Echocardiogram

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An echocardiogram leverages sound waves to create detailed images of the heart in motion. This test typically takes about 20 minutes and involves the application of a special gel on the chest, followed by the smooth movement of a transducer device over the area. The transducer captures real-time images of the heart, which are displayed on a monitor for comprehensive analysis by Dr. Tan Jian Jing.

What an echocardiogram shows

An echocardiogram is an ultrasound scan of the heart. Because it produces moving images, it shows the heart working rather than a single frozen picture. The scan looks at the four chambers and their size, the four heart valves and whether they open and close normally, the thickness of the heart muscle, and the sac surrounding the heart.

One of the most useful measurements is the ejection fraction, which estimates how much blood the left ventricle pushes out with each beat. Together with the images of the valves and chambers, this helps distinguish between different causes of the same symptom — breathlessness, for example, can arise from a weakened pumping chamber, a stiff one, or a valve that is narrowed or leaking.

When an echocardiogram is usually requested

An echocardiogram is commonly arranged when a murmur is heard during examination, when there is unexplained breathlessness or swelling of the legs, when heart failure is suspected, when a valve problem is already known and needs monitoring, or after a heart attack to assess how much of the heart muscle has been affected. It is also used to look for structural causes of palpitations, blackouts or stroke.

How to prepare and what happens on the day

A standard transthoracic echocardiogram needs no fasting and no injection, and you can take your usual medications unless you are told otherwise. Two-piece clothing is easier, since access to the chest is needed.

You will be asked to lie on your left side. Small electrodes are placed on the chest to track the heart rhythm, a water-based gel is applied, and the transducer is moved across the chest wall. You may be asked to hold your breath briefly or to roll further onto your side, both of which simply improve the view. The scan uses sound waves and no ionising radiation.

Other forms of echocardiography

A transoesophageal echocardiogram uses a probe passed into the oesophagus to sit directly behind the heart, giving a closer view of structures such as the mitral valve or the left atrial appendage. It is performed with sedation and is used when the standard scan cannot answer the question.

A stress echocardiogram images the heart before and immediately after exertion or medication that raises the heart rate, to see whether wall motion changes when the heart is working harder.

Limitations worth knowing

Image quality depends on the acoustic window between the ribs and the lungs, so scans can be more difficult in people with a larger body habitus or significant lung disease. Where the images are inconclusive, another form of imaging may be recommended rather than repeating the same test.

After the scan

The images are reviewed alongside your symptoms, examination findings and any other tests. Depending on what is found, the next step may be monitoring over time, a change in medication, or a further test. If you have questions about whether this scan is appropriate for you, or about arranging it at any of the three clinic locations, please contact the clinic.

Seek urgent medical attention rather than waiting for a scheduled scan if you develop chest pain that does not settle, sudden severe breathlessness, fainting, or a fast irregular heartbeat with light-headedness. In an emergency in Singapore, call 995 or go to the nearest emergency department.