2D Echocardiography with Colour Doppler

A 2D echocardiogram uses high-frequency sound waves (ultrasound) to produce real-time moving images of the heart's chambers, valves, and pumping muscle. Colour Doppler simultaneously maps blood flow through the valves. Together, these images show how well the heart pumps (ejection fraction), whether the valves are normal, whether the heart walls are moving correctly, and whether pressures are normal — without any radiation or needles. It is the most informative single cardiac test.

Ejection fraction (EF) is the percentage of blood pumped out of the left ventricle with each heartbeat. It is the primary measure of heart pumping function measured on echocardiography. A normal ejection fraction is 55–70%. EF 40–54% indicates mildly reduced function. EF 35–39% is moderately reduced. EF below 35% is severely reduced — this is the threshold for heart failure with reduced ejection fraction (HFrEF), at which point guideline-directed medical therapy and device therapy (CRT/ICD) are considered.

No — they are completely different tests. An ECG (electrocardiogram) records the electrical activity of the heart. A 2D echocardiogram uses ultrasound to produce images of the heart's physical structure and motion. Both are non-invasive and painless, but they provide entirely different information. An ECG shows heart rhythm and electrical conduction. An echo shows the anatomy, pumping function, valve structure, and blood flow. Most patients with heart symptoms have both tests.

A complete 2D echocardiogram with Colour Doppler at Heartwise Cardiology Clinic typically takes 20–30 minutes. No special preparation is needed — you can eat, drink, and take your medications as normal before the test. The result is available the same day and reviewed directly by Dr. Amit Singh, FACC.

No. Echocardiography uses ultrasound (high-frequency sound waves), not radiation. It is completely safe to repeat as often as needed — for monitoring heart failure, valve disease, or response to treatment. It is safe in pregnancy, in children, and in the elderly. There are no known health risks associated with diagnostic cardiac ultrasound at the frequencies used in standard echocardiography.

Minimal preparation is required. You can eat, drink, and take your medications as normal before the test. Wear a loose, comfortable two-piece outfit. Do not apply body lotions or powders to your chest area on the day of the test as they can interfere with ultrasound transmission. The test is performed with you lying on your left side, and a small amount of water-based gel is applied to your chest. The entire procedure takes about 20–30 minutes and you can resume normal activities immediately.

A standard resting echocardiogram cannot directly visualise the coronary arteries. However, it can detect the effects of blocked arteries by showing wall motion abnormalities — segments of the heart muscle that do not contract normally due to reduced blood supply. A stress echocardiogram (echo performed during exercise or with medication) is more sensitive for detecting significant coronary artery disease by comparing wall motion at rest and under stress. CT coronary angiography is the test that directly images the coronary arteries.

A transthoracic echocardiogram (TTE) is the standard test performed by moving an ultrasound probe on the surface of the chest. It is non-invasive and provides excellent images in most patients. A transoesophageal echocardiogram (TOE or TEE) involves passing a specialised probe down the oesophagus to obtain images from behind the heart. TOE provides higher-resolution images of certain structures — particularly the left atrial appendage, mitral valve, and aortic valve — and is used when TTE images are inadequate or specific clinical questions remain unanswered. TOE requires conscious sedation and fasting.

For stable heart failure with reduced EF (HFrEF), a follow-up echo is typically recommended 3–6 months after initiating or changing guideline-directed medical therapy to assess EF response. Once EF has stabilised, annual echo is usually sufficient unless symptoms change. If EF improves to >40%, medications should still be continued long-term as EF can decline again. For heart failure with preserved EF (HFpEF), routine follow-up echo is guided by symptom status rather than fixed intervals.