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The three most common types of echocardiograms (one-dimensional, two-dimensional and Doppler) are noninvasive and are particularly useful for diagnosing the following conditions:
- Valvular heart disease. Types of this disease include a condition in which the valves have narrowed (valvular stenosis: mitral stenosis, aortic stenosis, tricuspid stenosis or pulmonic stenosis), and a condition in which the valves are leaking (valvular regurgitation: mitral regurgitation, aortic regurgitation, tricuspid regurgitation or pulmonic regurgitation).
- Rheumatic heart disease. The effects of rheumatic fever that contribute to major problems with the heart’s valves, chambers and vessels.
- Bacterial endocarditis. An infection in one or more of the heart valves.
- Cardiomyopathy. A disease in which the heart muscle is unusually thick, stiff, dilated or weak.
- Heart failure. A condition in which the heart is unable to maintain adequate blood flow and circulation. It may involve the heart’s chambers, its valves, or both.
- Pericarditis. Inflammation of the pericardium (a thin, fluid-filled sac surrounding the heart).
- Tumors in the heart.
- Coronary artery disease.
 The obstruction of blood flow to the heart and the body due to hardened arteries (atherosclerosis).
- Cardiac ischemia. A condition in which the heart is not getting enough oxygen, usually because atherosclerosis restricts the flow of blood.
- Heart attack. Scarring, or death, of heart muscle due to oxygen deprivation from a closed artery.
- Shunt. Abnormal connection between the heart’s chambers.
- Pulmonary hypertension. High blood pressure (hypertension) in the blood vessels that supply oxygen-poor blood to the lungs.
The physician may also do a stress echocardiogram or “stress echo” to see how the heart functions during physical activity. Usually, a stress echocardiogram involves conducting the echocardiogram while the patient is exercising on a treadmill or a stationary bicycle, at varying speeds and elevations.
However, if the patient is unable to perform this physical activity, the physician may choose instead to do a chemical (e.g., dobutamine) stress echocardiogram. This is a test in which the patient is given a medication that causes the heart to beat more strongly, showing the physician how the heart would react to the stress of exercise.
In some cases, none of the types of noninvasive echocardiograms can provide the physician with enough information to make a firm diagnosis. For example, the tests may not give accurate information if the patient is obese (having a body mass index of 30 or greater) or has been diagnosed with chronic obstructive pulmonary disease (includes emphysema and chronic bronchitis).
Alternatively, the physician may be concerned that a blood clot is present in one of the heart’s upper chambers (atria), or that fatty plaque is present in the aorta. These areas are located deep in the chest and therefore may not be as visible with a traditional echocardiogram. In these situations, the physician may choose to do a minimally invasive form of the test called transesophageal echocardiogram (TEE). The TEE provides a clear view of the heart and/or blood vessels from the inside of the body instead of the outside.
In addition to diagnosing cardiovascular conditions, there is growing evidence of the usefulness of echocardiograms in assessing the future risk of a coronary event (e.g., heart attack). Researchers have found that in combination with established risk factors, certain echocardiogram findings indicate increased risk. This combined approach may be more effective in identifying people at high risk. Such use of echocardiograms is not yet common, but is likely to gain in popularity as more research is conducted.
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