Hypertrophic cardiomyopathy (HCM) is a heart condition that causes thickening and stiffening of the left ventricle, the lower left chamber of the heart. Most people with HCM have a thickening of the wall between the two ventricles of the heart called septal hypertrophy. This makes it difficult for the heart to pump blood properly.

Echocardiography is an imaging method that doctors use to look for abnormalities in the heart and diagnose HCM. It allows cardiologists to look at the heart muscle for thickening, which can’t be seen with chest X-rays.

What Is an Echocardiogram?

An echocardiogram is a type of ultrasound that looks at your heart’s movements. It uses sound waves that bounce off the heart and are sent back to a transducer (a hand-held wand), which turns them into live images. Cardiologists can use echocardiograms to diagnose cardiovascular issues with the chambers or valves of the heart. They can look at systolic function (how your heart pumps) and diastolic function (how it relaxes). Ultrasound technology doesn’t use radiation, unlike X-rays or CT scans.

Two main types of echocardiograms are used to look at the heart — transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE). Echocardiograms are performed by cardiac sonographers who specialize in using ultrasound equipment to take pictures of the heart.

In some cases, your cardiologist may order Doppler echocardiography, which measures the direction and speed of blood flowing through your heart.

Transthoracic Echocardiogram

A TTE is the most common type of echocardiogram. This noninvasive method involves pressing a transducer against your chest to look at your heart. Cardiologists use a TTE to check how well your heart is pumping blood, measure your heart chambers, and check blood pressure within the heart. They’re also used to diagnose different heart conditions, such as:

• Hypertrophic cardiomyopathy
• Heart failure
• Heart valve disease
• Aneurysms (bulges in blood vessels)

If your ribs or lungs block the view of the heart, the sonographer may use an enhancing agent — tiny bubbles filled with gas that help the heart stand out in images. A small amount of enhancing agent is infused into your bloodstream through a vein.

Transesophageal Echocardiogram

When your cardiologist wants more detailed pictures of your heart, or if the sonographer couldn’t get clear pictures with a TTE, you may have a transesophageal echocardiogram. A TEE is a more invasive method that requires placing an ultrasound probe in your esophagus. It lets cardiologists better see heart structures such as these:

• Thoracic aorta — The largest blood vessel in the chest
• Left atrium — The heart’s upper left chamber
• Interatrial septum — The wall that separates the heart’s upper chambers

This method can also be used to diagnose heart conditions, including:

• Blood clots
• Aneurysms in the aorta
• Heart valve disease, such as mitral valve disease
• Disease in the pericardium (the sac that surrounds the heart)
• Infections in the heart, such as endocarditis

How Is Echocardiography Used in Hypertrophic Cardiomyopathy?

HCM is diagnosed when the heart muscle in the left ventricle becomes enlarged (left ventricular hypertrophy, or LVH) and hardens, making it harder to pump blood. To see the structures in the heart and look for thickened walls, cardiologists use echocardiography. Different types of echocardiography are used to look for symptoms of HCM.

M-Mode Echocardiography

HCM was first seen and diagnosed using M-mode echocardiography. M-mode makes a one-dimensional image of the heart’s tissues, laid out in a flat line. This method works well for measuring left ventricle wall thickness. HCM is diagnosed when the left ventricle wall is thicker than 15 millimeters.

M-mode echocardiography can also help cardiologists find other abnormalities related to HCM, like an enlarged left atrium and problems with the mitral valve. These issues can lead to other heart problems like:

• Atrial fibrillation (AFib), a type of arrhythmia, or abnormal heart rhythm
• Mitral regurgitation, when the valve between the heart’s two left chambers doesn't close properly
• Abnormal blood flow

Two-Dimensional Echocardiography

Unlike M-mode echocardiography, which looks at the heart in one dimension, two-dimensional echocardiography can look at the whole heart to see if the left ventricle is enlarged and has thickened walls.

Doppler Echocardiography

What To Expect With an Echocardiogram

Getting an echocardiogram is a fairly straightforward procedure. A TTE typically takes 15 to 20 minutes, and a TEE also can take up to 20 minutes.

TTEs don’t require any preparation, and you can eat or drink as you normally do before the procedure. You’ll likely be asked to remove your shirt so the sonographer can place patches that measure your heart’s electrical activity onto your chest. This is known as an electrocardiogram (ECG), which is also used to check your heart health. The sonographer will add some gel to the end of the transducer and place it on your skin to take echocardiographic images. You may be asked to hold your breath at times throughout the procedure or move into different positions lying down to get different images.

A TEE is a more invasive procedure that requires preparation. You’ll be given medications to help you relax during the procedure, so you’ll need to have someone to drive you home. You also won’t be able to eat or drink for at least six hours before your TEE.

When you arrive at the hospital or clinic, your cardiology team will likely have you put on a hospital gown, and then they’ll place patches for an ECG. You might be given a numbing spray or a solution to gargle. An IV line will be placed in your arm to give you medication for sedation. Once you’re comfortable and relaxed, the TEE probe will be placed down your throat, and the physician will take the images they need.

After your echocardiogram, your cardiologist or health care team will follow up with you on the findings. They’ll likely discuss the next steps and a management or treatment plan with you if you are given a diagnosis of HCM. Sometimes, the echocardiographic findings guide your cardiologist on what treatments you may need.

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