"We should do an echo." In the GP's surgery this sentence often comes without any further explanation. The examination itself is harmless: no radiation, no preparation, and it takes about 30 to 45 minutes. What it delivers diagnostically is broader than most patients expect. What it does not deliver is narrower. This article shows you what a transthoracic echocardiogram measures, what it cannot see, how the appointment works in practice and when an echo on its own is enough.

What an echocardiogram measures and what it cannot see

In short
Transthoracic echocardiography (TTE) is an ultrasound of the heart performed through the chest wall. It shows the pump function of the left and right ventricles (LV ejection fraction and global longitudinal strain), the relaxation function, the size and volume of the four heart chambers, the function of the four heart valves, the pericardium and gross structural abnormalities such as hypertrophy or regional wall motion abnormalities [Lang RM et al., JASE 2015]. It is the standard imaging method in cardiology. [Galderisi M et al., Eur Heart J Cardiovasc Imaging 2017]. What TTE does not see: the coronary arteries themselves, or the blood supply to the heart muscle. A narrowing in a coronary artery is detected directly only by coronary angiography or coronary CT. TTE offers only indirect clues, via wall motion abnormalities [Lancellotti P et al., Eur Heart J Cardiovasc Imaging 2017]. At Dein Team fürs Herz we perform the examination during the consultation. The findings are discussed in the same session, and the written report goes to your GP and to you in parallel.

Why an echocardiogram is done

In outpatient cardiology an echocardiogram has four main indications, which overlap in the consultation.

  1. Suspected heart failure. Breathlessness on exertion, swollen legs, sudden weight gain, orthopnoea (breathlessness when lying flat). TTE determines the left ventricular ejection fraction (LVEF) and classifies the type of heart failure (with reduced, mildly reduced or preserved ejection fraction) [Lang RM et al., JASE 2015].
  2. Suspected valve disease. A newly detected heart murmur, exercise intolerance, dizziness on standing up, syncope. TTE quantifies stenosis and regurgitation of the aortic, mitral, tricuspid and pulmonary valves and grades their severity [Galderisi M et al., Eur Heart J Cardiovasc Imaging 2017].
  3. End-organ assessment in the presence of cardiovascular risk factors. In long-standing high blood pressure, diabetes or a family history, TTE assesses left ventricular hypertrophy, diastolic function and atrial size. These findings change the individual risk and with it the treatment [Lang RM et al., JASE 2015].
  4. Work-up after symptoms or findings. Atrial fibrillation flagged by an Apple Watch, unexplained chest pain, syncope, unusual tiredness, a previous stroke. TTE clarifies structural causes and provides the basis for further imaging or functional tests [Evangelista A et al., Eur J Echocardiogr 2008].

In our consultation we see the first two indications most often. The third is the least conspicuous and at the same time the most underestimated. Someone who has lived with high blood pressure for ten years is in a different risk class from a patient with the same blood pressure reading and no end-organ findings.

How the appointment works in practice

The examination is unspectacular. Here is the typical sequence in the consultation at Dein Team fürs Herz, from check-in to the written report.

  • 0 to 15 minutes · History and clinical examination. Current symptoms, previous illnesses, medication, family history. Auscultation, blood pressure measurement, clinical status. These 10 to 15 minutes shape the targeted question put to the echo.
  • 10 to 15 minutes · Preparation. You undress to the waist and lie on your left side. Three adhesive electrodes are attached for a simultaneous ECG. A water-soluble gel is applied to the ultrasound probe to improve sound transmission. It feels cool on application, the only unpleasant part. No special preparation on your part is needed. Eating, drinking and medication remain unchanged.
  • 15 to 35 minutes · Image acquisition. The ultrasound probe is placed in several standard positions: parasternal, apical, subcostal and suprasternal. In each position two- and three-dimensional images, Doppler measurements and colour Doppler are recorded. You will be asked to hold your breath briefly or to shift position slightly. The machine records the loops digitally for later analysis.
  • 35 to 50 minutes · Quantification and discussion of the findings. While you get dressed, the measurements are taken on the loops (volumes, ejection fraction, valve areas, pressure gradients). We then discuss the findings with you. You see your valves in motion, the pumping work of your ventricles, the relative size of your atria.
  • Same day · Written report. The structured report follows the recommendation of the European Association of Cardiovascular Imaging on standardised reporting [Galderisi M et al., Eur Heart J Cardiovasc Imaging 2017]. It goes to your GP, and you keep a copy yourself.

Allow around 60 to 90 minutes in the consultation overall. The echo itself takes 30 to 45 minutes; the rest is history, ECG, frequently a bicycle exercise test (ergometry) and discussion of the findings. There is no radiation. There is no pain either. Bringing someone with you is always welcome, though never required.

What is measured in an echo

A complete TTE delivers far more than the famous "ejection fraction". The standard report covers around 30 quantitative parameters, which fall into four groups [Lang RM et al., JASE 2015; Galderisi M et al., Eur Heart J Cardiovasc Imaging 2017].

  • Left ventricular function. Ejection fraction (LVEF, normal from 52% in men and from 54% in women), end-systolic and end-diastolic volume, wall thickness, mass, regional wall motion. With a reduced ejection fraction, the type of heart failure is defined [Lang RM et al., JASE 2015].
  • Global longitudinal strain (GLS). A quantitative measurement of deformation along the long axis, more sensitive than LVEF for early impairment of systolic function. Normal value around minus 18 percent or more negative. Clinically useful in cardiotoxicity during chemotherapy, early cardiomyopathy and subclinical diabetic cardiomyopathy [Mor-Avi V et al., JASE 2011].
  • Valve function. Aortic, mitral, tricuspid and pulmonary valves, each with quantification of stenosis and regurgitation via pressure gradients, valve areas and regurgitant volumes [Galderisi M et al., Eur Heart J Cardiovasc Imaging 2017]. Valve morphology is described as well (calcification, bicuspid aortic valve, mitral valve prolapse).
  • Diastolic function and atrial size. E/A ratio, E/e-prime ratio, mitral annular velocity, left atrial volume index. These parameters are the axis for diagnosing heart failure with preserved ejection fraction (HFpEF) and for risk assessment in high blood pressure and atrial fibrillation [Lang RM et al., JASE 2015].

In addition, the pericardium (pericardial effusion?), the aortic root and the proximal aortic arch, the inferior vena cava (volume status), gross right ventricular function and, where relevant, intracardiac thrombi are assessed. The structured report is built on this data.

What echocardiography does not see

An honest answer to the most frequent question. There are diagnostic limits, and they are clearly defined.

  • The coronary arteries themselves. TTE does not show whether there is a narrowing in a coronary artery and therefore a disturbance of blood flow to the heart muscle. It does, however, provide indirect clues through regional wall motion abnormalities, which may be caused by an insufficient blood supply to that area. [Lancellotti P et al., Eur Heart J Cardiovasc Imaging 2017]. Direct assessment of the coronary arteries requires a coronary CT (anatomical) or coronary angiography (anatomical and interventional in one).
  • Microvascular disease. A dysfunction of the smallest coronary vessels escapes a resting TTE. It is investigated with stress echo, cardiac MRI or invasively with pressure and flow measurement during catheterisation. This question comes up frequently in women's heart health.
  • Very subtle electrical abnormalities. Through the simultaneous ECG, TTE captures the rhythm during the examination, but no long-term profile. Atrial fibrillation that occurs only paroxysmally requires a long-term ECG or a wearable finding.
  • Lung parenchyma and pleura in detail. Accompanying pleural thickening or pulmonary pathology is not systematically assessed in an echo. That requires a lung function test or lung imaging.

Echocardiography is the most commonly used modality for the evaluation of cardiac structure and function. Standardisation of measurements is essential to allow comparison across centres and over time.

Lang RM et al., ASE/EACVI Chamber Quantification 2015, JASE 2015

These limits are part of the definition of the examination. A TTE is structural and functional imaging. Assessment of the coronary arteries is a separate examination with its own indications.

When an echo alone is enough and when it is supplemented

Diagnostic logic in cardiology is usually stepwise. TTE stands at the start of many pathways, and on its own it is sufficient for clearly defined questions.

In valve disease with a clear finding (for example moderate aortic stenosis without symptoms), TTE is sufficient as a regular follow-up examination. In heart failure with reduced ejection fraction, TTE provides the diagnosis, and follow-up measurements use the same method. In left ventricular hypertrophy as an end-organ finding of hypertension, TTE is the standard.

When the question goes beyond structural imaging, complementary tests are added. If coronary heart disease is suspected, a stress echo, a cardiac CT or coronary angiography follows [Lancellotti P et al., Eur Heart J Cardiovasc Imaging 2017]. In atrial fibrillation, a long-term ECG complements the rhythm assessment. In unexplained cardiomyopathy, a cardiac MRI provides the tissue characterisation that echo cannot capture.

In our consultation we discuss the findings in the same session. If complementary imaging becomes necessary, we schedule it directly. If no complementary imaging is needed, you hold the report in your hands the same day and go home with a clear plan.

Further reading in this cluster

These topics complement the cross-sections from this article:

  • High blood pressure. When it is time to ask a cardiologist. Hypertension is the most common indication for end-organ assessment by echo.
  • Heart check-up in Zürich. Costs and how insurance works. What a cardiological assessment with echo actually costs.
  • Cardiac catheterisation. When it really becomes necessary. Anatomical assessment of the coronary arteries beyond the echo.
  • Cardiac CT and calcium score in Zürich. Low-dose CT as a non-invasive alternative for direct coronary assessment.

Frequently asked questions about echocardiography

Do I need to fast before an echo?
No. A transthoracic echocardiogram needs no preparation. You eat, drink and take your medication as on a normal day. Coffee in the morning is fine too. You only need to fast for a transoesophageal echo, a stress echocardiogram with pharmacological stress or special contrast examinations.
How long does the examination take?
Image acquisition itself takes around 20 to 30 minutes. With history, clinical examination and discussion of the findings, allow about 60 minutes in the consultation. You receive the written report the same day.
Does an echocardiogram hurt?
No. You feel the light pressure of the ultrasound probe on your chest, the cool gel and the three adhesive ECG electrodes. There is no radiation, no contrast agent and no needle. A TTE is the cardiac imaging method with the least impact on the body \[Evangelista A et al., Eur J Echocardiogr 2008; Schweizerische Herzstiftung 2025\].
What is the difference between TTE and TEE?
TTE stands for transthoracic echocardiography, the ultrasound through the chest wall. TEE stands for transoesophageal echocardiography. For this, a swallowable probe is passed into the oesophagus. TEE delivers higher-resolution images of the left atrium and the valves and is used for specific questions, for instance before cardioversion of atrial fibrillation or to assess endocarditis. TTE is the standard outpatient examination \[Galderisi M et al., Eur Heart J Cardiovasc Imaging 2017\].
Can an echo detect a heart attack?
Indirectly, yes. After a previous heart attack, TTE often shows regional wall motion abnormalities in the affected territory, reduced regional deformation on strain and, where present, wall thinning with scar formation \[Lang RM et al., JASE 2015\]. However, TTE is not the primary tool for diagnosing an acute heart attack. In acute chest pain the ECG comes first, followed by troponin in the laboratory. TTE complements the acute work-up. With acute symptoms (persistent chest pressure, breathlessness at rest), call 144, the Swiss emergency number, rather than booking a consultation appointment.
Is an echo enough given my Apple Watch findings?
If a wearable flags atrial fibrillation, TTE usefully complements the rhythm work-up. It measures atrial size and left ventricular function and rules out accompanying structural findings that matter for the treatment decision \[Lang RM et al., JASE 2015\]. An echo on its own does not, however, replace a long-term ECG to confirm the rhythm.
What does "ejection fraction 55 percent" in the report mean?
That is the pumping work of your left ventricle per beat, expressed as the percentage of the preceding blood volume that is pumped out. Values from 52 percent in men and from 54 percent in women count as normal \[Lang RM et al., JASE 2015\]. An ejection fraction of 55 percent is within the normal range. Values between 41 and 49 percent count as mildly reduced (HFmrEF), values below 40 percent as reduced (HFrEF).
Does my health insurance cover the echo?
With a medical indication (symptoms, risk factors, suspected heart failure or valve disease), compulsory Swiss health insurance (Grundversicherung) covers the examination, minus your annual deductible (Franchise) and the 10 percent co-payment up to the yearly cap. An echo purely on request without an indication is a self-pay service. Since 1 January 2026, billing follows the TARDOC tariff.