How to read an echocardiogram: 5 steps to know if your heart is normal or has valve regurgitation

Echocardiography is one of the most common cardiovascular examination methods today, allowing doctors to observe the heart's activity in real time without causing pain or affecting health. However, many people, after receiving their results, are often confused by a series of technical terms and professional indicators, not knowing what they mean.

According to statistics, cardiovascular disease remains among the leading causes of death worldwide. Therefore, a basic understanding of echocardiogram results, important echocardiogram indicators, and what your doctor is evaluating will help you be more proactive in monitoring your heart health.

In this article, Tiptory will help you understand how to read echocardiogram images, identify important information on your results sheet, and know when certain indicators may be warning signs that require early monitoring or treatment.

Part 1: How to read echocardiogram indicators accurately

Step 1: Understand heart size on echocardiogram

Check for heart enlargement

When reviewing your echocardiogram results, you should ask your doctor about the overall size of your heart. A heart larger than normal or a thickened heart wall can be a warning sign of various cardiovascular issues that need monitoring.

• Doctors often assess the thickness of the left ventricular wall, the main pumping chamber of the heart responsible for circulating blood throughout the body.
• If the left ventricular wall is thicker than about 1.5 cm, this is generally considered abnormal on an echocardiogram.
• This condition can affect the heart's ability to contract and function over time.

Possible causes of thickened heart walls

When echocardiogram indicators show abnormally thickened heart walls, the causes may be related to:

• Prolonged high blood pressure, forcing the heart to work harder to pump blood.
• Weak heart valves, reducing the efficiency of blood flow in the heart.
• Damaged or narrowed heart valves, requiring the heart to increase its contractile force to maintain blood flow.

Why is this information important?

Early detection of an enlarged heart or thickened heart walls via echocardiogram images helps doctors assess the risk of cardiovascular disease and recommend appropriate treatment. If the results show abnormalities, you should discuss them thoroughly with your doctor to understand the cause and the long-term monitoring plan.

Step 2: Evaluate the heart's pumping ability

Check if the heart is pumping blood efficiently

One of the important goals of an echocardiogram is to assess the heart's contractility. Through specialized indicators, doctors can determine whether the heart is pumping enough blood and oxygen to the organs in the body.

• If the pumping ability is reduced, the body may not receive enough oxygen to function normally.
• This is also one of the signs that help detect the early risk of heart failure.
• When reading echocardiogram results, there are two important indicators you should pay attention to.

Left ventricular ejection fraction (EF)

Left ventricular ejection fraction (EF) indicates the percentage of blood ejected from the left ventricle with each heartbeat.

• This is one of the most commonly used echocardiogram indicators to assess heart function.
• An EF of about 60% is generally considered normal.
• Low EF can indicate that the heart is contracting inefficiently and increases the risk of heart failure.
• Doctors often combine EF with other clinical signs to make a more accurate assessment of cardiovascular health.

Cardiac output indicator

Cardiac output is the amount of blood the heart pumps per minute.

• This indicator reflects the heart's ability to meet the body's oxygen and nutrient demands.
• In healthy resting adults, the heart typically pumps about 4.8 to 6.4 liters of blood per minute.
• If cardiac output decreases, patients may experience symptoms such as fatigue, shortness of breath, or reduced exercise capacity.

Significance of these indicators on echocardiogram

Understanding indicators like EF and cardiac output helps you read echocardiogram results more easily. When these indicators are outside the normal range, your doctor may recommend further tests or appropriate treatments to protect heart function and prevent long-term complications.

Step 3: Evaluate heart wall motion

Observe the contractility of each myocardial region

In addition to measuring size and pumping function, echocardiography also helps doctors assess how the heart walls contract with each beat. If a region of the heart muscle functions weakly or abnormally, it could indicate that this area of the heart has been previously damaged.

• This condition is often seen in people who have had a myocardial infarction.
• Prolonged coronary artery disease can also reduce blood flow to the heart muscle, leading to impaired contractility.
• When analyzing echocardiogram images, doctors will examine the wall motion of each myocardial region to detect abnormalities.

Hyperkinesis

This is a condition where a part or the entire heart wall contracts more vigorously than normal.

• Excessive myocardial activity can be a compensatory response when other areas of the heart are functioning less efficiently.
• This indicator needs to be evaluated in conjunction with other examination results to determine the specific cause.

Hypokinesis

Hypokinesis occurs when a region of the heart muscle contracts weaker than normal.

• This is one of the common abnormalities found in echocardiogram results.
• This condition can be related to myocardial ischemia or previous myocardial damage.
• The more pronounced the hypokinesis, the more the heart's pumping function may be affected.

Akinesis

Akinesis is a condition where a region of the heart muscle barely contracts.

• This often indicates that the myocardial tissue has been severely damaged or has formed scars after a myocardial infarction.
• The akinetic area will not contribute effectively to the heart's pumping activity.

Dyskinesis

Dyskinesis occurs when the heart wall bulges abnormally at a time when it should be contracting.

• This is a sign that the heart muscle's movement is no longer synchronized.
• This condition can reduce pumping efficiency and affect overall heart function.
• In some cases, dyskinesis is related to long-standing myocardial damage or complications after myocardial infarction.

Significance of evaluating heart wall motion

Through echocardiography, doctors can accurately identify which areas of the heart muscle are functioning normally or have been damaged. This is important information for diagnosing cardiovascular disease, assessing the extent of the disease, and developing an appropriate treatment plan for each patient.

Step 4: Check heart valves on echocardiogram

Observe the opening and closing movement of heart valves

During an echocardiogram, the doctor will assess the structure and function of the heart valves. On the ultrasound image, heart valves typically appear as continuous gray lines that open and close with each heartbeat to regulate blood flow between the heart chambers.

• Normally functioning heart valves will open completely when blood passes through and close tightly afterward.
• Any abnormalities in the heart valves can affect blood flow and increase the heart's workload.
• This is one of the important aspects when reading echocardiogram results.

Detecting valvular regurgitation (leaky heart valve)

Valvular regurgitation occurs when a valve does not close completely after each heartbeat.

• Some blood may flow backward into the previous heart chamber instead of moving in the correct direction.
• This condition is also known as a leaky heart valve.
• If regurgitation is prolonged or severe, the heart has to work harder to maintain blood circulation in the body.
• On a Doppler echocardiogram, doctors can assess the degree of backflow to determine the severity of the regurgitation.

Detecting valvular stenosis (narrowing of the heart valve)

Valvular stenosis occurs when a valve does not open to its normal extent.

• The narrowed valve opening makes it difficult for blood to flow through the heart.
• The heart must increase its contractile pressure to push blood through the narrowed area.
• Over time, this condition can affect heart function and lead to symptoms such as shortness of breath, fatigue, or chest pain.
• Echocardiogram indicators will help the doctor assess the severity of the stenosis and its impact on blood circulation.

Significance of checking heart valves

Heart valve assessment is an important step in reading echocardiogram images. Early detection of valvular regurgitation or stenosis helps doctors monitor disease progression, select appropriate treatment methods, and reduce the risk of future cardiovascular complications.

Step 5: Detect heart defects on echocardiogram

Check for structural abnormalities in the heart

One of the important values of echocardiography is its ability to detect heart defects or structural abnormalities. Through the images obtained, doctors can assess whether the heart chambers, heart valves, and major blood vessels are formed correctly.

• These abnormalities can be present from birth or develop during the fetal stage.
• Early detection helps improve the effectiveness of monitoring and treatment.
• This is a content often carefully evaluated when analyzing echocardiogram results.

Detecting abnormal openings between heart chambers

In a normal heart, the heart chambers are completely separated by intact septa.

• If there are holes in these septa, blood can flow in the wrong direction between the heart chambers.
• Some common abnormalities include atrial septal defects or ventricular septal defects.
• On echocardiogram images, doctors can identify the location, size, and impact of these openings.

Checking for abnormal connections between the heart and blood vessels

Echocardiography also helps detect abnormal connections between the heart and major blood vessels.

• These abnormalities can alter blood flow in the circulatory system.
• Depending on the case, patients may have no symptoms or experience shortness of breath, fatigue, or slowed physical development.
• The echocardiogram indicators will help the doctor assess the extent of the impact on heart function.

Detecting congenital heart defects in fetuses

In addition to evaluating the heart in adults, fetal echocardiography is also used to check the heart structure of the fetus during pregnancy.

• This method helps detect many types of congenital heart defects early, before the baby is born.
• Doctors can assess the formation of the heart chambers, heart valves, and major blood vessels.
• Early detection helps families and medical teams plan for appropriate monitoring, care, and treatment after birth.

Significance of early detection of heart defects

Through echocardiography, many structural heart abnormalities can be identified at an early stage, even before obvious symptoms appear. This helps doctors make timely interventions, limit complications, and improve the quality of life for patients in the future.

Part 2: What is echocardiography and what you need to know

Meaning 1: When is echocardiography needed?

Understand why your doctor ordered an echocardiogram

If you are asked to undergo an echocardiogram, you should discuss it with your doctor to understand the purpose of this test. Echocardiography not only helps visualize heart structures but also supports the assessment of heart function and the detection of many important cardiovascular diseases.

• This is a non-invasive, safe, and commonly used diagnostic method.
• The ultrasound results help doctors determine the cause of symptoms such as shortness of breath, chest pain, palpitations, or prolonged fatigue.
• At the same time, echocardiogram results also support monitoring the effectiveness of treatment and disease progression.

Detecting heart murmurs

Your doctor may order an echocardiogram if an abnormal heart murmur is heard during a physical examination.

• Heart murmurs can be related to abnormal blood flow through the heart valves or chambers.
• Echocardiography helps determine the cause and the extent of the impact on heart function.

Assessing valvular heart disease

Problems related to heart valves are one of the common indications for echocardiography.

• Detecting valvular regurgitation or valvular stenosis.
• Assessing the extent of damage and its impact on blood circulation.
• Monitoring disease progression over time.

Checking for atrial fibrillation

Atrial fibrillation is a common type of heart rhythm disorder.

• Echocardiography helps assess heart structure in people with atrial fibrillation.
• It helps detect accompanying complications such as chamber dilation or blood clot formation.

Detecting heart valve infection

In some cases of suspected infective endocarditis, your doctor may order an echocardiogram.

• This method helps detect damage or infected masses on the heart valves.
• It helps assess the extent of the disease's impact on heart function.

Checking for fluid around the heart

Echocardiography can detect fluid accumulation in the pericardial sac.

• Too much fluid can compress the heart and affect its pumping ability.
• Early detection helps the doctor make appropriate interventions.

Detecting blood clots in the heart

Some people are at risk of developing blood clots within the heart chambers.

• Echocardiography helps identify the location and size of blood clots.
• This is especially important because blood clots can increase the risk of stroke or embolism.

Assessing myocardial thickening

When the heart muscle thickens abnormally, the heart's ability to contract and relax can be affected.

• Echocardiography helps measure heart wall thickness and assess heart function.
• This is important information for early detection of cardiomyopathy.

Detecting congenital heart disease

Many structural heart abnormalities can be detected through echocardiogram images.

• This includes abnormal openings between heart chambers or major blood vessel malformations.
• Can be detected in children or adults who have not been previously diagnosed.

Assessing pulmonary hypertension

Pulmonary hypertension is a condition where the pressure in the pulmonary vascular system is abnormally high.

• Echocardiography helps estimate pulmonary artery pressure and assess the extent of its impact on the heart.
• This is one of the important echocardiographic indicators in diagnosing and monitoring the disease.

Why is echocardiography so important?

Through echocardiography, doctors can directly observe the structure and activity of the heart in real-time. As a result, many cardiovascular diseases can be detected earlier, improving treatment effectiveness and reducing the risk of serious complications.

Significance 2: Common types of echocardiography

Ask your doctor what type of echocardiogram you will be having

Not all cases use the same echocardiography method. Depending on symptoms, health status, and diagnostic purpose, the doctor will select the appropriate type of ultrasound to gather necessary information about heart structure and function.

• Each method has its own advantages and is indicated in different situations.
• Understanding the type of echocardiogram being performed will help you better prepare for the examination.
• This is also useful information when researching and interpreting echocardiogram results.

Transthoracic Echocardiogram

This is the most commonly used type of echocardiogram today.

• Non-invasive, safe, and almost painless method.
• The doctor will apply a layer of gel to the chest and then move the ultrasound transducer over the skin surface.
• Ultrasound waves will pass through the body and create real-time images of the heart on the screen.
• This method helps evaluate heart size, pumping function, myocardial wall thickness, and valvular heart diseases.

Transesophageal Echocardiogram

In some cases, the doctor may order a transesophageal echocardiogram to get a clearer view of the heart.

• A small ultrasound transducer is passed through the esophagus to reach a position close to the heart.
• Patients are usually given medication to relax and throat anesthetic before the procedure.
• The images obtained have higher detail compared to transthoracic echocardiograms.
• This method is particularly useful when evaluating heart valves, detecting blood clots, or looking for structural heart abnormalities that are difficult to observe.

Stress Echocardiogram

Stress echocardiography is used to evaluate heart function when the body is working harder than usual.

• Heart images are recorded while the patient exercises on a treadmill or exercise bike.
• If exercise is not possible, the doctor may use medication to temporarily increase heart rate.
• The results help evaluate the heart's response to working under pressure.
• This method is often indicated to detect coronary artery disease or myocardial ischemia that may not be detected by conventional echocardiography.

Which type of echocardiogram is best?

There is no single best method for all cases. The doctor will choose the appropriate type of echocardiogram based on symptoms, medical history, and diagnostic goals. Understanding each method will help you be more proactive during the examination and easily discuss the echocardiogram results with your doctor afterward.

Significance 3: Commonly used echocardiography techniques

Learn about the techniques that appear on the echocardiogram screen

During echocardiography, doctors may use various techniques to gather detailed information about the structure, contractile function, and blood flow within the heart. Each technique provides a unique perspective, helping to diagnose cardiovascular disease more accurately.

• In reality, many techniques are often combined in a single ultrasound examination.
• Understanding the meaning of each method will help you follow and interpret echocardiogram results more easily.

M-mode Echocardiogram

M-mode is one of the basic echocardiography techniques and has been used since very early on.

• Creates a linear cross-sectional image to measure heart structures.
• Supports assessment of heart chamber size and myocardial wall thickness.
• Helps doctors monitor the movement of heart valves and myocardium with each beat.
• Often used to measure important echocardiographic parameters related to heart size and function.

Doppler Echocardiogram

Doppler ultrasound is used to evaluate blood flow within the heart and blood vessels.

• Measures the speed of blood flowing through heart chambers and valves.
• Determines the direction of blood movement in the circulatory system.
• Helps detect abnormalities such as valvular stenosis, valvular regurgitation, or flow disorders.
• Helps doctors assess whether the heart's pumping capacity meets the body's needs.

Color Doppler Echocardiogram

Color Doppler is an advanced version of conventional Doppler ultrasound.

• Blood flow is displayed in different colors on the screen.
• Helps doctors visually observe the direction of blood flow.
• Easily detects conditions such as backflow due to valvular regurgitation or circulatory abnormalities.
• This technique is very important when evaluating valvular heart diseases on echocardiogram images.

Two-dimensional (2D) Echocardiogram

This is the most commonly used technique in cardiac examinations.

• Creates a two-dimensional image of the heart functioning in real-time.
• Allows observation of heart chambers, valves, and major blood vessels.
• Supports assessment of heart structure and myocardial contractility.
• Most basic information in echocardiogram results is collected using this technique.

Three-dimensional (3D) Echocardiogram

3D echocardiography creates images with depth and higher detail.

• Displays heart structures more realistically than two-dimensional ultrasound.
• Helps doctors accurately assess the shape and function of heart valves.
• Useful for treatment planning or preparation for cardiac procedures and surgeries.
• Increasingly applied in modern cardiac centers.

Why combine multiple echocardiography techniques?

Each technique provides a different set of information about the heart's structure and activity. Combining M-mode, Doppler, color Doppler, 2D, and 3D ultrasound helps doctors gain a more comprehensive understanding of the cardiovascular condition, thereby making accurate diagnoses and selecting appropriate treatment methods.

References

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Content edited by: Lesley Collins Tran.

Information consulted and verified by expert: Isabella Moore.