What is an Echocardiogram
Echocardiogram is a non-invasive and painless test that uses ultrasound to assess the heart’s structure and function. A trained sonographer places a handheld probe (called a transducer) on the chest to capture real-time images of the heart’s chambers, valves, and blood flow. Unlike imaging techniques that involve radiation, echocardiography is completely safe and does not expose the patient to X-rays. It plays a crucial role in the early detection of a wide range of cardiac conditions and is often used to evaluate symptoms such as shortness of breath, chest discomfort, or unexplained fatigue.
🫀 When and Why an Echocardiogram May Be Recommended
An echocardiogram can be an essential tool in diagnosing, monitoring, and managing a wide range of heart conditions. It offers real-time insight into the heart’s structure, motion, and blood flow, allowing cardiologists to detect abnormalities early and tailor treatment plans accordingly. Common reasons your doctor may recommend an echocardiogram include:
🔉 A Heart Murmur Is Detected
If your doctor hears an unusual sound during your examination — known as a heart murmur — an echocardiogram can help determine its cause. It provides detailed imaging of your heart valves and chambers, helping differentiate between harmless (innocent) murmurs and those caused by structural heart disease.
😮💨 Symptoms Like Chest Pain or Shortness of Breath
When you experience chest discomfort or breathlessness, an echocardiogram may be used to assess whether heart disease is involved. It can reveal conditions such as coronary artery disease, valve abnormalities, or heart failure. In cases where symptoms occur during exertion, a stress echocardiogram may be performed to evaluate heart function under physical load.
💓 Irregular Heart Rhythm (Arrhythmia)
Echocardiography can help evaluate structural abnormalities that may underlie an arrhythmia, such as atrial fibrillation or ventricular ectopy. It allows your cardiologist to assess the size and function of the heart chambers, which can influence rhythm control strategies and treatment decisions.
🫀 Cardiomyopathy (Heart Muscle Dysfunction)
Cardiomyopathies — diseases affecting the heart muscle — reduce the heart’s ability to pump efficiently and may lead to heart failure. An echocardiogram is the gold-standard imaging test to diagnose and monitor cardiomyopathies, helping guide both medical and device-based therapies.
🫧 Suspected Valvular Heart Disease
The heart’s four valves ensure blood flows in one direction. An echocardiogram is the most accurate and widely used test to assess valve anatomy and function. It detects problems like:
- Stenosis: valves that don’t open properly
- Regurgitation: valves that don’t close properly, leading to backflow
👶 Congenital Heart Defects
In children or adults born with heart abnormalities, an echocardiogram can identify structural defects such as septal defects (holes in the heart) or abnormal blood vessel connections. This is key in both diagnosis and long-term follow-up of congenital heart disease.
🔁 Monitoring Heart Function Over Time
For patients with chronic heart conditions, periodic echocardiograms are often used to monitor heart function and evaluate response to treatment. This helps guide adjustments to medications, devices, or other interventions to optimise outcomes.
🩺 Preoperative Cardiac Evaluation
Before non-cardiac surgeries (especially in older adults or patients with comorbidities), an echocardiogram may be requested to assess baseline heart function and rule out silent valvular or systolic dysfunction.
💊 Monitoring Cardiotoxicity from Chemotherapy
Patients undergoing chemotherapy (e.g. with anthracyclines or trastuzumab) often need serial echocardiograms to detect early declines in left ventricular function and prevent irreversible heart damage.
📉 Suspected Pericardial Effusion or Tamponade
Echo is the go-to test when pericardial effusion is suspected — e.g., in cancer, post-surgery, or inflammatory conditions — and is essential in urgent settings to assess for tamponade physiology.
⚠️ Unexplained Syncope or Dizziness
While not the first-line in all cases, an echo may be performed to rule out structural causes of syncope, especially in patients with known or suspected cardiomyopathy, aortic stenosis, or pulmonary hypertension.
🫁 Evaluation of Pulmonary Hypertension
Echocardiography provides indirect estimation of pulmonary artery pressures and right heart function. It’s a key non-invasive screening tool in suspected pulmonary hypertension, especially in breathless patients.
🩸 Endocarditis or Septic Workup with a Murmur
If infective endocarditis is suspected (especially in patients with fever and a new murmur), echo — often followed by TOE — is used to detect vegetations or valvular destruction.
🧠 The Role of Echocardiography in Stroke Evaluation and Management
Transthoracic echocardiography (TTE) plays an important role in evaluating patients after stroke or transient ischaemic attack (TIA), especially when a cardiac source of embolism is suspected. While the majority of strokes are caused by atherosclerotic disease affecting cerebral arteries, approximately 20–25% are due to cardioembolic causes — most commonly from atrial fibrillation, valvular disease, or structural cardiac abnormalities. Echocardiography is essential in identifying stroke-related heart conditions that might otherwise go unnoticed. From clots in the heart to valve disease and structural abnormalities, the following are key cardiac sources that can be evaluated using echocardiography.
🩸 Cardiac Embolism (Blood Clots in the Heart)
In patients with atrial fibrillation or severe left ventricular dysfunction, blood clots may form within the heart and embolize to the brain. TTE — and in some cases, transesophageal echocardiography (TEE) — can detect these clots, especially in the left atrium or left atrial appendage, which are common sources in AF-related strokes.
🫀 Patent Foramen Ovale (PFO)
A patent foramen ovale (PFO) is a small, flap-like opening between the upper chambers of the heart that should close shortly after birth. In approximately 25% of people, it remains open. While often harmless, a PFO can allow blood clots to bypass the lungs and reach the brain, increasing stroke risk in select individuals. This is particularly relevant in cases of cryptogenic stroke (stroke of unknown cause) in younger patients.
The ROPE score (Risk of Paradoxical Embolism) helps assess the likelihood that a PFO is responsible for a stroke. You can calculate your ROPE score using our ROPE Score Calculator to better understand the clinical context.
A transesophageal echocardiogram (TEE) is often the most effective method to detect a PFO and assess its characteristics for management.
🔄 Valvular Heart Disease
Valvular conditions such as rheumatic mitral stenosis or infective endocarditis can significantly increase stroke risk. Narrowed or leaking valves may promote clot formation, while vegetations from infection can break off and embolize. Mechanical prosthetic valves also carry a known embolic risk. Echocardiography is the gold-standard for evaluating these conditions and identifying associated thrombus or vegetations.
💔 Left Ventricular Dysfunction and Post-MI Risk
Following a large myocardial infarction, particularly anterior wall infarcts, regions of akinetic or dyskinetic myocardium may lead to stasis of blood in the left ventricle. This creates an ideal environment for clot formation, with the potential for embolization to the brain. Echocardiography can identify areas of poor contractility and visualise thrombus within the ventricular cavity.
🧬 Cardiac Masses
Structural cardiac masses — whether benign or malignant — can also be a source of embolic stroke. Echocardiography helps detect, localise, and characterise these lesions:
Benign Cardiac Masses:
- Myxomas: The most common primary benign cardiac tumour, typically arising in the left atrium.
- Rhabdomyomas, fibromas: More often seen in younger patients, usually in the ventricles.
- These masses may obstruct flow or embolize.
Case 1: Left atrial myxoma
Video: A 38-year-old man presented with palpitations. As part of the work-up, an Echocardiogram revealed the presence of a mobile mass in the left atrium. The mass appeared benign and was attached to the left atrial wall by a stalk, along with a few loosely attached strands. Due to the high risk of detachment of fragments and embolization to the brain, leading to a stroke, it is crucial to remove the mass surgically.
Images: Figure 1 displays the Left Atrial mass on a CT Coronary Angiogram before his surgery, while Figure 2 illustrates the mass after surgical removal. The mass was fragile and could easily be fragmented during resection. This raises the probability of embolization, leading to a devastating stroke in a young individual. Following the surgery, a pathology report confirmed that the mass was a benign Myxoma.
Malignant Cardiac Masses:
- Primary cardiac sarcomas or lymphomas are rare.
- Metastatic lesions (from lung, breast, melanoma, etc.) are more common.
- Echo helps assess the extent of infiltration and hemodynamic impact.
Case 2: Metastatic Melanoma in the Left Ventricle
Video: A 65-year-old man presented with a stroke. During the investigations, he underwent an Echocardiogram that revealed a mobile mass in his left ventricle. Further tests and pathological reports confirmed that the mass was melanoma, a form of malignant skin cancer. Unfortunately, part of the mass had metastasized to his brain, causing a stroke.
Valvular Masses:
Small masses on the heart valves, such as papillary fibroelastomas or valve strands, are potential embolic sources. These are most commonly found on the aortic or mitral valves and may lead to stroke despite their small size. Transesophageal echocardiography (TEE) offers superior resolution for detecting such lesions, particularly when TTE is inconclusive.
🧪 The Role of Echocardiography in Cancer Patients and Chemotherapy
Transthoracic echocardiography (TTE) has become a cornerstone in the care of cancer patients, especially those receiving chemotherapy with known cardiotoxic potential. Many cancer therapies can negatively impact the heart, either acutely or over time, making cardiac imaging an essential part of treatment planning and monitoring.
❤️ Common Cardiac Complications from Cancer Therapy
Chemotherapy and immunotherapy can lead to a wide range of cardiovascular issues, particularly in patients with pre-existing heart disease. Common complications include:
- Arrhythmias (irregular heart rhythms)
- Dilated cardiomyopathy (heart enlargement and reduced pump function)
- Coronary vasospasm leading to angina or myocardial infarction
- Pericardial effusion or pericarditis (fluid or inflammation around the heart)
💊 Cardiotoxic Chemotherapy Agents
Several classes of cancer therapies are associated with direct cardiac toxicity:
- Anthracyclines (e.g. doxorubicin, epirubicin): Widely used but dose-dependent risk of cardiomyopathy
- HER2-targeted therapies (e.g. trastuzumab/Herceptin): Reversible cardiac dysfunction, especially when combined with anthracyclines
- Tyrosine kinase inhibitors (e.g. sunitinib, sorafenib): May cause hypertension and heart failure
- Checkpoint inhibitors (e.g. pembrolizumab, nivolumab): Rare but potentially life-threatening myocarditis
| Drug/Class | Examples | Main Cardiac Effects | Monitoring Needed |
|---|---|---|---|
| Anthracyclines | Doxorubicin, Epirubicin | Dilated cardiomyopathy, ↓ LVEF, heart failure | Baseline + serial Echo + GLS |
| HER2-targeted agents | Trastuzumab (Herceptin) | Reversible ↓ LVEF, cardiomyopathy | Frequent Echo (esp. with anthracyclines) |
| Tyrosine kinase inhibitors | Sunitinib, Sorafenib | Hypertension, ↓ LVEF, ischemia | Echo + BP monitoring |
| Checkpoint inhibitors | Nivolumab, Pembrolizumab | Myocarditis, arrhythmias | Baseline Echo ± biomarkers |
| Alkylating agents | Cyclophosphamide | Pericardial effusion, myocarditis | Echo if symptomatic |
| VEGF inhibitors | Bevacizumab, Pazopanib | Hypertension, arterial events | BP, Echo (if risk factors) |
| Immunotherapies | CAR-T therapy, ICIs | Arrhythmias, myocarditis, QT prolongation | Echo, ECG ± Cardiac MRI |
🔍 Echocardiogram in Chemotherapy Monitoring
📋 Baseline Cardiac Assessment
A pre-treatment echocardiogram is recommended before initiating potentially cardiotoxic therapy. This provides a baseline assessment of left ventricular function, most commonly using left ventricular ejection fraction (LVEF) and increasingly global longitudinal strain (GLS) for greater sensitivity.
🧭 Ongoing Monitoring for Cardiotoxicity
Serial echocardiograms are used during treatment to detect early signs of cardiac dysfunction:
- LVEF below the normal range (55–70%) may indicate myocardial injury
- GLS is more sensitive than LVEF and can detect subclinical damage before symptoms arise
Early detection allows oncologists and cardiologists to modify treatment plans—by adjusting chemotherapy doses, switching agents, or adding cardioprotective therapies (e.g. ACE inhibitors, beta-blockers).
📆 Long-Term Cardiac Follow-Up
Even after chemotherapy has ended, patients remain at risk of late-onset cardiotoxicity. Ongoing surveillance with echocardiography is essential—especially for those with prior cardiotoxicity—to monitor for the development of heart failure or arrhythmias and to ensure long-term cardiac well-being.
🫀 Summary
Echocardiography is a vital tool in the multidisciplinary care of cancer patients. It facilitates early detection of chemotherapy-induced cardiotoxicity, informs treatment decisions, and supports long-term cardiac health in cancer survivors. By integrating cardiac imaging into oncology care pathways, clinicians can balance effective cancer treatment with protection of heart function and quality of life.
What to Expect During an Echocardiogram: Procedure, Duration, and Comfort
Understanding what happens during an echocardiogram can help ease anxiety and ensure you’re prepared. The test is non-invasive, painless, and typically takes less than an hour. Here’s what to expect:
🧍♀️ 1. Before the Test: Getting Ready
- You may be asked to remove clothing from your upper body and wear a gown.
- You’ll lie on an examination table while small sticky electrodes are placed on your chest to monitor your heart rhythm.
❄️ 2. Applying the Gel
- A water-based ultrasound gel is applied to your chest to help the transducer glide smoothly and improve image clarity.
- It might feel a bit cold but is completely harmless.
🖐️ 3. Image Acquisition
- The sonographer uses a handheld probe (transducer) to capture moving images of your heart.
- They may press gently or ask you to change positions or briefly hold your breath for clearer views.
- The sound waves are converted into real-time visuals of your heart, valves, and blood flow.
⏱️ 4. Duration and Comfort
- Most echocardiograms take 30 to 45 minutes.
- The procedure is usually comfortable. At most, mild pressure from the transducer may cause brief discomfort.
👕 5. After the Test
- The gel and electrodes are removed, and you can get dressed and return to your normal activities.
- Your cardiologist will review the images and explain the results at your follow-up or consultation.
Conclusion
Echocardiography is a cornerstone of modern cardiology—offering a safe, non-invasive way to assess the heart’s structure and function in real time. While it’s not used as a routine screening tool for the general population, it plays a vital role in diagnosing heart conditions, tracking disease progression, and guiding treatment decisions in patients with symptoms or known risk factors. Its ability to provide detailed insights without radiation makes it an invaluable tool in both acute and ongoing cardiac care.
If you’re looking to book an echocardiogram in Westmead, visit our Echocardiogram Service Page.