Your Echocardiogram in Ajax: A Closer Look

People who are booked for an echocardiogram often arrive with a few ideas that are not quite right. Some expect a quick picture, like an X-ray. Some worry that the test involves needles or dye. Others assume that because it takes about an hour, something must be wrong. None of those assumptions hold up, and clearing them away tends to make the appointment feel far more manageable.

An echocardiogram is an ultrasound of the heart. At Durham Cardiology, the cardiology team at Rossland Diagnostic Clinic in Ajax, the test offered is a transthoracic echocardiogram, which means the images are taken from the outside of the chest. Our general article on heart testing in Ajax introduces it alongside the other cardiac tests. This one slows down and looks more closely at the echocardiogram itself: what is being looked at, why the visit is the length it is, and what some of the words around the test mean.

If you have chest pain or pressure, sudden shortness of breath, fainting, or signs of a stroke such as facial drooping, arm weakness or trouble speaking, call 911. An echocardiogram is a planned test and is not a substitute for emergency care.

Moving pictures, not a snapshot

The biggest difference between an echocardiogram and many other imaging tests is movement. An X-ray captures a single moment. An echocardiogram records your heart as it beats, in real time, from several angles.

That matters because the heart is a pump, and much of what a cardiologist wants to know is about how it works, not just how it looks. Are the walls squeezing evenly? Do the valves open fully and close firmly? Is blood moving smoothly in the right direction? These are questions about motion, and ultrasound is well suited to answering them.

Like other ultrasound exams, an echocardiogram uses sound waves rather than radiation. Nothing is injected for a standard transthoracic study, and nothing goes inside your body. If you have ever had an abdominal or pregnancy ultrasound, the gel and the handheld probe will feel familiar.

A tour of what is being looked at

You do not need to know heart anatomy to have an echocardiogram. Still, many people find it reassuring to understand what the sonographer is working through as they move the probe around.

The four chambers

The heart has two upper chambers, the atria, which receive blood, and two lower chambers, the ventricles, which pump it out. The left ventricle sends blood to the body and the right ventricle sends it to the lungs. On an echocardiogram, each chamber can be seen and its size estimated.

The walls

The muscular walls of the heart, especially those of the left ventricle, are looked at for thickness and for how well each section contracts. A cardiologist reviewing the images can see whether the muscle moves in a coordinated way.

The valves

Four valves keep blood flowing forward through the heart. On an echocardiogram they appear as thin moving flaps that open and close with each beat. The test can help show whether a valve opens properly and whether it seals well enough to stop blood leaking backward.

Blood flow

Using Doppler techniques, the machine can display the direction and speed of blood moving through the heart and across the valves, often in colour. You may hear rhythmic whooshing sounds during this part. That is normal and simply part of how the flow is measured.

Put together, these views allow your cardiologist to evaluate heart size, composition, blood flow and valve function, which is what the test is designed to do.

Why a provider might request one

Health-care providers order echocardiograms for many different reasons. Some common ones include:

• a heart murmur heard through a stethoscope
• shortness of breath, reduced exercise tolerance or swelling in the legs that needs a closer look
• checking the heart in people with long-standing high blood pressure
• following up a known valve or heart muscle condition over time
• assessing the heart after an earlier cardiac event or as part of a broader workup
• an abnormal finding on an electrocardiogram or chest X-ray

An echocardiogram is often ordered as part of a sensible, thorough check rather than because something alarming is suspected. If you are not sure why yours was requested, ask the provider who ordered it.

How the hour is spent

The test takes approximately one hour, which surprises people who expect a quick scan. The length reflects how much there is to look at and how carefully each view is captured.

Here is the general shape of the visit. Individual steps can vary.

1. Registration. You check in with your signed requisition and valid OHIP card. Arriving 15 minutes early gives you time for this without feeling rushed.
2. Changing. You are typically asked to undress from the waist up and wear a gown that opens at the front, so the probe can reach different parts of the chest.
3. Positioning. You lie on an exam bed. Many people are asked to lie partly on their left side for much of the test, because this brings the heart closer to the chest wall and improves the view.
4. Imaging from several windows. The sonographer places the probe in a handful of spots: beside the breastbone, near the left side of the chest, below the ribs and sometimes just above the breastbone. Each spot gives a different angle on the heart.
5. Measurements. Throughout the scan, images are frozen and measured. This is why there are pauses where the sonographer is focused on the screen.
6. Breathing instructions. You may be asked to breathe out and hold for a few seconds, because air in the lungs can get in the way of the sound waves.

Some firm pressure from the probe is normal, especially below the ribs. If anything becomes uncomfortable, say so. The sonographer can adjust.

Getting ready, simply

Preparation for an echocardiogram at Durham Cardiology is short:

• Bring your signed requisition and valid OHIP card.
• Arrive 15 minutes early.
• Wear comfortable clothing, ideally a top you can easily remove.
• Do not apply cream or lotion to your upper body on the day of your test. Lotion can interfere with the gel and the contact between the probe and your skin.

There is no special diet or fasting listed for a standard echocardiogram. If you have been given different instructions by your provider or our team, follow those.

Words you might hear or read

Medical language around the heart can be dense. A few terms you may come across, explained in everyday words:

• Transthoracic: “through the chest.” The images are taken from the outside of the chest wall.
• Sonographer: the trained professional who performs the ultrasound and captures the images.
• Doppler: the technique that shows the speed and direction of blood flow.
• Ejection fraction: an estimate of how much blood the left ventricle pumps out with each beat compared with how much it holds. Your provider will explain what your number means for you.
• Regurgitation: blood leaking backward through a valve. It can range from trivial to significant, and small amounts are common.
• Stenosis: narrowing of a valve opening.

Seeing one of these words on a report does not, on its own, tell you how important a finding is. Context is everything, and your provider is the one who puts it together.

Echocardiogram, stress echo or something else

Durham Cardiology also offers a stress echocardiogram, which captures ultrasound images of the heart before and after treadmill exercise. The resting echocardiogram described in this article shows the heart at rest. The stress version adds information about how the heart responds when it is working harder. Your requisition will say which one you need, and the preparation is different, so check carefully.

Other cardiac tests answer different questions again. An electrocardiogram records electrical activity, a Holter monitor follows your rhythm over days, and myocardial perfusion imaging looks at blood flow through the heart muscle. If your provider has ordered more than one, it is usually because each adds a piece of the picture.

Echocardiograms look at the heart. If your provider has also asked about the blood vessels in your neck or legs, that is a separate test, a vascular ultrasound, which Rossland Diagnostic Clinic also offers.

Frequently asked questions

Is an echocardiogram safe? A standard transthoracic echocardiogram uses sound waves, not radiation, and does not involve needles. It is considered a very safe test.

Can I drive myself home? For a standard resting echocardiogram, most people return to their normal day straight away. If you have any concerns about your own situation, ask when you book.

Will I find out the results during the test? The sonographer captures the images but does not give a diagnosis during the visit. A report goes to the provider who ordered the test, and they will discuss it with you.

Can someone come with me? If you would like a family member or friend with you, or you need support during the scan, call ahead and ask what is possible for your appointment.

Booking your echocardiogram in Ajax

Durham Cardiology is located inside Rossland Diagnostic Clinic at Unit 102, 300 Rossland Road East, Ajax, with free parking and ground-floor access. We see patients from Ajax, Pickering, Whitby and across Durham Region. If you have a requisition for an echocardiogram, call us at 905-426-3111 or request an appointment and our team will contact you to confirm a time.