Echocardiogram (heart ultrasound) (Echocardiography)
An ultrasound scan of the heart that shows how well it is pumping and whether the valves and chambers are working normally.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An echo is a safe, usually not painful ultrasound that shows how the heart is built and how well it pumps and its valves work.
- It does not show the coronary arteries or the heart's electrical rhythm, so a normal echo does not rule out narrowed arteries or every cause of symptoms.
- A standard scan takes about 30 to 40 minutes, has no radiation and needs no recovery time.
- What matters most is that a trained specialist performs it and a cardiologist explains what the result does and does not change for you.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Shows how strongly the heart muscle is pumping
A standard echo is the wrong test if the real question is whether the coronary arteries are narrowed; that needs a CT coronary angiogram or an angiogram.
You lie still while the probe is moved over your chest and may be asked to change position, breathe in or hold your breath. It is usually not painful...
A clear report reviewed by a cardiologist, with the findings explained in plain language.
You lie still while the probe is moved over your chest and may be asked to change position, breathe in or hold...
The gel is wiped off and you can dress, eat, drive and return to work or normal activity straight away.
You rest until any sedation wears off. Do not eat or drink until your swallow has recovered from the throat spray...
You are monitored until your heart rate settles back to normal, then you can usually go home the same day.
What is an echocardiogram (heart ultrasound)?
An echocardiogram, often called an 'echo', is an ultrasound scan of the heart. It uses sound waves, not radiation, to build moving pictures of the heart as it beats. A specialist called a cardiac physiologist or sonographer carries it out, and a cardiologist reviews the images.
The scan shows the size of the heart's chambers, how strongly the muscle is pumping, how the valves open and close, and the flow of blood through the heart. It is used to look into symptoms such as breathlessness, chest pain, palpitations, swollen ankles or a heart murmur, and to check conditions such as heart failure, valve disease and some heart problems present from birth.
An echo is a picture of the heart's structure and pumping at one moment in time. It is good at showing how the heart is built and how it moves, but it does not show the coronary arteries (the small vessels that can fur up and cause heart attacks) and it does not record the heart's electrical rhythm in the way an ECG or a monitor does.
A normal echo is reassuring, but it cannot rule out every heart problem. Some conditions only show up during exercise, only affect the arteries, or come and go, so your cardiologist decides what the result means alongside your symptoms and other tests.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Echocardiogram vs ECG
| Question | Echocardiogram | ECG |
|---|---|---|
| What it shows | Structure, pumping and valves | Electrical rhythm and signals |
| Uses | Ultrasound (no radiation) | Sticky electrodes only |
| Shows arteries? | No | No |
| Typical time | 30 to 40 minutes | A few minutes |
An echo and an ECG answer different questions and are often done together. Neither shows the coronary arteries directly.
Preparing for your test
- For a standard echo you can usually eat, drink and take your medicines as normal.
- Wear something easy to remove from the waist up; you will be given a gown.
- Bring a list of your medicines and any previous heart test results or letters.
- For a transoesophageal echo (TOE) you will usually be asked not to eat or drink for several hours beforehand.
- If you are having a TOE with sedation, arrange for someone to take you home and stay with you, as you should not drive afterwards.
- For a stress echo, ask whether to hold any heart-rate medicines beforehand and wear clothes and shoes you can exercise in.
- Tell the team if you are or might be pregnant, have swallowing problems, or have a latex or medicine allergy.
What happens
For a standard (transthoracic) echo you lie on a couch, usually on your left side, with sticky patches on your chest to track your heartbeat. The sonographer puts warm gel on your chest and moves a small probe over different areas, sometimes pressing or asking you to hold your breath to get clearer views. You may hear a 'whoosh' as blood flow is recorded. It is usually not painful and usually takes 30 to 40 minutes.
For a stress echo, images are taken at rest and then again straight after exercise or a heart-rate-raising medicine, so the heart can be compared under load. For a transoesophageal echo, your throat is numbed with a spray and light sedation is often offered; a thin probe is then gently passed down your gullet for more detailed views. A bubble or contrast echo adds a quick injection into a vein during the scan.
The person doing the scan records the images, but they are usually reviewed and reported afterwards. You will not always be told the result on the day.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- A standard echo is the wrong test if the real question is whether the coronary arteries are narrowed; that needs a CT coronary angiogram or an angiogram.
- A transoesophageal echo may not be suitable, or needs caution, if you have certain swallowing problems or gullet disease.
- A stress echo is not appropriate if you cannot safely have your heart rate raised, or if you have unstable chest pain that needs urgent assessment instead.
- If symptoms suggest a heart attack or another emergency, urgent care is needed rather than a planned scan.
Delay or rearrange if…
- You have an active throat or chest infection and are due a transoesophageal echo.
- You have eaten or drunk recently and are due a TOE that needs an empty stomach.
- You have unstable or worsening chest pain, which needs urgent assessment before any stress test.
- You are unsure whether to hold heart-rate medicines before a stress echo and have not checked with the team.
Alternatives to discuss
- An ECG or a 24-hour heart-rhythm monitor if the question is about heart rhythm rather than structure.
- A cardiac MRI for very detailed pictures of the heart muscle and structure.
- A CT coronary angiogram or an angiogram if the coronary arteries need to be assessed.
- Watchful waiting with symptom review if symptoms are mild and a clinician advises it is safe.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Shows how strongly the heart muscle is pumping
- Shows whether the heart valves are narrowed or leaking
- Helps explain symptoms such as breathlessness, murmurs or swollen ankles
- Uses no radiation and is usually not painful for a standard scan
- Can be repeated safely over time to follow a known heart condition
- Helps your cardiologist decide whether further tests or treatment are needed
Risks & complications
- Cool gel and some pressure from the probe during a standard scan
- A normal result that does not fully explain your symptoms, so further tests are still needed
- Incidental findings of unclear importance that may lead to more scans
- A sore throat for a day or two after a transoesophageal echo (TOE)
- Feeling drowsy after sedation for a TOE, with a temporary ban on driving
- Tiredness, breathlessness or an irregular heartbeat during a stress echo that settles with rest
- A brief flushing feeling or headache from medicines used in a stress echo
- Bleeding, a damaged or perforated gullet, or an irregular heart rhythm during a TOE (reported in fewer than 1% of TOEs)
- A reaction to the bubble or contrast agent or to a stress medicine
- A serious heart event during a stress echo, which is why it is done with monitoring and trained staff on hand
A standard echo is one of the lowest-risk heart tests and the British Heart Foundation describes it as having no risks or side effects. The main thing to discuss is what the result will and will not change: an echo does not show the coronary arteries, so it cannot on its own rule out the narrowings that cause most heart attacks. The added risks come mainly from a transoesophageal echo (passing a probe into the gullet) or a stress echo (deliberately stressing the heart), so ask which type you are having and why.
Published figures to discuss
A standard transthoracic echo is essentially without risks, so meaningful complication rates apply mainly to a transoesophageal echo, which involves passing a probe into the gullet, and to a stress echo, which deliberately stresses the heart. As a diagnostic test, the more important uncertainties are about what it can and cannot find: a normal echo does not exclude coronary artery disease or conditions that come and go, and incidental findings of unclear importance can lead to further scans.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Physical risk from a standard transthoracic echo | Essentially none | It is an ultrasound scan on the chest wall. The commonest issue is mild pressure from the probe. | Transoesophageal echocardiography related complications — PMCncbi.nlm.nih.govSource-linked context |
| Serious complication of a transoesophageal echo (TOE) | Reported in fewer than 1% of TOEs, including irregular heartbeat, bleeding, or injury to the gullet | These are uncommon and a standard echo carries no such risk; ask which type you are having and why. | Transoesophageal echocardiography related complications — PMCncbi.nlm.nih.govPublished figure |
| Incomplete or technically limited images | Recognised | Body habitus, lung disease, chest wall shape and inability to lie flat can limit image quality and may require contrast echo, TOE, CT or MRI. | Transoesophageal echocardiography related complications — PMCncbi.nlm.nih.govSource-linked context |
| False reassurance from a normal echo | Recognised | A normal echo does not rule out coronary artery disease, intermittent arrhythmia or all causes of chest pain and breathlessness. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery after a standard echo and you can go straight back to normal life. The main wait is for a specialist to review the images and for your cardiologist to explain what they mean.
- Cool gel and mild pressure during a standard scan, with no after-effects
- A mildly sore throat for a day or two after a transoesophageal echo
- Feeling tired or a little breathless for a short time after a stress echo
- Waiting a short period for the images to be reviewed and reported
- Being asked to come back for results rather than being told them on the day
Aftercare
- Wipe off any remaining gel and put your own clothes back on.
- After a standard echo, carry on with normal eating, driving and activity.
- After a transoesophageal echo, wait until your throat is no longer numb before eating or drinking, to avoid choking.
- Do not drive for the rest of the day if you had sedation for a TOE, and have someone with you.
- After a stress echo, rest until you feel back to normal and restart any medicines you were told to hold as advised.
- Make sure you know how and when you will get your results and who to contact with questions.
- Keep any planned follow-up appointment, as the scan is only useful once it has been reviewed alongside your symptoms.
- List of current medicines ready to show the team
- Previous heart test results or clinic letters to hand
- Loose, easy-to-remove top for a standard scan
- Someone to drive you home if you are having a TOE with sedation
- Confirmation of any medicines to hold before a stress echo
- A note of how and when you will be given the results
⚠ Get urgent help if…
- Severe or lasting chest pain after the scan
- Difficulty breathing or worsening breathlessness
- Fainting, collapse or a fast or irregular heartbeat that does not settle
- After a TOE: severe throat or chest pain, trouble swallowing, vomiting blood or black stools, which can signal a rare injury to the gullet
- A high temperature, neck or chest pain or feeling very unwell in the days after a TOE
- Signs of an allergic reaction after contrast or a stress medicine, such as a rash, swelling or wheeze
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good-quality echo tells your cardiologist how well your heart is pumping (the 'ejection fraction'), whether the valves are working, and whether the chambers or walls look normal. This can confirm or rule out conditions such as heart failure or valve disease and help plan treatment or further tests.
A normal echo is reassuring about the heart's structure and pumping, but it is not a clean bill of health for the whole heart. It does not show the coronary arteries, so it cannot rule out the narrowings that cause most heart attacks, and conditions that come and go or only appear on exertion can be missed. Results are interpreted together with your symptoms, examination and other tests, not in isolation.
An echo reflects your heart at the time of the scan. If your symptoms change or a condition is being monitored, the test may need repeating to track any change over months or years. Because ultrasound uses no radiation, it can be repeated safely. How often is needed depends on the condition, and your cardiologist will advise.
Related tests, treatments or support
An echo is often done alongside an ECG, a 24-hour heart-rhythm monitor, blood tests or a treadmill test, because each looks at a different aspect of the heart. If the coronary arteries need checking, a separate test such as a CT coronary angiogram or an angiogram is used, as an echo cannot show them.
Follow-up & long-term care
Your cardiologist usually reviews the reported scan with you at a clinic appointment, sometimes on the same day for an urgent question. They will explain whether the result is normal, whether anything needs watching, and whether further tests, treatment or a repeat scan are needed. Make sure you leave knowing who to contact if you do not hear about your results.
- Repeat scans at intervals if you have a valve problem or other condition being monitored
- Bringing previous echo reports to future appointments so changes can be compared
- Keeping to any medicines or lifestyle advice given after the result
Repeat, follow-on and what comes next
- An echo may need repeating if the views were limited, for example by body shape or lung air, sometimes with contrast added.
- A normal echo with continuing symptoms often leads to further, different tests rather than a repeat echo.
- Conditions that are being monitored are followed with repeat scans over time to track any change.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear report reviewed by a cardiologist, with the findings explained in plain language.
- A named way to contact the clinic if you have not received your results.
- Honest discussion of what a normal or abnormal result means for you and what happens next.
- A sensible plan for any further tests or a repeat scan, rather than open-ended repeat imaging.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The type of scan (a standard echo, a stress echo or a more involved transoesophageal echo)
- Whether contrast or a bubble study is needed to improve the pictures
- Whether sedation is used for a transoesophageal echo
- The fee for the cardiologist who reports and explains the scan
- Whether a consultation and other tests, such as an ECG, are included
- Whether a follow-up appointment to discuss results is part of the price
- The fee for performing the scan itself
- The reporting cardiologist's fee
- Any charge for contrast, a bubble study or sedation
- Whether a consultation before or after the scan is included
- Whether discussing the results with a cardiologist is included
- What happens, and what it costs, if a further test is needed
- The cancellation and rebooking policy
On the NHS? Echocardiograms are routinely provided on the NHS when a heart problem is suspected; private scans are usually chosen for speed, convenience or a second opinion rather than because the test is unavailable.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told that a standard echo does not show the coronary arteries, so cannot rule out the cause of most heart attacks.
- Not understanding why a transoesophageal echo (with a probe into the gullet) or a stress echo is being recommended over a standard scan.
- No clear plan for who reviews the images and how and when you receive the results.
- Not being warned about driving and eating restrictions after sedation or throat spray for a TOE.
Marketing red flags
- Promoting a heart ultrasound as a complete check that 'rules out heart disease', when it does not show the arteries.
- Offering an echo as a stand-alone screen without a clinical reason or a cardiologist to interpret it.
- Implying a normal scan guarantees you will not have a heart attack.
- Bundling extra scans or tests without explaining what each one adds.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which type of echo am I having (standard, stress or transoesophageal), and why that one?
- What question are you hoping this scan will answer?
- What will the result change about my treatment or further tests?
- What happens if the scan is normal but my symptoms continue?
- Do I need any other test, such as an ECG or a test of my arteries?
- When and how will I get the results, and who do I contact if I do not hear?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is an echocardiogram available on the NHS?
Does an echocardiogram hurt or use radiation?
Will an echo show if my arteries are blocked?
What is the difference between an echo and an ECG?
When will I get my results?
Can a normal echo miss a heart problem?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Echocardiogram British Heart Foundation — Echocardiogram British Society of Echocardiography — Clinical indications for echocardiography Transoesophageal echocardiography related complications — PMC Princess Alexandra Hospital NHS Trust — Transoesophageal echocardiogram (patient leaflet)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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