiography also if the images of the heart are not very clear. The rest of the procedure remains same.

Dobutamine stress echocardiography

Q : What is dobutamine stress echocardiography?
A :

It is also a form of stress echocardiography, performed when the patient is unable to exercise. In this test, instead of exercise, a medication known as dobutamine is administered through an intravenous drip to speed up the heart beating to produce stress on the heart. In some patients in whom dobutamine alone is unable to speed up the heart beating as desired, another medication known as atropine may also have to be injected. Rest of the procedure is nearly same as exercise stress echocardiography.


Although exercise stress echocardiography is generally preferred over dobutamine stress echocardiography in patients who can exercise, there are certain cardiac conditions in which the latter is preferred. Your doctor should be able to choose the most appropriate test for you.

Q : What specific preparations are required for dobutamine stress echocardiography?
A : The preparations are generally same as for exercise stress echocardiography. However, fasting for roughly 4 hours is essential. Additionally, intravenous line needs to be placed as a routine for dobutamine stress echocardiography. Also, the patients who have glaucoma need to inform the doctor about it because atropine may worsen it.
Q : How is the test performed?
A : The initial steps are same as for exercise stress echocardiography. After the baseline echo images are obtained, dobutamine drip is started and the dose is gradually increased. Echocardiography is repeated at every step as the heart rate increases. Once the heart rate increases to the desired level (usually takes 12-15 min), another set of images is obtained and the dobutamine drip is stopped. The test is ended when the heart rate and blood pressure return to the baseline level which usually takes about 10-15 minutes.
Q : What will I feel during the test?
A : As the dobutamine dose is increased, you will feel your heart beating faster and harder. This may sometimes feel weird because the heart beating is increasing without you performing any exercise. Dobutamine may also cause nausea, less often vomiting, and an urge to pass urine. All these side effects are short-lasting and subside within few minutes of stopping the drip.
Q : How safe is dobutamine stress echocardiography?
A : Dobutamine stress echocardiography is also a very safe procedure with the risk of serious complications being as small as with exercise echocardiography. However, heart rhythm abnormalities are more common during dobutamine test as compared to the exercise stress test.


The content provided by Dr Sweety Thakkar, edited by Dr Nitin Burkule, Dr Manish Bansal