An echocardiogram is one of the most widely used tests for examining the structure and function of the heart.
Using ultrasound waves, it creates moving images that allow healthcare professionals to assess the heart chambers, valves, walls, blood flow, and pumping performance.
Learning how to interpret echocardiograms involves more than checking whether individual measurements fall within a reference range.
The findings need to be considered together because chamber dimensions, ventricular function, valve performance, blood-flow patterns, and pressure estimates can influence one another.
In this guide, we explain the major sections of an echocardiogram and what common measurements and findings can tell you about heart function.
What Is an Echocardiogram?
An echocardiogram, commonly called an echo, is an ultrasound examination of the heart. Sound waves are transmitted toward cardiac structures and reflected back to create images of the heart while it beats.
Unlike an X-ray, echocardiography does not rely on ionizing radiation. A standard transthoracic echocardiogram is generally noninvasive and can provide detailed information about cardiac anatomy and function.
An echo can help evaluate:
- Heart chamber size
- Heart wall thickness
- Left ventricular pumping function
- Right ventricular function
- Heart valve structure and movement
- Blood-flow direction and velocity
- Diastolic or relaxation function
- Abnormal wall movement
- Fluid surrounding the heart
- Estimated pressures within parts of the heart
Doctors may order echocardiography when investigating symptoms such as shortness of breath, unexplained fatigue, chest symptoms, swelling, abnormal heart sounds, or suspected cardiovascular disease.
Understanding the Main Types of Echocardiograms
Before interpreting an echo report, it helps to identify which type of echocardiogram was performed. Different approaches provide different types and levels of information.
➢ Transthoracic Echocardiogram
A transthoracic echocardiogram (TTE) is the standard and most commonly performed type.
A transducer is moved over different areas of the chest to obtain images of the heart from several angles. It can assess chamber dimensions, ventricular contraction, valve function, wall motion, and blood flow.
➢ Transesophageal Echocardiogram
A transesophageal echocardiogram (TEE) uses a specialized probe passed into the esophagus.
Because the esophagus lies close to the heart, TEE can provide detailed images of certain cardiac structures.
It may be particularly useful when clinicians need closer evaluation of valves or when standard transthoracic images are inadequate.
➢ Stress Echocardiogram
A stress echocardiogram evaluates heart function under increased workload.
Images are generally compared before and after exercise or medication-induced cardiac stress. Changes in regional heart-wall movement may provide information relevant to suspected coronary artery disease.
➢ Doppler Echocardiography
Doppler techniques evaluate the direction and velocity of blood flow.
Doppler measurements are especially important when assessing valve narrowing, valve leakage, intracardiac pressure differences, and patterns associated with ventricular filling.
How to Read an Echocardiogram Report
A systematic approach makes a detailed echocardiogram report easier to understand.
Rather than concentrating immediately on a single number, review the report in sections:
- Left ventricular size and function
- Right ventricular size and function
- Left and right atrial dimensions
- Heart valve findings
- Doppler measurements
- Diastolic function
- Aortic dimensions
- Pericardium
- Estimated pulmonary pressures
- Overall impression or conclusion
This approach connects individual findings to the overall assessment.
Start With the Left Ventricle
The left ventricle (LV) is one of the most important structures evaluated during an echocardiogram. It receives oxygenated blood from the left atrium and pumps it into the aorta for circulation throughout the body.
An echo report commonly describes:
- Left ventricular dimensions
- Wall thickness
- LV mass
- End-diastolic volume
- End-systolic volume
- Ejection fraction
- Regional wall motion
- Overall systolic function
Left Ventricular Size
The size of the left ventricle is assessed using measurements obtained during different phases of the heartbeat.
An enlarged left ventricle can occur in several clinical settings. Potential explanations include chronic volume overload, certain valve disorders, cardiomyopathy, or other conditions that cause structural remodeling.
A smaller or larger measurement should not be interpreted independently. Body size, age, sex, imaging technique, clinical history, and other echo findings can influence interpretation.
Understanding Ejection Fraction
Left ventricular ejection fraction (LVEF) is one of the most recognizable measurements on an echocardiogram.
It represents the percentage of blood within the left ventricle that is ejected during each contraction.
For example, an EF of 60% does not mean the heart contains only 60% of its normal blood supply. It means approximately 60% of the blood present in the ventricle at the end of filling is pumped out during that contraction.
LVEF is commonly used to categorize left ventricular systolic performance.
A reduced EF can be associated with impaired systolic function, but EF should never be considered in isolation. Some people can have symptoms of heart failure despite having a preserved ejection fraction.
Similarly, measurement techniques and image quality can affect the reported value.
What Does “Normal LV Systolic Function” Mean?
You may see a statement such as:
“Left ventricular systolic function is normal.”
This generally indicates that the left ventricle appears to contract adequately based on the measurements and visual assessment obtained during the study.
Other reports may describe LV function as:
- Normal
- Low-normal
- Mildly reduced
- Moderately reduced
- Severely reduced
The precise interpretation depends on the measurement method and laboratory reference standards.
Understanding Left Ventricular Wall Thickness
An echocardiogram also evaluates the thickness of the muscular walls surrounding the left ventricle.
Two commonly assessed structures include:
- Interventricular septum: the wall separating the right and left ventricles
- Posterior LV wall: the muscular wall toward the back of the left ventricle
Increased wall thickness may be described as left ventricular hypertrophy (LVH).
LVH can develop when the heart has to work against increased resistance over time. High blood pressure and certain valve conditions are among the possible causes, although interpretation requires the full clinical picture.
The pattern of thickening is also important. Echocardiography can help distinguish between concentric remodeling, concentric hypertrophy, asymmetric thickening, and other structural patterns.
Regional Wall Motion Abnormalities
The left ventricle does not simply contract as one uniform structure. Clinicians assess different segments of the ventricular wall individually.
A normal report may state:
“No regional wall motion abnormalities.”
This means the assessed segments appear to move and thicken appropriately during contraction.
Abnormal wall motion may be described using terms such as:
- Hypokinetic: reduced movement
- Akinetic: little or no movement
- Dyskinetic: abnormal outward movement during contraction
Regional abnormalities can provide important diagnostic information, particularly when evaluated alongside symptoms, electrocardiogram findings, medical history, and other cardiac testing.
Understanding the Right Ventricle
After reviewing the left ventricle, the right ventricle (RV) deserves equal attention.
The right ventricle receives blood returning from the body and pumps it toward the lungs. Echo reports typically assess its size and systolic function.
Common descriptions include:
- Normal RV size
- Mildly dilated RV
- Moderately dilated RV
- Severely dilated RV
- Normal RV systolic function
- Reduced RV systolic function
Several measurements can assess right ventricular performance.
One commonly reported parameter is TAPSE, or tricuspid annular plane systolic excursion. Other methods include tissue Doppler measurements and visual assessment of RV contraction.
Because the right ventricle has a complex shape, clinicians generally consider several findings rather than relying on one measurement.
Understanding the Left Atrium
The left atrium (LA) receives oxygenated blood from the lungs before delivering it to the left ventricle.
Its size can provide useful information about longer-term pressure and volume conditions affecting the heart.
Reports may provide a left atrial volume index (LAVI), which adjusts left atrial volume for body surface area.
An enlarged left atrium may occur with conditions associated with elevated filling pressures, certain valve disorders, hypertension, or rhythm disturbances such as atrial fibrillation.
However, left atrial enlargement is not a diagnosis by itself. Its significance depends on the patient’s history and accompanying echo findings.
Understanding the Right Atrium
The right atrium (RA) receives blood returning from the body before passing it into the right ventricle.
Its dimensions are also assessed during echocardiography.
Right atrial enlargement may occur alongside right ventricular abnormalities, elevated right-sided pressures, certain valve problems, or other cardiopulmonary conditions.
As with other chamber measurements, the finding should be interpreted within the complete echocardiographic and clinical context.
Why You Should Not Interpret One Echo Number Alone
One of the most important principles in learning how to interpret echocardiograms is avoiding conclusions based on a single measurement.
An echocardiogram contains interconnected information.
For example, a clinician may examine:
- Ejection fraction
- Ventricular volumes
- Wall thickness
- Left atrial volume
- Valve appearance
- Doppler velocities
- Filling patterns
- Right ventricular function
- Estimated pulmonary pressure
These findings are then compared with symptoms, physical examination, blood pressure, heart rhythm, previous imaging, laboratory testing, and medical history.
Reference ranges are valuable, but they are not substitutes for clinical interpretation. Echocardiographic guidelines emphasize considering measurements within the broader clinical context.
Why the Final Echo Impression Matters
Most echocardiogram reports finish with an impression, summary, or conclusion.
This section is particularly useful because it brings the major findings together rather than presenting isolated measurements.
The impression may summarize:
- Overall ventricular function
- Chamber enlargement
- Significant valve disease
- Abnormal wall motion
- Diastolic dysfunction
- Elevated pulmonary pressure estimates
- Aortic abnormalities
- Pericardial findings
However, a qualified healthcare professional should interpret the final impression in the context of why the test was ordered.
How to Interpret Heart Valve Findings
Heart valve assessment is a major part of echocardiogram interpretation. The heart contains four valves: the mitral, aortic, tricuspid, and pulmonary valves.
Echocardiography shows how these valves open and close and how blood moves through them.
Two abnormalities frequently discussed in echo reports are stenosis and regurgitation.
Stenosis means a valve opening has become narrowed, which can restrict forward blood flow. Regurgitation means blood leaks backward through a valve that does not close completely.
Reports may classify valve abnormalities as:
- Trace
- Mild
- Moderate
- Severe
A small amount of valve regurgitation can sometimes be seen without significant structural heart disease. Therefore, the severity, valve anatomy, chamber response, symptoms, and other measurements should all be considered together.
Understanding Doppler Measurements
Doppler echocardiography helps clinicians understand how blood travels through the heart.
It can measure blood-flow velocity, direction, and pressure differences across certain cardiac structures. Color Doppler provides a visual representation of blood flow, while spectral Doppler displays velocities over time.
Important Doppler findings can include:
- Peak blood-flow velocity
- Mean and peak pressure gradients
- Direction of blood flow
- Valve regurgitation patterns
- Ventricular filling velocities
For example, unusually high velocity across a narrowed valve can help clinicians determine the severity of stenosis.
Interpret Doppler findings alongside two-dimensional images and other measurements rather than using them independently.
How to Interpret Diastolic Function
Systolic function describes how effectively the ventricles contract. Diastolic function describes how the heart relaxes and fills between contractions.
A person can have a preserved ejection fraction while still having impaired ventricular relaxation or abnormal filling pressures.
Several measurements may contribute to the assessment of left ventricular diastolic function, including:
- Mitral E-wave velocity
- Mitral A-wave velocity
- E/A ratio
- Tissue Doppler e′ velocity
- E/e′ ratio
- Left atrial volume
- Tricuspid regurgitation velocity
These values work together. One abnormal value does not automatically establish clinically significant diastolic dysfunction.
What Are E/A and E/e′?
The E/A ratio compares early passive ventricular filling with filling associated with atrial contraction.
The E/e′ ratio combines transmitral blood-flow information with tissue Doppler measurements of myocardial movement. It can contribute to the assessment of left ventricular filling pressures.
Age, rhythm, valve disease, and other cardiac conditions can influence these measurements. Interpretation therefore requires appropriate clinical context.
Understanding Diastolic Dysfunction Grades
When abnormalities are present, an echo report may describe diastolic dysfunction and sometimes assign a grade.
Depending on the clinical situation and criteria used, reports may describe impaired relaxation or more advanced filling abnormalities.
The grade should not be interpreted from a single number. Cardiologists consider multiple Doppler and structural findings together.
This is particularly important because diastolic abnormalities may occur even when left ventricular ejection fraction remains within the preserved range.
Estimated Pulmonary Artery Pressure
An echocardiogram may provide an estimate of pressure within the pulmonary circulation, often expressed as pulmonary artery systolic pressure (PASP) or a related right ventricular pressure estimate.
The calculation commonly incorporates the velocity of tricuspid regurgitation along with an estimate of right atrial pressure.
Elevated estimates can occur for different reasons, including cardiac and pulmonary conditions.
Importantly, an echocardiogram provides an estimate, not necessarily a definitive pressure measurement. When clinicians suspect pulmonary hypertension, they may use additional testing depending on the individual situation.
Understanding Aortic Measurements
An echo may measure several portions of the aorta, particularly structures close to the heart.
These can include:
- Aortic root
- Sinuses of Valsalva
- Proximal ascending aorta
The significance of an aortic measurement depends partly on body size, age, sex, measurement technique, and clinical history.
When clinicians detect enlargement, they may compare the result with previous studies to determine whether the dimensions are stable or changing.
Clinicians may recommend additional imaging when a more detailed assessment is needed.
What Does Pericardial Effusion Mean?
The pericardium is the sac surrounding the heart. An echocardiogram can detect abnormal fluid accumulation within this space, known as a pericardial effusion.
Reports may describe an effusion as small, moderate, or large.
The amount of fluid alone does not determine its clinical importance. Clinicians also assess whether the fluid affects cardiac filling or causes signs of pressure on the heart chambers.
For this reason, interpret an effusion alongside symptoms, blood pressure, heart rate, and other echocardiographic findings.
Common Echocardiogram Terms Explained
Echo reports often contain terminology that may seem concerning without context.
Normal chamber size: The measured chamber dimensions are within the laboratory’s expected reference range.
Preserved ejection fraction: The left ventricular pumping percentage is not reduced according to the criteria used.
No regional wall motion abnormality: No significant localized contraction abnormality was identified.
Mild regurgitation: A relatively small amount of backward flow was detected across a valve.
Dilated chamber: A heart chamber measures larger than expected.
Hypertrophy: Heart muscle thickness or calculated muscle mass is increased.
Technically difficult study: Image quality was limited, which may reduce confidence in some measurements.
Interpret these terms within the complete report rather than as independent diagnoses.
A Step-by-Step Approach to Reading an Echocardiogram
For a practical overview, review an echo report in a consistent order:
- Check the study type and image quality.
- Review left ventricular size and ejection fraction.
- Look at wall thickness and regional wall motion.
- Assess right ventricular size and function.
- Review both atria for enlargement.
- Check each valve for stenosis or regurgitation.
- Review Doppler and diastolic measurements.
- Look at estimated pulmonary pressures.
- Check aortic and pericardial findings.
- Read the final impression and compare with previous studies.
This method reduces the chance of focusing too heavily on one isolated measurement.
What Makes an Echocardiogram Abnormal?
An “abnormal” echocardiogram can describe many different findings and does not automatically indicate severe heart disease.
Examples may include:
- Reduced ventricular function
- Chamber enlargement
- Increased ventricular wall thickness
- Significant valve narrowing
- Moderate or severe valve leakage
- Abnormal ventricular relaxation
- Regional wall motion abnormalities
- Elevated pulmonary pressure estimates
- Aortic enlargement
- Pericardial fluid
The clinical importance depends on severity, symptoms, medical history, previous test results, and whether the finding is stable or progressing.
Final Thoughts on How to Interpret Echocardiograms
Learning how to interpret echocardiograms begins with understanding that an echo is a collection of related measurements rather than a simple pass-or-fail test.
Ejection fraction, chamber dimensions, valve function, Doppler patterns, wall motion, and pressure estimates all contribute to the overall picture.
For patients reading their own reports, the summary or impression can provide a useful overview, but they should not use individual measurements for self-diagnosis.
Reference values can also vary by measurement method, patient characteristics, and laboratory standards.
For reliable interpretation, a qualified physician or cardiology professional should review echocardiogram findings alongside symptoms, medical history, physical examination, and other relevant tests.
This combined approach provides the most clinically meaningful understanding of what an echocardiogram shows.
References
https://en.wikipedia.org/wiki/Echocardiography
https://www.healthline.com/health/echocardiogram
https://www.webmd.com/heart-disease/echocardiogram
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