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Echocardiograms-Botched, Misread, or Overutilized

Cardiologists have developed an absolutely awesome tool for  both visualizing the anatomical structure and movement of the cardiac valves and chambers  and precisely measuring the flow of blood through the heart called  Doppler-echocardiography.

The echocardiogram constructs a moving two-dimensional (more recently three-dimensional) “movie” from analyzing the time and intensity of sound waves reflected off the various valves, walls and structures within the heart.

The Doppler principle is utilized to precisely measure the location and velocity of blood flowing through the heart from high frequency sound waves reflected off red blood cells.

I’m the medical director of the St. Lukes Echocardiography laboratory. Prior to entering private practice my academic career was spent researching and writing about echocardiography as a clinical tool. I spend a lot of time making sure that the echos performed in our lab are high of consistency and high quality and that they are interpreted correctly.

When an echo is done elsewhere, I have no guarantees that it has been performed and/or interpreted properly.

On a regular basis, I see serious and highly significant errors made in the findings of echos performed elsewhere on patients that come to me for a second opinion or due to moving from another city.

Causes of Errors in Echos

The heart alone, among the body’s organs, is constantly moving. This means that standard ultrasound and x-ray techniques, which work great for static body parts, are useless. The techniques in a modern echo  that have evolved to fully evaluate all of the heart’s highly dynamic functions are complicated and require state-of-the art ultrasound equipment, as well as a sonographer who has been fully and expertly trained in using such equipment.

Such sonographers typically go through a two year program that is specific for cardiac ultrasound. To verify their knowledge and skills, they have a certification from either RDMS or CCT.

There is no government or insurance company mandate that a TTE be performed by a qualified, competent sonographer!


Who Will Read Your Echo? 

 Will it be read by a cardiologist trained like me who has gone through an additional year of cardiology training specifically in echocardiography, and who has reached what is termed Level III training?

Does that reading doctor have, like I do, have verification of the acquisition and maintenance of the incredibly complicated knowledge base for echocardiography by taking and passing the National Board of Echocardiography examinations?

Is he/she keeping up to date on new techniques and scientific findings in the field by  reading scientific journals and attending regular educational  sessions on echo.

Does he/she regularly try to correlate the findings from the echos he/she reads with findings from other imaging techniques and surgical pathology?

Chances are the answers to some or all of the above questions will be no.

There is currently no country-wide government or insurance company mandate requiring the reader of an echo to be competent to get reimbursed!

Blog Posts on Echocardiography

Read about my dad’s heart murmur and his botched echocardiogram here.

Read about the dangers of undergoing shoddy, mobile cardiovascular screenings including echos here and here,


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