Bubble echocardiogram

About a bubble echocardiogram

An echocardiogram or ‘echo’ is a scan which uses high frequency sound waves (ultrasound) to produce images of your heart.

A bubble echocardiogram (bubble echo) uses ultrasound imaging combined with an injection of saline (salt-water) solution containing tiny bubbles.

The scan is painless and does not use radiation.

Why we recommend a bubble echo

A bubble echo helps us to diagnose and recommend the right treatments for you.

It can help us identify any holes in your heart that may not show up on a normal echo. Examples include an atrial septal defect or a patent foramen ovale (PFO). 

• An atrial septal defect is a hole in the wall (septum), between the two upper chambers of your heart (the atria). 
• A patent foramen ovale (PFO). A PFO is a small flap-like opening between the top two chambers of your heart (the atria). It is present in up to 25% of the adult population. In some patients with a previous stroke, we look for a PFO as a possible cause for the stroke.

Preparing for your scan

You do not need to do anything special to prepare for this scan.

You can eat and drink as normal on the day and take all your regular medication.

Your scan appointment

A bubble echo usually takes around 30 minutes to complete.

The person performing the scan is called a sonographer. They may be male or female. A second member of staff will be present to perform the salt-water bubble injection. A doctor may or may not be present.

You can expect the following during your scan.

• We will take you into an echo room in the Cardiac Investigations Department, and explain the test to you. We will ask you to sign an electronic consent form. If you have any questions, you can ask them before we begin the scan.
• We will ask you to undress to your waist and put on a hospital gown that opens at the front. We will respect your privacy while you are getting changed. We will ask you to lie on your left-hand side, on the echo couch.
• We will attach stickers to your chest and connect them to the echo machine to monitor your heart rate and rhythm.
• We will insert a small plastic tube (a cannula) into a vein in your arm. We will use this to inject the microbubbles during the scan. We will remove the cannula before you leave the department.
• We will darken the room so that we can see the ultrasound images clearly.
• The sonographer will take images of your heart by placing an ultrasound probe, covered with a small amount of gel, on several areas of your chest. This enables them to look at your heart from different angles. They will record these images on the echo machine.
• Once we have obtained the baseline images, we will perform the bubble study. We make up the bubbles in a syringe using saline mixed with some air and a little of your blood drawn back from your vein through the cannula. We then mix these up rapidly to make the tiny microbubbles which we inject into your vein.  
• We will take further images of your heart after the injection. We may also ask you to perform special breathing techniques, which we will explain to you.

Risks

There are no known risks with cardiac ultrasound. The bubble injection is not known to cause any harm.

You may have some bruising at the site where we insert the cannula.

After the scan

Your sonographer will write a report after the scan and  send it to the doctor who referred you for the test.

This doctor will contact you to give you the scan results, or discuss them with you at your next appointment. 

After your scan you can carry on as normal for the rest of your day. You can drive a vehicle after the test has been completed.

More information

For further NHS information visit Echocardiogram.

For British Heart Foundation information visit Echocardiogram.