What Does an Echocardiogram Actually Show? A Plain-Language Guide
Most people have heard of an echocardiogram but have never had one — and have little idea what the test actually reveals. Here's everything you need to know in plain language, without the medical jargon.
By Emanuel Papadakis, RDCS, RVT
Medically reviewed by Dr. Glenn Gandelman, MD, MPH, FACC, FASE — Board-Certified Cardiologist
February 2025
✓ARDMS Certified Sonographer
✓ASE Member — Echo Standards
✓IAC Accredited Cardiologist
✓Board-Certified Cardiologist Review
An echocardiogram is one of the most information-rich tests in cardiovascular medicine. In 30 to 45 minutes, it produces a real-time moving picture of your heart: valves opening and closing, chambers filling and emptying, walls contracting with every beat. Yet most people who have had one received their results without a clear explanation of what was actually being measured. This guide changes that.
What an Echo Actually Captures
An echocardiogram uses high-frequency sound waves to create detailed images of the heart. Because sound reflects differently off moving tissue, blood, and structural boundaries, the machine calculates dimensions, velocities, and pressure gradients without any radiation, contrast agents, or invasive procedures.
The sonographer acquires images from multiple windows on the chest wall where the ultrasound beam has a clear path to the heart. The parasternal long-axis view shows the left ventricle and mitral valve together. The apical four-chamber view shows all four chambers simultaneously. Together, these create a comprehensive structural and functional portrait.
Ejection Fraction: The Number Everyone Asks About
Ejection fraction (EF) measures what percentage of blood the left ventricle pumps out with each beat. A normal EF is 55 to 70 percent, according to the American Heart Association.[1] When it falls below 40 percent, the heart is pumping less than half of what it contains. This is called reduced ejection fraction heart failure, or HFrEF. Values between 40 and 55 percent represent a borderline zone that warrants close monitoring.
A normal EF does not mean the heart is perfectly healthy. Heart failure with preserved ejection fraction (HFpEF) occurs when the EF is normal but the heart stiffens and cannot relax properly.[2] This is common in older women and requires findings beyond EF alone to diagnose.
Valve Function: What the Echo Reveals
The heart has four valves: mitral, aortic, tricuspid, and pulmonic. The echo evaluates all of them. Two primary problems are detected. Stenosis is narrowing that restricts flow. Regurgitation is leaking where blood flows backward. Both can be mild and monitored over years, or severe enough to require surgical repair or replacement.
Aortic stenosis is particularly common in older adults. The aortic valve gradually calcifies and stiffens over decades. An echocardiogram calculates the pressure gradient across the valve to determine severity and guide the timing of intervention before the heart muscle is irreversibly damaged from compensating.[3]
Wall Motion: Finding Areas of Reduced Blood Flow
Each segment of the heart wall should contract with uniform strength during every beat. When a segment moves poorly or not at all, it is called a wall motion abnormality. This suggests that region of muscle is not receiving adequate blood flow. It can indicate a prior heart attack, even one the patient did not know they had, or active ischemia from coronary artery disease.
A wall motion abnormality is one of the most clinically significant findings an echo can produce and frequently changes the patient management plan immediately. Finding one does not require the patient to have had symptoms. Many are discovered incidentally during routine screening.
Who Should Get an Echocardiogram
›Anyone with a heart murmur that has never been formally evaluated
›Patients with unexplained shortness of breath, especially with exertion
›Individuals with a family history of cardiomyopathy or sudden cardiac death
›Anyone diagnosed with atrial fibrillation, where echo guides anticoagulation decisions
›Patients with longstanding hypertension, to assess for left ventricular hypertrophy
›Anyone who has had a prior heart attack and wants to assess current function
›Patients being evaluated for potential valve surgery
BlackPoint performs echocardiograms at your home using hospital-grade phased-array transducers. Every study is interpreted by Dr. Glenn Gandelman, MD, MPH, FACC, FASE, and the written report is delivered within 24 to 48 hours. $397, no referral required.
Frequently Asked Questions
What does an echocardiogram actually capture?
An echocardiogram uses high-frequency sound waves to create detailed images of the heart. It calculates dimensions, velocities, and pressure gradients without radiation, contrast agents, or invasive procedures. The sonographer acquires images from multiple chest wall windows to create a comprehensive structural and functional portrait.
What is ejection fraction and what is a normal range?
Ejection fraction measures what percentage of blood the left ventricle pumps out with each beat. A normal EF is 55 to 70 percent. Below 40 percent indicates reduced ejection fraction heart failure. Values between 40 and 55 percent represent a borderline zone that warrants close monitoring.
What valve problems can an echocardiogram detect?
The echo evaluates all four heart valves — mitral, aortic, tricuspid, and pulmonic — for two primary problems. Stenosis is narrowing that restricts flow. Regurgitation is leaking where blood flows backward. Both can be mild and monitored or severe enough to require surgical repair or replacement.
What is a wall motion abnormality on an echocardiogram?
Each segment of the heart wall should contract with uniform strength. When a segment moves poorly or not at all, it suggests that region is not receiving adequate blood flow. It can indicate a prior heart attack the patient did not know they had, or active ischemia from coronary artery disease.
Who should get an echocardiogram?
Anyone with a heart murmur never formally evaluated, unexplained shortness of breath, family history of cardiomyopathy or sudden cardiac death, atrial fibrillation, longstanding hypertension, a prior heart attack, or those being evaluated for potential valve surgery should consider an echocardiogram.
Lang RM, Badano LP, Mor-Avi V, et al. "Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging." J Am Soc Echocardiogr, 2015. PMID: 25559473
Nagueh SF, Smiseth OA, Appleton CP, et al. "Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging." J Am Soc Echocardiogr, 2016. PMID: 27037982
Doherty JU, Kort S, Mehran R, et al. "ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease." J Am Coll Cardiol, 2019. PMID: 30744922
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