context: An echocardiogram (often called an "echo") is a graphic outline of your heart's movement. During this test, high-frequency sound waves, called ultrasound, provide pictures of your heart's valves and chambers. This allows your doctor to see the pumping action of the heart. Echo is often combined with tests called Doppler ultrasound and color Doppler to check the blood flow through the heart's valves. Your doctor may order an echo to: Check the overall health of your heart See if you have heart disease, including heart failure Follow the progress of heart disease See how well your heart treatment is working The types of echoes include: Transthoracic: This is the standard echo. It's a painless test similar to an X-ray, but without radiation. Ultrasound waves are bounced off the heart to make images and sounds that can help your doctor judge your heart's health. Transesophageal: A device called a transducer is inserted down your throat into your esophagus (the swallowing tube that connects your mouth to your stomach.) Since the esophagus is close to the heart, clear images of the heart can be gotten without messing with the lungs and chest. Stress: This is done while you exercise on a treadmill or stationary bicycle. This test can show the motion of the hearts walls and the heart's pumping action when it's stressed. It can show a lack of blood flow that isn't always seen on other heart tests. The echo is performed just before and after the exercise. Dobutamine or adenosine stress: This is another form of stress echo. In this one, instead of exercising to stress the heart, you're giving a drug that stimulates the heart and makes it "think" it is exercising. It's used when you can't use a treadmill or stationary bike. It shows how well your heart tolerates activity. It can also show your odds of having coronary artery disease, diagnose significant blockages in the arteries; and tell the effectiveness of your cardiac treatment plan. Intravascular ultrasound. During this procedure, the transducer is threaded into the heart's blood vessels via a catheter in the groin. It is often used to provide detailed information about blockage inside the blood vessels. On the day of most echoes, eat and drink as you normally would. Take all of your medications at the usual times as prescribed by your doctor. On the day of the echo, do not eat or drink anything except water for 4 hours before the test. Do not take the following heart medications on the day of your test unless your doctor tells you to: Beta-blockers (for example, Inderal, Lopressor, Tenormin, or Toprol) Isosorbide dinitrate (for example, Isordil, Sorbitrate) Isosorbide mononitrate (for example, Imdur, Ismo, Monoket) Nitroglycerin (for example, Deponit, Nitrostat) Your doctor may also ask you to stop taking other heart drugs on the day of your test. If you have questions about your medications, ask your doctor. Do not stop taking any medication without first talking with your doctor. The guidelines are a bit different if you have diabetes: If you take insulin to control your blood sugar , ask your doctor what amount of your medication you should take the day of the test. Often, your doctor will tell you to take only half of your usual morning dose and to eat a light meal 4 hours before the test. If you take pills to control your blood sugar, do not take your medication until after the test is complete unless otherwise directed by your doctor. Do not take your diabetes medication and skip a meal before the test. If you own a glucose monitor, bring it with you to check your blood sugar levels before and after your test. If you think your blood sugar is low, tell the lab personnel immediately. Plan to eat and take your blood sugar medication following your test. You'll be given a hospital gown to wear. You'll be asked to remove your clothing from the waist up. A cardiac sonographer will place three electrodes (small, flat, sticky patches) on your chest. The electrodes are attached to an electrocardiography monitor ( EKG) that charts your heart's electrical activity. The technician will ask you to lie on your left side on an exam table. He or she will place a wand (called a sound-wave transducer) on several areas of your chest. The wand will have a small amount of gel on the end. Sounds are part of the Doppler signal. You may or may not hear the sounds during the test. You may be asked to change positions several times so the technician can take pictures of different areas of your heart. You should feel no major discomfort during the test. You may feel coolness from the gel on the transducer and a slight pressure of the transducer on your chest. The test will take about 40 minutes. After the test, you can get dressed and go back to your daily activities. Before your stress echo, a technician will gently rub several small areas on your chest and place electrodes (small, flat, sticky patches) on these areas. The electrodes are attached to an EKG that charts your heart's electrical activity during the test. If you are getting a stress test with medication, an IV will be put into a vein in your arm so medication (such as dobutamine) can be delivered directly into your bloodstream. The technician will perform a resting EKG, measure your resting heart rate, and take your blood pressure. The doctor or nurse will put the medication into the IV while the technician continues to get echo images. The medication will cause your heart to react as if you were exercising. At regular intervals, the lab personnel will ask how you are feeling. Tell them if you feel chest, arm, or jaw pain or discomfort; short of breath; dizzy; lightheaded; or if you have any other unusual symptoms. The lab personnel will watch for any changes on the EKG that suggest the test should be stopped. The IV will be removed from your arm once all of the medication has entered your bloodstream. The medication may cause a warm, flushing feeling and in some cases, a mild headache. If you begin to notice these or other symptoms of concern like chest discomfort, shortness of breath, or irregular heartbeats, tell the lab personnel immediately. If the test is done on a treadmill or arm ergometer, you will perform exercise until you are fatigued, you reach your target heart rate, or you have symptoms. During activity, your blood pressure will be regularly checked. An echo will be done before and after exertion, and the images will be compared. The appointment will take about 60 minutes. Before a transesophageal echo, you will be asked to remove any dentures and lie down on your left side on the exam table. You will be given some IV fluids and some medicine to help you relax. Your heart rate and blood pressure will be monitored throughout the procedure. Finally, an anesthetic spray is sprayed into your throat to reduce the gag reflex. Then a small transducer attached to a long tube is inserted into your esophagus through your mouth. This won't affect your breathing, but swallowing may be affected temporarily. Next, the doctor will perform the test to visualize the heart. When completed, the tube is withdrawn. Vital signs will be monitored for about 20-30 minutes. You cannot eat or drink until the anesthetic spray wears off -- about an hour. The test takes about 30 minutes to perform. You will need to arrange transportation home since you may feel groggy from the sedative.