If you’ve been told you need an echocardiogram, or you’re wondering whether one might be appropriate for you, it’s helpful to understand what the test involves and when it’s used. Even if you don’t have symptoms, there are situations where having an echo can be a sensible decision, especially if heart disease runs in your family.
I’ll walk you through what an echocardiogram is, why it’s used, what to expect during the test, and whether it’s better to go through the NHS or opt for a private scan.
What Is an Echocardiogram?
An echocardiogram, or echo for short, is a type of ultrasound scan that takes moving pictures of your heart using sound waves. It helps doctors see the size, structure, and movement of your heart and valves, all in real time. It’s non-invasive, completely painless, and doesn’t use radiation unlike CT or MRI scans.
You can think of it as the heart’s version of the scans used during pregnancy. It shows how the heart pumps blood, whether the valves open and close properly, and if there are any areas that look unusual.
What Does It Include?
A standard transthoracic echocardiogram (TTE) is the most common version. It includes:
Heart chamber size and function
Valve movement and structure
Blood flow direction using colour Doppler
Pericardial fluid (if any)
General rhythm and heartbeat strength
Some echo scans can be more detailed depending on what your doctor is looking for. For example:
A transoesophageal echocardiogram (TOE) gives a closer look by passing a probe down the throat
A stress echo shows how your heart behaves under physical exertion or medication
A fetal echo is used during pregnancy to check a baby’s heart
Do I Need to Prepare for an Echo?
In most cases, no special preparation is needed. If you’re having a standard TTE, you can eat and drink as normal and take your usual medications.
However, if you’re scheduled for a TOE, you’ll need to fast for at least 6 hours beforehand. You may also be given a sedative during the test and need someone to drive you home afterwards.
It’s helpful to wear loose clothing, as you may be asked to remove your top or wear a gown so the chest area is accessible.
What’s Involved in the Test?
A typical transthoracic echo lasts around 20–30 minutes. You’ll lie on your side while a technician or cardiologist applies gel to your chest and moves a handheld probe over specific areas.
The probe sends high-frequency sound waves into the chest, which bounce off the heart and create moving images on a screen. You might hear whooshing sounds from the machine, but that’s the blood flow being recorded.
It’s completely safe and not painful, though you may feel mild pressure if the probe is pressed firmly to get clearer pictures.
What Is It Used For?
Doctors request echocardiograms to check for a wide range of heart-related concerns, such as:
Valve disease (e.g. stenosis, regurgitation)
Heart failure or reduced pumping function
Signs of previous heart attacks
Congenital heart defects
Infections like endocarditis
Blood clots or tumours in rare cases
It’s also used to monitor existing heart conditions or check progress after treatment.
Even without symptoms, an echo might be useful if you have a family history of heart disease, high blood pressure, or other risk factors like diabetes or high cholesterol.
How Much Does It Cost?
NHS echocardiograms are free if referred by your GP or a hospital consultant. However, wait times can vary, typically between 4 to 8 weeks, depending on urgency and where you live.
Private echocardiograms in the UK usually cost between £250 and £600, depending on the clinic and the complexity of the scan. Transoesophageal and stress echos can be more expensive, ranging from £700 to £1,200.
Going private often means faster appointments, longer scan times, and access to more detailed reports.
NHS vs Private, What’s the Difference?
Both the NHS and private providers follow the same safety guidelines, including those from NICE and the British Society of Echocardiography. The main differences lie in access and flexibility:
Feature | NHS | Private |
Cost | Free | £250–£1,200 depending on type |
Wait time | 4–8 weeks or longer | Often available within a few days |
Appointment time | Standardised 20–30 min | Often longer, with immediate consultation |
Access to advanced scans | May be limited without referral | Readily available |
Is It Safe? Are There Any Risks?
Yes echocardiograms are very safe. They don’t involve radiation, injections, or invasive procedures. The only slight discomfort might come from:
The pressure of the probe against the chest
Throat irritation after a TOE
Temporary dizziness if having a stress echo
There are no long-term side effects, and the test can be repeated safely if needed.
Could an Echo Miss Anything?
While echocardiograms provide a lot of valuable information, no test is perfect. In some cases:
Mild coronary artery disease might not show up
Very obese patients or those with lung issues may have unclear images
The quality of the scan can depend on the technician’s skill
This is why doctors sometimes request additional tests like ECGs, CT angiograms, or MRI scans for a more complete picture.
When Might Someone Without Symptoms Get an Echo?
In the UK, it’s becoming more common for people to request preventive heart scans even if they don’t have symptoms. Reasons include:
A strong family history of heart conditions
High blood pressure or abnormal blood tests
Competitive athletes undergoing screening
Reassurance before starting a new exercise programme
Follow-up after a viral infection (e.g. COVID) affecting the heart
These requests are easier to arrange privately, as the NHS typically requires a clinical reason for referral.
How Does the Ultrasound Part Work?
The echocardiogram uses high-frequency ultrasound waves to create moving images. The probe (transducer) sends out sound waves, which bounce off the heart’s internal structures. These echoes are picked up by the probe and turned into real-time visuals.
Doppler imaging shows blood flow and pressure, which can reveal leaks, blockages or backflow through valves.
The process is quick and harmless and unlike CT scans or X-rays, there's no exposure to ionising radiation.
What Happens After the Test?
Once the scan is complete, the results are reviewed by a cardiologist. If you’re at a private clinic, you may receive your report on the same day. Through the NHS, results usually arrive within a week or two. So, if you are looking for fast, high quality results, definitely go private.
Your doctor will go over:
How well your heart is pumping
Any valve issues
Signs of enlargement or reduced function
Any areas needing further investigation
Depending on the findings, next steps might include medication, lifestyle changes, or other tests such as an ECG, MRI, or angiogram.
Understanding Key Terms in Your Echocardiogram Report
Once you receive your echocardiogram results, the report might include technical terms that can seem overwhelming. Understanding these key measurements and phrases can help you make sense of the findings before discussing them with your doctor. Here's a breakdown of some common ones, explained in simple terms:
Ejection Fraction (EF): This percentage shows how much blood your left ventricle pumps out with each heartbeat. Normal EF is usually between 50% and 70%. Lower values might indicate weakened heart function, like in heart failure.
Left Ventricular End-Diastolic Dimension (LVEDD) or Volume (LVEDV): These measure the size of your left ventricle when it's full of blood, just before it contracts. Enlarged values could suggest dilation from conditions like high blood pressure or valve problems.
Valve Regurgitation or Stenosis: Regurgitation means a valve leaks, allowing blood to flow backward, while stenosis indicates narrowing that restricts forward flow. The report might grade these as mild, moderate, or severe based on Doppler imaging.
Wall Thickness or Hypertrophy: This refers to the thickness of the heart muscle walls. Increased thickness (hypertrophy) can occur from long-term high blood pressure and might affect how well the heart relaxes and fills.
Pericardial Effusion: This describes any excess fluid around the heart in the pericardial sac. Small amounts are often harmless, but larger ones could signal inflammation or other issues.
Remember, these are general explanations—your cardiologist will interpret them in the context of your overall health. If anything in the report concerns you, ask for clarification during your follow-up appointment.
Here is an in-depth video explaining results and how to understand them:
Final Thoughts
An echocardiogram is one of the most valuable tools we have for checking heart health. It’s non-invasive, safe, and gives real-time insights into how your heart is working. Whether you’re experiencing symptoms or have risk factors like family history or high blood pressure, an echo can provide peace of mind or guide the next steps.
At Heartsure, we help people navigate whether a heart scan is appropriate for them, whether through private or NHS pathways. If you’re unsure, it’s always worth having a conversation with your GP or a cardiologist.
Taking early action, even without symptoms could be one of the best decisions you ever make for your heart health.
