A Transthoracic Echocardiogram (TTE)—often called an echocardiogram or “echo”—is a non-invasive heart ultrasound performed by placing an ultrasound probe on the chest. It uses sound waves (not radiation) to create real-time images of your heart. This common cardiology test helps your clinician see how well your heart is built and how well it is working.

A TTE provides key information for a complete cardiac assessment, including:

• Heart structure: the size and thickness of the heart chambers (atria and ventricles) and whether the heart is enlarged.

• Heart function: how strongly the heart pumps blood. One commonly reported measure is the ejection fraction (EF), which estimates the percentage of blood pumped out of the left ventricle with each beat.

• Heart valves: whether valves open and close properly and if there is valve narrowing (stenosis) or leakage (regurgitation).

• Blood flow: Doppler ultrasound evaluates the direction and speed of blood flow through the heart and valves.

• Pressures and strain on the heart: the study may estimate pressures in the lungs’ arteries (pulmonary artery pressure), helping evaluate pulmonary hypertension or strain from lung/heart disease.

• Fluid or masses: it can detect fluid around the heart (pericardial effusion) and may identify certain masses or clots (though additional imaging may be needed for confirmation).

In plain language, TTE results help answer questions such as: “Is my heart pumping normally?”, “Are my heart valves working correctly?”, “Is my heart enlarged or thickened?”, and “Is blood moving through my heart in the right direction at the right speed?” A report may describe findings as normal, mildly/moderately/severely abnormal, or may recommend follow-up testing depending on what’s seen.

A TTE is often ordered when symptoms, exam findings, or other tests suggest a possible heart problem. It is a first-line heart test because it is painless, widely available, and provides a lot of information about heart function and valve performance.

Your clinician may recommend a TTE if you have symptoms such as:

• Shortness of breath (with activity or at rest), decreased exercise tolerance, or unexplained fatigue

• Chest pain or chest pressure (depending on the situation, other tests may be used alongside an echo)

• Palpitations, rapid heartbeat, or irregular heartbeat

• Swelling in the legs/ankles, sudden weight gain, or signs of fluid overload

• Dizziness or fainting (syncope), especially if a structural heart issue is suspected

A TTE is also commonly ordered when a clinician hears an abnormal heart sound on exam, such as:

• A heart murmur (to check for valve disease)

• Signs of heart failure (to assess pumping strength and fluid status)

Other reasons a TTE may be done include:

• Follow-up of known heart disease: monitoring previously diagnosed valve disease, cardiomyopathy, heart failure, congenital heart defects, or pulmonary hypertension

• After a heart attack or suspected heart muscle injury: to look for weakened areas of the heart muscle or complications

• High blood pressure (hypertension): to evaluate thickening of the heart muscle (left ventricular hypertrophy) or changes in heart function

• Infection concerns: if endocarditis is suspected, an echo can help evaluate valve involvement (sometimes a transesophageal echo is preferred for more detail)

• Pre-op or clearance evaluations: when heart function or valve status needs clarification before a procedure

Because it is non-invasive and uses ultrasound, a TTE is generally safe for most people, including during pregnancy, and it is a common form of chest imaging for the heart.

• Heart failure (reduced or preserved ejection fraction)
• Valvular heart disease (aortic stenosis, mitral regurgitation, mitral stenosis, tricuspid regurgitation)
• Cardiomyopathy (dilated, hypertrophic, restrictive)
• Coronary artery disease complications (reduced wall motion after a heart attack)
• Atrial fibrillation and other rhythm-related structural concerns (e.g., enlarged atria)
• Pericardial effusion and pericarditis
• Pulmonary hypertension
• Congenital heart disease (e.g., atrial septal defect, ventricular septal defect)
• Infective endocarditis (evaluation for valve involvement; may require additional imaging)
• Left ventricular hypertrophy due to long-standing hypertension

• Monitoring overall cardiovascular health and heart function over time
• Evaluating symptoms early to help detect heart disease before complications develop
• Tracking known valve disease to guide timing of medication changes or procedures
• Assessing response to treatment for heart failure (medications, devices, lifestyle changes)
• Risk assessment and follow-up after a heart attack or suspected heart muscle injury
• Checking for heart changes related to chronic high blood pressure
• Clarifying abnormal findings from other tests (ECG/EKG, chest X-ray, blood tests) as part of a complete cardiac assessment
• Pre-procedure planning and medical clearance when heart pumping or valve status is uncertain