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  1. Graham S Hillis, senior lecturer in cardiology (g.hillis@abdn.ac.uk)1,
  2. Peter Bloomfield, consultant cardiologist2
  1. 1 University of Aberdeen, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN
  2. 2 Royal Infirmary, Edinburgh Peter Bloomfield
  1. Correspondence to: G Hillis

    Introduction

    Transthoracic echocardiography is one of the most commonly performed cardiac investigations. It can provide comprehensive information about cardiac structure and function, helping to establish a diagnosis and guide therapy, and is no longer the preserve of the specialist cardiology department. Examinations are frequently requested by doctors in other branches of medicine; they need to know what questions an echocardiogram can, and cannot, answer.

    Echocardiography images are best viewed as moving pictures. These are shown on bmj.com, several with the motion of a full cardiac cycle. The website also contains brief explanations of the commonly used imaging modalities.

    Sources and scope

    As a brief review cannot encompass a field as vast as transthoracic echocardiography, we have focused on common clinical problems that can be investigated by echocardiography. Our primary sources were echocardiographic texts and clinical guidelines (see educational resources on bmj.com). We used Medline searches to update and supplement information on specific conditions.

    Indications for echocardiography

    Assessment of left ventricular function

    The commonest reason for undertaking an echocardiogram is to assess left ventricular function.1 2 In accordance with NICE (National Institute for Health and Clinical Excellence) guidelines,3 this is often requested when patients have symptoms suggesting heart failure. Although clinical information and basic investigations will often identify patients with significant left ventricular systolic dysfunction,4–6 echocardiography can quantify the severity and determine the underlying cause. Many patients with heart failure have concomitant or predominant diastolic dysfunction,7 8 which may be more difficult to detect clinically but should be suspected in patients with evidence of heart failure but normal systolic function, particularly elderly people and those with hypertension.

    Echocardiography is valuable in patients with known coronary heart disease, even those without overt heart failure. Some may have important systolic dysfunction and may benefit from treatments such as β blockers, angiotensin converting enzyme inhibitors, or, in selected cases, surgical …

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