What happens during an echocardiogram for heart failure? 

An echocardiogram, often simply called an ‘echo’, is the gold standard test for diagnosing and monitoring heart failure. It is a non-invasive ultrasound scan that uses sound waves to create a moving picture of your heart as it beats. Unlike an X-ray, it does not use radiation. For patients with suspected or confirmed heart failure, this test is essential because it allows doctors to see exactly how well the heart muscle is pumping and whether any structural issues, such as leaky valves, are contributing to your symptoms. 

What We’ll Discuss in This Article 

• The preparation required for a transthoracic echocardiogram 

• A step-by-step guide to the procedure in a clinic or hospital 

• The key measurements taken, including Ejection Fraction (EF) 

• What the specialist is looking for in your heart’s structure 

• How the results are analysed and shared with your GP 

• The difference between a standard echo and other types 

• When to seek urgent medical advice based on symptoms 

Preparation and the Procedure 

A standard echocardiogram (transthoracic echocardiogram or TTE) is a painless procedure that usually takes between 30 and 60 minutes. You do not typically need to fast or follow special instructions before the test unless you have been told otherwise for a specific type of scan. 

The Preparation 

When you arrive at the clinic, you will be asked to remove your clothing from the waist up. You will be provided with a hospital gown to wear, which usually opens at the front to allow the specialist (a cardiac sonographer or physiologist) access to your chest. 

During the Scan 

• Sensor Attachment: You will lie on a bed, usually on your left-hand side. This position helps bring the heart closer to the chest wall for clearer images. Three small, sticky sensors called electrodes will be placed on your chest to monitor your heart rhythm throughout the scan. 

• The Gel and Probe: A clear, cool gel is applied to your skin or directly to the ultrasound probe (transducer). This gel ensures there is no air between the probe and your skin, allowing the sound waves to travel clearly. 

• The Scanning Process: The specialist will move the probe firmly over different areas of your chest. You may feel some pressure, but it should not be painful. 

• The Noises: You may hear a ‘swishing’ or ‘pulsing’ noise. This is normal; it is the machine using the Doppler effect to measure the speed and direction of blood flow through your heart valves. 

What the Specialist is Looking For 

While the scan is happening, the computer creates real-time images. The specialist is performing a detailed structural and functional assessment of your heart. 

Ejection Fraction (EF) 

This is the most critical number for heart failure patients. It measures the percentage of blood that the heart’s main chamber (the left ventricle) pumps out with each squeeze. It is calculated using the following formula: 

EF = \frac{EDV – ESV}{EDV} \times 100\% 

In this equation, $EDV$ is the End-Diastolic Volume (the amount of blood in the heart after it fills) and $ESV$ is the End-Systolic Volume (the amount of blood left after it pumps). 

• Normal EF: 50% to 70%. 

• Borderline EF: 41% to 49%. 

• Reduced EF (HFrEF): 40% or lower. 

Heart Structure and Valves 

The scan also evaluates: 

• Chamber Size: Whether the heart is enlarged (dilated), which happens when it struggles to pump. 

• Wall Thickness: Whether the heart muscle is too thick (hypertrophy), often caused by long-term high blood pressure. 

• Valves: Whether the four heart valves are opening fully (preventing stenosis) and closing tightly (preventing regurgitation). 

• Diastolic Function: How well the heart relaxes to fill with blood between beats, which is crucial for diagnosing heart failure with preserved ejection fraction (HFpEF). 

After the Echocardiogram 

Once the scan is finished, the gel will be wiped off, and you can get dressed and go home immediately. There are no side effects, and you can drive and return to normal activities. 

Getting Your Results 

The sonographer often cannot give you the results immediately because the images need to be formally interpreted by a cardiologist. A detailed report will be sent to the doctor who requested the test, usually within a week or two. If you are already in the hospital, the results are typically available much faster. 

According to the NHS, the results are used to determine your treatment plan, such as which medications will best support your heart’s specific type of failure. 

Conclusion 

An echocardiogram is a safe, painless, and vital tool in the management of heart failure. It provides a detailed look at your heart’s pumping strength and structural health, helping your medical team tailor your care. While waiting for results can be stressful, knowing your Ejection Fraction and valve status is the first step toward getting the right treatment. 

Emergency Guidance 

If you experience a sudden increase in breathlessness, chest pain, or fainting while waiting for your echo results, call 999 immediately. Do not wait for your follow-up appointment if you are in acute distress. 

FAQ Section 

Authority Snapshot 

This article was written by Dr. Rebecca Fernandez, a UK-trained physician with experience in cardiology, internal medicine, and emergency care. Dr. Fernandez has managed critically ill patients and provided comprehensive care for heart failure within the NHS framework. This guide draws upon established protocols from the NHS and the British Heart Foundation to explain the echocardiogram procedure and what it means for your heart health.