Cardiac Imaging
Echocardiography — Heart Ultrasound
Real-time imaging of the heart's structure and function using ultrasound — the cornerstone of cardiac assessment, from evaluating valve disease and heart failure to monitoring conditions over time.
The Cornerstone of Cardiac Imaging
What Is an Echocardiogram?
An echocardiogram is an ultrasound scan of the heart. A transducer (probe) placed on the chest emits high-frequency sound waves that reflect off the moving cardiac structures and return as echoes, which are converted in real time into detailed moving images on screen. The technique uses the same ultrasound technology as obstetric scanning and is completely safe — no radiation, no injections, and no discomfort beyond mild probe pressure.
Echocardiography can assess virtually every aspect of cardiac structure and function: the pumping strength of the left and right ventricles, the anatomy and function of all four heart valves, the size of the cardiac chambers, the thickness of the heart wall, the presence of fluid around the heart, and the performance of the pericardium. It is also the primary tool for serial monitoring — comparing scans over months or years to track disease progression or treatment response.
Dr Nijjer performs and personally reviews every echocardiogram, integrating the imaging findings with his full clinical assessment. He will explain what he sees on the screen during the scan, so you leave the appointment fully informed.
What We Assess
Key Measurements from Every Echo
A comprehensive echocardiogram generates dozens of measurements. The six below are among the most clinically important, each shedding light on a different aspect of cardiac function and health.
The percentage of blood pumped out of the left ventricle with each beat. The single most important marker of systolic function. An EF below 40% defines heart failure with reduced ejection fraction (HFrEF) and directs specific medication strategies. EF is the primary measure used to assess response to heart failure treatment over time.
The internal diameter of the left ventricle measures chamber size. Dilation can indicate longstanding volume overload (from aortic or mitral regurgitation), dilated cardiomyopathy, or ischaemic damage. Wall thickness measurements distinguish concentric hypertrophy (pressure overload from hypertension) from dilated disease.
Diastolic function refers to how well the ventricle relaxes and fills between beats. Impaired relaxation — common in hypertension, diabetes, and ageing — raises filling pressures, causing breathlessness even when the ejection fraction appears normal (heart failure with preserved EF, HFpEF). The E/e’ ratio, derived from Doppler measurements, provides a non-invasive estimate of left atrial filling pressure.
Doppler echocardiography measures the speed of blood flowing through the aortic valve. An elevated peak velocity indicates aortic stenosis — narrowing of the valve outlet — graded as mild, moderate, or severe. Aortic valve area below 1.0 cm² defines severe stenosis and is a threshold for considering valve replacement. Aortic regurgitation (leakage) is quantified by the width and length of the regurgitant jet.
The mitral valve is the most commonly affected by degenerative disease. Echocardiography grades regurgitation (leakage back into the left atrium) from trace to severe, and identifies the mechanism — prolapse, flail leaflet, or annular dilation — which determines both urgency and surgical approach. Serial scans track whether mild disease is progressing and the optimal timing for intervention.
TAPSE measures the downward excursion of the tricuspid annulus during systole — a simple, reproducible marker of right ventricular systolic function. RV dysfunction is a critical finding in pulmonary hypertension, pulmonary embolism, right heart failure, and following extensive inferior myocardial infarction. It carries strong prognostic weight in conditions such as pulmonary arterial hypertension.
Echocardiography Modalities
Types of Echocardiogram
Transthoracic Echocardiogram (TTE)
The standard echocardiogram — the probe is applied to the chest wall from outside. This is the first-line investigation and provides the majority of the clinical information needed. It is performed in the clinic with no special preparation and takes approximately 30–45 minutes.
Transoesophageal Echocardiogram (TOE)
A probe is passed via the mouth into the oesophagus, providing images from directly behind the heart. TOE gives superior image quality for assessment of mitral valve anatomy, left atrial appendage clot (in AF before cardioversion), infective endocarditis, and aortic pathology. Performed under sedation.
Strain Imaging (Speckle Tracking)
An advanced technique that analyses subtle deformation of the heart muscle at a pixel level to detect subclinical dysfunction before the ejection fraction falls. Particularly valuable in patients receiving chemotherapy (cardio-oncology), early cardiomyopathy, and assessment after myocardial infarction.
Contrast Echocardiography
A small quantity of microbubble contrast agent is injected intravenously to enhance the endocardial border, enabling accurate EF measurement when image quality is suboptimal. Contrast echo also enables perfusion assessment and characterisation of cardiac masses or thrombus.
What to Expect
The Procedure
Positioning
You will lie on your left side on a couch with the chest exposed. This position moves the heart closer to the chest wall, improving image quality. ECG electrodes are attached to synchronise the images with your heart rhythm.
Gel Application
Ultrasound gel is applied to the chest. This is cold but harmless — it eliminates air between the probe and skin, ensuring clear sound transmission. There is no radiation, and the gel is easily wiped off afterwards.
Imaging
The probe is moved to several positions on the chest (windows) to visualise the heart from different angles. Gentle pressure is applied but this should not be painful. You may be asked to hold your breath briefly for a clearer image.
Review & Report
All images and measurements are reviewed by Dr Nijjer. A formal written report is generated and findings are explained clearly. If any follow-up scans are required for serial monitoring, the timing is agreed at this stage.
After Your Scan
Understanding Your Results
A normal echocardiogram — with preserved ejection fraction, normal valve function, and no structural abnormality — is a highly reassuring finding that effectively rules out the most significant structural causes of cardiac symptoms. It is one of the most valuable pieces of information a cardiologist can have.
Abnormal findings are explained in full at the appointment. Mild valve disease or borderline measurements are common and may simply require repeat scanning at 1–3 year intervals. More significant findings — significant aortic stenosis, reduced ejection fraction, severe regurgitation — will trigger a discussion of further investigation or treatment options, which may include medication changes, intervention planning, or onward referral to valve or cardiac surgery colleagues.
Previous echocardiogram reports from other hospitals are always welcome — comparison with a prior scan is often the most informative part of the investigation, demonstrating whether a finding is stable, improving, or progressing.
Concerned About Your Heart's
Structure or Function?
An echocardiogram is the most comprehensive way to assess the heart non-invasively. Dr Nijjer performs and personally reviews every scan at his Harley Street and London clinics.