Short answer: an echocardiogram is an ultrasound scan that shows the heart’s chambers, walls, valves, pumping function and blood flow. For athletes, it can help distinguish normal training adaptation from structural heart disease when symptoms, an examination or an ECG create a clinical reason to look further.
An echocardiogram is not a universal certificate of cardiovascular safety. A normal scan does not rule out high blood pressure, coronary plaque, intermittent arrhythmias or every early cardiomyopathy.
Key takeaway: echocardiography answers structural and functional questions. Its value depends on a clear indication and interpretation that accounts for body size, training type, symptoms, blood pressure and drug exposure.
Table of contents
- What is an echocardiogram?
- What does it measure?
- Types of echocardiogram
- Why athletes may need one
- Training adaptation on an echo
- What a normal echo cannot rule out
- AAS and enhanced-athlete considerations
- Understanding common report terms
- What to expect and how to prepare
- Frequently asked questions
- References
What is an echocardiogram?
An echocardiogram, often shortened to “echo”, uses high-frequency sound waves to create moving images of the heart. A standard transthoracic echocardiogram is performed by moving a probe across the chest with ultrasound gel.
Unlike an X-ray or CT scan, a standard echo does not use ionising radiation. It examines structure and movement; an ECG records electrical activity. Many assessments use both because they answer different questions.
What does an echocardiogram measure?
- left and right ventricular size;
- heart-wall thickness and calculated ventricular mass;
- ejection fraction and other measures of pumping function;
- diastolic filling and relaxation;
- heart-valve structure, narrowing and leakage;
- atrial size;
- aortic-root dimensions;
- estimated pressures and blood-flow patterns; and
- fluid around the heart.
Some laboratories also report global longitudinal strain, a measure of myocardial deformation. It may add information in selected situations, but it is influenced by equipment, technique and loading conditions and should not be interpreted in isolation.
Types of echocardiogram
| Test | How it is performed | Typical purpose |
|---|---|---|
| Transthoracic echo | Probe on the chest | First-line assessment of structure and function |
| Stress echo | Images before and after exercise or medicine | Assesses response to stress and possible reduced blood supply |
| Transoesophageal echo | Special probe in the oesophagus | Closer views for selected valve, clot or structural questions |
Most athletes discussing a routine echo mean a transthoracic echocardiogram.
Why athletes may need one
A clinician may request an echo following:
- exertional chest discomfort, unexplained breathlessness or reduced performance;
- fainting or near-fainting, particularly with exercise;
- an abnormal ECG or heart murmur;
- persistent high blood pressure;
- a family history of cardiomyopathy or premature sudden cardiac death;
- recurrent arrhythmia or palpitations;
- suspected myocarditis or heart failure;
- known valve or congenital heart disease; or
- a clinician-led risk assessment after prolonged AAS exposure.
Routine echo screening of every asymptomatic recreational athlete is not automatically necessary. Testing is most useful when the result can answer a real clinical question or change follow-up.
Training adaptation on an echo
Intensive endurance, mixed and strength training can remodel the heart. Chamber size, wall thickness and ventricular mass may differ from sedentary reference values. The pattern varies with sport, training history, sex, age, ethnicity, body size and blood pressure.
“Athlete’s heart” describes physiological adaptation, not one measurement. A larger chamber or thicker wall does not become normal merely because someone trains, and it does not become disease solely because it falls outside a generic reference range.
The distinction can require athlete-specific indexing, diastolic measures, strain, exercise response, cardiac MRI, family assessment or follow-up over time. Read the detailed guide to athlete’s heart versus cardiomyopathy.
What a normal echo cannot rule out
A normal resting echocardiogram does not exclude:
- coronary atherosclerosis or all causes of chest pain;
- an arrhythmia that occurs intermittently;
- high ApoB, LDL-C or lipoprotein(a);
- masked or exercise-induced hypertension;
- every inherited electrical disorder;
- very early cardiomyopathy; or
- future harm from ongoing exposure.
Blood pressure, blood tests, ECG monitoring, exercise testing, CT or cardiac MRI may be needed for different questions.
AAS and enhanced-athlete considerations
Recent meta-analysis of resistance-trained men found that AAS users, compared with trained non-users, had on average greater ventricular wall thickness and mass, along with less favourable measures of ejection fraction and global longitudinal strain. Most included evidence was observational, so it cannot precisely predict an individual athlete’s outcome.
An echo can identify some structural or functional changes, but one normal scan does not make supraphysiological AAS exposure safe. Timing, dose, duration, blood pressure, sleep apnoea, genetics and other drugs all influence risk.
Tell the referring clinician and sonographer about prescribed testosterone, non-prescribed AAS, growth hormone, thyroid hormone and stimulants. Accurate exposure history improves interpretation. The wider monitoring framework is covered in Heart Health for Enhanced Athletes.
Understanding common report terms
| Term | Plain-English meaning |
|---|---|
| LVEF | Estimated percentage of blood ejected from the left ventricle with each beat |
| LV mass | Calculated amount of left-ventricular muscle |
| Wall thickness | Thickness of measured ventricular muscle segments |
| Diastolic function | How the ventricle relaxes and fills |
| GLS | A strain measure describing myocardial deformation |
| Regurgitation | Backward leakage through a valve |
These terms need the numbers, image quality and clinical context. Mild valve leakage can be common and may not be disease; a report impression should be discussed with the clinician who ordered the test.
What to expect and how to prepare
A standard transthoracic echo usually needs no special preparation. You will remove clothing from the upper body, lie in several positions and have electrodes attached for rhythm timing. The sonographer may press the probe firmly between the ribs to obtain clear images.
Bring previous echo reports when available so genuine change can be separated from normal measurement variation. Ask whether the interpreting service routinely assesses athletes.
Do not wait for a routine scan if you have chest pressure, severe breathlessness, collapse or a sustained dangerous-feeling rhythm. In Australia, call Triple Zero (000) for an emergency.
Frequently asked questions
What does an echocardiogram show?
It shows heart chambers, walls, valves, pumping function and blood-flow patterns using ultrasound.
Is an echo the same as an ECG?
No. An echo images structure and movement; an ECG records electrical activity.
Does an echocardiogram use radiation?
A standard ultrasound echocardiogram does not use ionising radiation.
Can an echo detect blocked arteries?
A resting echo does not directly map coronary plaque. A stress echo may identify changes suggesting reduced blood supply in selected patients.
What is a normal ejection fraction for an athlete?
Interpretation depends on the measurement method, loading conditions and the rest of the study. Use the laboratory report and clinician assessment.
Can training enlarge the heart?
Intensive training can cause physiological remodelling, but enlargement still needs interpretation in context.
Can an echo distinguish athlete’s heart from cardiomyopathy?
Often it contributes substantially, but borderline cases may need ECG, exercise testing, cardiac MRI, family assessment or follow-up.
Should AAS users get an echocardiogram?
Testing should be individualised. Prolonged exposure, symptoms or other abnormal findings may justify clinician-directed imaging.
Does a normal echo mean AAS use is safe?
No. It cannot exclude every cardiovascular effect or prevent future harm from ongoing exposure.
References and further reading
- Heart Foundation: medical tests for heart disease
- Echocardiography in sports cardiology: expert opinion statement
- AAS and cardiac structure and function: systematic review and meta-analysis
This article provides general education and cannot interpret an individual echocardiogram. Discuss your report with a qualified health professional.