What is it? 
An echocardiogram is a test that uses high-frequency sound waves (ultrasound) to create an image of the heart (Figure 1).  A Doppler test uses sound waves to measure the speed and direction of blood flow.  By combining these tests, a pediatric cardiologist gets useful information about the heart’s anatomy and function. Echocardiography is the most common test used in children to diagnose or rule out heart disease and also to follow children who have already been diagnosed with a heart problem. This test can be performed on children of all ages and sizes including fetuses and newborns.

How is it done? 
The ultrasound test is done with your child lying down comfortably on a bed or examination table. Infants may be able to lie in their parents lap.

The examiner may select and show a variety of pictures on a TV screen.  You’ll be able to see a picture of the beating heart, and you may be able to see and hear the flow of blood.  The picture normally changes when the transducer is moved.  Expect to hear loud sounds from the ultrasound instrument.  Portions of the test may be recorded on videotape or stored as computer files for later measurement, interpretation and storage as part of the patient record.

Echocardiographic examinations take 20 to 30 minutes.  It is important that your child remain still to obtain an examination of acceptable quality. Younger children often require sedation to allow your cardiologist to obtain a complete study.  In some instances, children may be comforted by watching a videotape or DVD. If sedation is needed, your child will be asked not to eat or drink for several hours prior to testing. Prior to giving medicine, a physician or nurse will make sure there are no reasons why sedation should not be given (i.e, bad cold) and then explain the procedure to you.  The most commonly used sedatives are chloral hydrate, which is given by mouth, and midazolam (Versed), which is placed in your child’s nose. Intravenous medications are rarely needed. Children usually fall asleep within 30 minutes and sleep for about an hour. Even though sedated echocardiograms are very safe, close monitoring of heart rate, blood pressure, and oxygen is performed while your child is asleep.  When your child wakes up, he or she may have poor balance (may last for more than an hour) and should be watched closely.  Your doctor and nurse will continue careful observation until your child is fully awake and tolerating juice or milk.

Older children and teenagers usually don’t need sedation and may enjoy watching the test.  To avoid any anxiety, be sure your child knows that the test is fun, that it doesn’t hurt, and that you or whoever brings your child to the test may stay in the exam room and watch.

Except for allowing for the possibility of sedation, you don’t need to make any special preparations.  Having your child wear a shirt or blouse that buttons down the front is helpful.  Your child may eat normally before the test; bring a bottle if you have an infant or a video for your child to watch.

Does it hurt? 
No.  No feeling comes from the sound waves themselves; sometimes the skin feels mildly warm.  Occasionally there’s mild discomfort from the transducer pressing on the skin.

Is it harmful? 
No.  There are no known ill effects of the sound waves used during a standard echocardiogram.