Hypertrophic cardiomyopathy (HCM) is a heart condition where the heart muscle becomes thicker and stiffer than normal, especially in the lower left chamber of the heart (called the left ventricle). Most people with HCM have a thickened wall between the heart’s two lower chambers. This condition is known as septal hypertrophy. The thickening makes it harder for the heart to pump blood properly.

Echocardiography is a type of imaging test that helps doctors check for signs of HCM and other heart problems. It shows the heart’s structure and movement in real time, making it easier to spot areas where the heart muscle is too thick. These changes usually don’t show up on a regular chest X-ray.

What Is an Echocardiogram?

An echocardiogram is a type of ultrasound that shows how your heart moves. It uses sound waves that bounce off your heart and return to a hand-held device called a transducer, which turns the sound waves into live images. Cardiologists (heart doctors) use echocardiograms to find problems with the heart’s chambers or valves. They can check your systolic function (how well your heart pumps) and diastolic function (how your heart relaxes). Ultrasound technology doesn’t use radiation, unlike X-rays or CT scans.

Cardiologists can use echocardiograms to diagnose cardiovascular issues with the chambers or valves of the heart.

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. It’s a noninvasive test, which means it doesn’t involve surgery or going inside the body. During a TTE, a doctor presses a transducer against your chest to get pictures of your heart. This test helps doctors see how well your heart is pumping, measure the size of your heart chambers, and estimate the blood pressure inside your heart. TTEs are also used to diagnose heart conditions, such as:

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

If your ribs or lungs make it hard to see your heart clearly, the sonographer may use an enhancing agent. This is a liquid with tiny gas-filled bubbles that help the heart show up better in the images. A small amount of this liquid is sent 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 (the tube connecting your mouth to your stomach). This closer view helps doctors see certain parts of your heart more clearly, such as:

• 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.

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 treatment plan with you.

An echocardiogram is just one test cardiologists use to diagnose HCM. Other tools include a physical exam, electrocardiogram (ECG or EKG), cardiac MRI, blood tests, and cardiac catheterization. Your healthcare provider will also consider your medical and family history and may recommend genetic testing.

Different types of echocardiography are used to look for symptoms of HCM.

Strain Imaging

In addition to regular echocardiographic methods, cardiologists may also use a newer technique called strain imaging or speckle-tracking echocardiography. This test shows how the heart muscle stretches and moves with each beat. It can catch small changes in how the heart works, even when the ejection fraction (how much blood the heart pumps out) still looks normal. Strain imaging helps find early signs of HCM and keeps track of the condition over time.

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. Smaller adults and children need size adjustments to get the right results.

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

• 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

M-mode echocardiography is still used sometimes, but it’s mostly seen as a backup tool. Today, doctors mainly rely on more advanced methods like two-dimensional and Doppler echocardiography to diagnose and check for HCM.

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

Doppler echocardiography shows how blood flows through the heart. As blood cells move, they change the sound waves’ pitch — like how a siren sounds different as it passes by. Doctors can measure these changes to check for problems. This test can help find obstructive HCM, a type of HCM where blood flow is slowed down or blocked.

What To Expect With an Echocardiogram

Getting an echocardiogram is a fairly straightforward procedure. A TTE typically takes 30 to 60 minutes, and a TEE takes up to 90 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 on your chest to measure your heart’s electrical activity. 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 change into a hospital gown, and then they’ll place patches on your chest for an ECG. You might be given a numbing spray or a liquid to gargle. An intravenous line will be placed in your arm to give you medicine to help you relax. Once you’re comfortable, the doctor will gently place the TEE probe down your throat and begin taking images of your heart.

Your throat may feel sore for a few days after your TEE. If your throat is numbed for the procedure, you should wait until the numbness wears off before eating or drinking. Ask your doctor for additional information about what to do or not do when you get home from your TEE.

After your echocardiogram, your cardiologist or healthcare 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’re given a diagnosis of HCM. Your echocardiogram results may help your cardiologist choose the best treatment plan for you.

Talk With Your Doctor

An echocardiogram is a safe, noninvasive test to see how your heart is working. For people with HCM, this test helps doctors find thickened heart walls, problems with blood flow, and other signs of the condition. Different types of echocardiograms give doctors a better look at the heart from different angles. Whether you have symptoms or a family history of HCM, this test is an important step in getting the care you need. Talk with your doctor if you have questions or concerns about the test or your results.

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