An echocardiogram report is a page of measurements written for another doctor, in a shorthand that was never intended for the person it describes. People take it home, read words like regurgitation, dilatation and dysfunction, and spend the evening on a search engine that returns the worst version of each. What follows is a translation of the parts that appear on nearly every report.
What the test actually is
An echocardiogram is an ultrasound scan of the heart. A probe with gel is moved across the chest and the reflected sound is assembled into a moving picture. There is no radiation, no injection and no preparation. It takes twenty to thirty minutes. The Doppler part — the colours on the screen and the whooshing sound — measures the speed and direction of blood flow, which is how valves are assessed.
It is important to know that the echo looks at structure and function: how big the chambers are, how thick the walls are, how well the muscle contracts and relaxes, and how the four valves open and close. It does not look at the coronary arteries themselves. An echo cannot tell you whether an artery is blocked, and a normal echo does not exclude coronary disease.
Ejection fraction: the number everyone looks for
Ejection fraction, written LVEF or simply EF, is the percentage of the blood in the main pumping chamber that is ejected with each beat. The chamber never empties completely, and it is not meant to. A normal EF is roughly 55 to 70 per cent. An EF of 60 per cent does not mean the heart is working at 60 per cent of its capacity, and this is the single most common misreading of an echo report.
- 55 per cent and above — normal.
- 45 to 54 per cent — mildly reduced.
- 30 to 44 per cent — moderately reduced.
- Below 30 per cent — severely reduced.
Two caveats are worth carrying. First, EF is an estimate, and by eye or by the standard measurement it carries a margin of several percentage points between operators and between studies. A change from 60 to 55 on two reports is usually measurement variation rather than deterioration. Second, a normal EF does not mean a normal heart: a stiff heart that fills poorly can produce genuine heart failure symptoms with an EF of 60 per cent, which is what the diastolic function section of the report is about.
Chamber sizes and wall thickness
The report lists dimensions of the left ventricle, the left atrium, the right-sided chambers, and the thickness of the walls. These are compared against ranges adjusted for body size.
The finding seen most often in Indian outpatient practice is left ventricular hypertrophy — thickened walls of the main pumping chamber. It is usually the consequence of years of blood pressure that has been higher than it should be, because the muscle thickens against the load in the same way any muscle does against resistance. It is not a tumour and not a separate disease. It matters because it makes the chamber stiffer and is associated with rhythm problems, and because it is a visible record that blood pressure control has been inadequate over a long period.
An enlarged left atrium usually reflects raised pressures over time, often from the same cause, and is one of the reasons atrial fibrillation becomes more likely with age and untreated hypertension.
Valves, and the word 'trivial'
Each of the four valves is described in two ways: whether it leaks when closed, called regurgitation, and whether it is narrowed when open, called stenosis. Each is graded trivial, mild, moderate or severe.
Trivial or mild regurgitation of the mitral and tricuspid valves is extremely common and is found on echoes of people with entirely normal hearts. It is a normal finding of a sensitive test, in the same way that a small amount of joint fluid appears on an MRI of a normal knee. It is reported because the report describes what was seen, not because it requires action. Trivial and mild findings of this kind generally need no treatment and no restriction, and are simply noted.
Moderate and severe findings are a different matter, and they are followed over time with repeat scans at intervals decided by the cardiologist, because the interval itself is part of the management. Aortic stenosis in particular is followed carefully, since it progresses and the timing of intervention depends on both the measurements and the symptoms.
Regional wall motion abnormality
This phrase means that one region of the heart muscle is not contracting as well as the rest. Because each region is supplied by a particular coronary artery, a localised abnormality suggests that the artery supplying it has been or is compromised — an old heart attack, or an area with a poor blood supply. It is one of the more clinically significant phrases on an echo report and is the sort of finding that leads to a conversation about further assessment of the arteries.
Diastolic function
The heart has to relax and fill as well as squeeze and eject. Reports describe filling as normal or as grade I, II or III diastolic dysfunction. Grade I — impaired relaxation — is very frequently reported in people over fifty, and in isolation, with no symptoms and a normal EF, it is generally regarded as an age-related change rather than a disease. Higher grades carry more weight, particularly alongside breathlessness, and are managed with attention to blood pressure, weight, diabetes and, where relevant, fluid.
Pulmonary artery pressure, and the last line
Most reports include an estimated pulmonary artery systolic pressure, derived from the speed of a small tricuspid leak. It is an estimate from an indirect measurement and, when mildly raised in isolation, is interpreted with caution rather than treated as a diagnosis. The final line of the report is the summary impression, and it is the line to read first, not last.
How to read your own report sensibly
- Read the impression at the end before the table of numbers.
- Take previous echo reports to every appointment. The direction of change over years is more informative than any single scan.
- Treat trivial and mild valve findings as description, not diagnosis, unless the summary says otherwise.
- Do not compare your EF with another person's. It is interpreted against your symptoms, your age, your blood pressure and your other results.
- Write down the questions the report raises and ask them at the review. A report is meant to be explained, and the person who ordered it is the person to explain it.
Call 108 or go to the nearest emergency department rather than waiting for an appointment.
This article is general education about a condition or a test. It is not medical advice about you, it does not create a doctor and patient relationship, and it is not a substitute for consultation with a qualified doctor who has examined you.