Echocardiography tests
Echocardiography is a type of heart scan that uses sound waves to create moving pictures of the heart. Mayo Clinic Healthcare uses advanced echocardiography tests to see how well the heart muscle and valves are working, how blood flows through the heart, and whether there are any signs of problems, such as weakness, narrowing or leakage of the valves.
Echocardiography is a safe, painless test that does not use radiation. Different types of echocardiograms are used depending on what your doctor needs to look at in more detail.
Transthoracic echocardiogram
Transthoracic echocardiogram (TTE) is a safe, painless ultrasound scan of your heart. It uses sound waves to create moving pictures so that your doctor can see how your heart looks and how well it is working.
What does an echocardiogram show?
An echocardiogram gives a clear picture of how your heart looks and how well it works. It shows:
- The size and shape of the heart.
- How strongly it pumps.
- How the valves are working.
- How blood flows through the heart.
- Whether there are any signs of weakness, damage or fluid around the heart.
Mayo Clinic Healthcare experts use the latest guidelines to adjust TTE measurements for factors such as body surface area. They also apply several advanced parameters and techniques to improve the accuracy of detecting any structural or functional irregularities at rest. This helps the specialists understand your heart health and decide if you need any treatment or follow‑up.
How do I prepare for my echocardiogram?
Most people do not need to do anything special before the test. You can eat, drink and take your usual medicines. Wear loose, comfortable clothing. You may be asked to remove clothing from your upper body and wear a gown. There is no radiation, and a standard echocardiogram does not involve any injections.
What happens during the exam?
You lie on a couch, usually on your left side. A clinician puts gel on your chest and moves the probe over your skin to take pictures of your heart. You may be asked to take a deep breath or hold your breath for a moment. The test is not painful. The scan shows how well your heart is working.
How long does an echocardiogram take?
A standard echocardiogram usually takes 30 to 40 minutes.
What happens after my echocardiogram?
You can go home or get back to your usual activities straightaway. There are no side effects. A specialist looks at the images from your scan. A report with the results is sent to the doctor who requested the test.
Bubble study echocardiogram
A bubble study echocardiogram is a safe, painless ultrasound scan of your heart. It works like a standard echocardiogram but includes an injection of harmless saline “bubbles” into a vein. These tiny bubbles help show how blood flows through the heart and whether any blood passes through small openings between the heart chambers.
What does a bubble study show?
A bubble study helps check for irregular connections inside the heart, such as a patent foramen ovale or an atrial septal defect. It also shows:
- The size and shape of the heart.
- How strongly the heart pumps.
- How the valves are working.
- How blood flows through the heart chambers.
Mayo Clinic Healthcare experts use the latest guidelines to adjust bubble study measurements for factors such as body surface area. They also apply several advanced parameters and techniques to improve the accuracy of detecting any structural or functional irregularities at rest. This helps specialists understand your heart health and decide if you need any treatment or follow‑up.
How do I prepare for my bubble study?
Most people do not need to do anything special before the test. You can eat, drink and take your usual medicines. Wear loose, comfortable clothing. You may be asked to remove clothing from your upper body and wear a gown. The saline bubbles are safe, contain no medication and dissolve naturally within seconds.
What happens during the bubble study?
You lie on a couch, usually on your left side. A clinician places gel on your chest and moves the probe over your skin to take pictures of your heart. A small cannula is placed in a vein in your arm so the saline bubbles can be injected during the scan. You may be asked to take a deep breath, cough or briefly hold your breath. This helps show how the bubbles move through your heart. The test is not painful.
How long does a bubble study take?
A bubble study usually takes 45 to 60 minutes, similar to a standard echocardiogram.
What happens after my bubble study?
You can go home or return to your usual activities straightaway. There are no side effects. A specialist reviews the images from your scan. A report with the results is sent to the doctor who requested the study. Your doctor explains the results at your next appointment.
Exercise stress echocardiogram
An exercise stress echocardiogram is an ultrasound scan that looks at how your heart works when it is under stress, usually while you walk on a treadmill or pedal on a bike. The test can show how well your heart pumps blood when it has to work harder.
What does an exercise stress echocardiogram show?
The test can show if there are any problems with the blood supply to your heart and how well your heart muscle and valves are working. It also checks how your heart copes with exercise. If unusual parameters are seen, an exercise stress echocardiogram can help your doctor:
- Decide whether further tests are needed to rule out coronary artery disease.
- Assess blood flow and pressure changes during stress.
- Look more closely for valve problems that only appear when the heart is working harder.
Sometimes the consultant recommends additional heart imaging, such as a CT coronary angiogram or a stress cardiac MRI, to get more-detailed information.
When should I have an exercise stress echocardiogram, and when is a dobutamine stress echo used instead?
An exercise stress echo is usually chosen if you can walk on a treadmill, as it shows how your heart works when your heart rate increases naturally.
A dobutamine stress echocardiogram is used when you can't exercise enough because of pain, mobility issues or other health issues. The test uses medicine to raise your heart rate, similar to how exercise raises it. The test checks how your heart responds to the elevated heart rate.
How do I prepare for my exercise stress echocardiogram?
To prepare for the test, you may be asked not to eat a heavy meal beforehand and to avoid caffeine for a few hours. Wear comfortable clothes and shoes suitable for walking. You can take your usual medicines unless your doctor advises otherwise.
What happens during the exam?
During the exam, some ultrasound pictures of your heart are taken while you are resting. A clinician places sticky pads on your chest to monitor your heart rhythm. You then walk on a treadmill or use a bike, with the speed or resistance gradually increasing. As soon as you finish exercising, more heart ultrasound pictures are taken to see how your heart responds to the extra effort from exercise.
You may feel warm or a little out of breath. The team supports you throughout and can stop the test at any time if needed.
How long does an exercise stress echocardiogram take?
The whole appointment usually takes about 60 minutes, although the exercise part itself is only a few minutes long.
What happens after my exercise stress echocardiogram?
After the exercise stress echo, you can rest for a short time and then return to your usual activities. A consultant looks at your results. And a cardiologist reviews them in detail and explains what they mean at your next appointment. The cardiologist also advises whether you need lifestyle changes, medication or further heart tests.
Dobutamine stress echocardiogram
A dobutamine stress echocardiogram is a heart ultrasound scan that shows how your heart works when it is made to beat faster. Instead of exercising on a treadmill or bike, you receive a medicine called dobutamine. The medicine makes your heart work harder in a safe and controlled way. This helps your team see how well your heart pumps blood when it is under stress.
What does a dobutamine stress echocardiogram show?
A dobutamine stress echo can show if there are problems with the blood supply to your heart and how well your heart muscle and valves are working. Instead of exercise, the medicine dobutamine makes your heart beat faster so the test can check how your heart performs under stress. If unusual parameters are seen, it can help your doctor:
- Decide whether further tests are needed to rule out coronary artery disease.
- Assess blood flow and pressure changes during stress.
- Look more closely for valve problems that only appear when the heart is working harder.
Sometimes the consultant recommends additional heart imaging, such as a CT coronary angiogram or a stress cardiac MRI, to get more-detailed information.
How do I prepare for my dobutamine stress echocardiogram?
To prepare for the test, you may be asked not to eat a heavy meal beforehand and to avoid caffeine for a few hours. Wear comfortable clothing and take your usual medicines unless your doctor advises otherwise. Your team will let you know in advance if any medicines need to be stopped before the test.
What happens during the exam?
During the exam, you lie on a couch while sticky pads are placed on your chest to monitor your heart rhythm. A clinician puts a small amount of gel on your chest. Then the sonographer takes ultrasound pictures of your heart while you are resting. You then receive dobutamine through a small cannula in your arm. As your heart rate increases, more ultrasound pictures are taken to see how your heart responds.
You may feel your heart beating faster or feel warm. The team monitors you closely and can stop the test at any time if needed.
How long does a dobutamine stress echocardiogram take?
The whole appointment usually takes around 45 to 60 minutes, although your heart rate will be elevated for only a short part of the test.
What happens after my dobutamine stress echocardiogram?
After the dobutamine stress echocardiogram, you can rest for a short time and then get back to your usual activities. A consultant checks your results, reviews them in detail and explains the results at your next appointment. The consultant also advises whether you need lifestyle changes, medication or further heart tests.
Transoesophageal echocardiogram
A transoesophageal echocardiogram (TOE) is a special heart ultrasound that gives very clear pictures of your heart. Instead of taking the images from the outside of your chest, a small probe is gently passed down your throat and into the tube that connects your mouth to your stomach, called the oesophagus, which sits close to the heart. This probe helps the team see the heart in more detail.
What does a TOE show?
The test shows:
- How your heart valves are working.
- How blood is flowing through the heart.
- Whether there are any clots, infections or other concerns that may not be easy to see on a standard echocardiogram.
How do I prepare for my TOE?
To prepare for the test, you may be asked not to eat or drink for six hours beforehand. You can take your usual medicines unless your doctor advises otherwise. You also need to have someone who can take you home afterward, as you will have a sedative before the test to help you relax.
What happens during the exam?
During the exam, you lie on your side. A nurse places a small cannula in your arm so you can receive a sedative. The nurse uses a spray to numb your throat. This is to make the procedure more comfortable for you.
Once you are relaxed, the doctor gently guides the probe down your throat and into your oesophagus. The team takes ultrasound pictures of your heart from inside your chest.
You may feel a little pressure in your throat, but the sedative helps you stay calm and comfortable throughout.
How long does a TOE take?
The test usually takes around 20 to 30 minutes. You may be at the clinic for 2 to 3 hours to allow time for preparation and recovery.
What happens after my TOE?
After the test, you rest for 45 to 60 minutes while the sedation wears off. Once you are fully awake, you can go home. Someone must take you home and stay with you for the rest of the day. You should not drive, drink alcohol or make important decisions until the next day.
A cardiologist checks your results, reviews them in detail and explains the results at your next appointment. The cardiologist also advises whether you need lifestyle changes, medication or further heart tests.
Doppler echocardiography
Doppler echocardiography provides essential information about how blood moves through the heart and major blood vessels — details that cannot be seen on standard images alone. This test helps doctors understand whether the heart is pumping efficiently, whether the valves are opening and closing properly, and whether pressures inside the heart are within standard range.
Doppler is a vital tool for:
- Identifying valve disease. It shows how fast blood flows through each valve and helps diagnose valve narrowing, called stenosis, or leakage, called regurgitation.
- Estimating pressures inside the heart and lungs. This is important for conditions such as pulmonary hypertension and heart failure.
- Detecting flow patterns. It can reveal shunts, turbulent flow or unusual pathways seen in congenital heart disease.
- Assessing heart failure and diastolic function. Doppler helps determine how well the heart relaxes and fills with blood between beats.
- Supporting 2D and 3D imaging. It adds crucial functional information to the structural images, giving a more complete picture of heart performance.
Because Doppler is used in all types of echocardiography, including routine scans, stress tests and contrast studies, it forms a core part of Mayo Clinic Healthcare's heart assessments and guides many important clinical decisions.
Tissue Doppler imaging
Tissue Doppler imaging (TDI) is a specialised echocardiography technique that measures the speed and movement of the heart muscle itself, rather than the blood flowing through it, as Doppler does.
TDI is used across all types of echocardiography, including routine scans, stress echocardiography and contrast studies. It supports both 2D and 3D imaging by adding detailed information about how the heart muscle performs.
Why TDI is useful
TDI provides important information about how well the heart muscle contracts and relaxes. It can detect subtle irregularities that may not be visible on standard imaging or Doppler blood flow measurements. It is especially valuable for:
- Assessing diastolic function. TDI helps determine how well the heart relaxes and fills with blood between beats, which is essential in diagnosing early heart failure and diastolic dysfunction.
- Detecting early cardiomyopathy. TDI can reveal reduced muscle movement before changes appear on standard echocardiography, making it useful in identifying inherited or acquired cardiomyopathies.
- Evaluating regional wall motion. TDI can identify areas of the heart muscle that are moving more slowly or weakly, which may suggest previous heart damage or ischaemia, a condition that occurs when blood flow to your heart is reduced, preventing the heart muscle from receiving enough oxygen.
- Monitoring chemotherapy effects. TDI can detect subtle changes in muscle movement early, helping guide treatment and protect heart function.
- Supporting heart failure assessment. TDI contributes to estimating filling pressures and understanding how well the heart muscle is working overall.
By measuring the heart muscle directly, TDI adds an extra layer of detail to the echocardiogram, helping Mayo Clinic Healthcare specialists diagnose conditions earlier and manage them more effectively.
Speckle tracking
Speckle tracking is a form of strain imaging. This is a specialised echocardiography technique that measures how the heart muscle stretches, shortens and moves during each heartbeat. The procedure tracks tiny natural patterns, called speckles, within the heart muscle on the ultrasound image to assess how well different areas of the heart are working.
Why it’s useful
Speckle tracking can detect very early changes in heart muscle function, even when standard measurements such as ejection fraction still appear normal. This makes it especially valuable in the assessment of cardiomyopathies, where subtle anomalies in the heart muscle may develop long before symptoms appear. Speckle tracking helps identify regional or global reductions in heart muscle performance, monitor disease progression and guide treatment decisions.
Speckle tracking also is widely used in chemotherapy monitoring, heart failure and valve disease, as it can reveal early signs of heart muscle stress or weakness that may not be visible on routine echocardiography.
3D echocardiography
3D echocardiography creates a 3D view of the heart, allowing the structures to be seen in much greater detail than standard 2D images. It can be used alongside all types of echocardiography, including routine scans, stress echocardiography and contrast studies.
Why it’s useful
3D echocardiography provides highly accurate images of the heart valves, chamber size and structure. It allows doctors to see the heart from different angles and assess how the valves open and close in real time. This is especially helpful for diagnosing valve disease, measuring heart chamber volumes more precisely and identifying congenital heart conditions.
Doctors often use 3D imaging for preprocedure planning, such as before valve repair or replacement, device closure of holes in the heart, or other structural heart interventions. It helps guide treatment decisions by giving a clearer understanding of the heart's anatomy and function. And it improves accuracy when standard 2D images are limited.
Contrast echocardiography using ultrasound enhancement agents
Contrast echocardiography uses microbubble contrast agents, usually based on sulphur hexafluoride, injected into a vein to improve image clarity. When clearer images are needed, contrast can be used with any type of echocardiography, including standard scans, stress echocardiography and bubble studies.
Before the test, the team checks for any known allergies to sulphur‑based products or polyethylene glycol (PEG), which is sometimes found in laxatives and other medicines. These allergies are very rare, but it is important to confirm them for safety.
Why it’s useful
Contrast echocardiography provides enhanced images of the heart chambers and borders, improves assessment of heart pumping function, and helps identify intracardiac clots or areas with reduced blood flow.
Book an appointment
If you need an accurate echocardiography imaging with quick results, request an appointment at Mayo Clinic Healthcare in London online or call us at +44 (0) 207 871 2575.