When your child is referred for an echocardiogram, you may wonder what the scan can show and whether the referral means that a serious heart problem is suspected. An echocardiogram, often called an echo, is an ultrasound scan that creates moving images of your child’s heart and allows the cardiology team to assess its structure, function and blood flow without using ionising radiation.
The scan can help identify heart defects, valve problems and conditions affecting the heart muscle, as well as monitor a known condition or check the results of treatment. However, an echocardiogram is only one part of the assessment, and your child’s cardiologist will consider the scan results alongside symptoms, medical history, examination findings and other tests.
What Does an Echocardiogram Show?
An echocardiogram shows your child’s heart as it beats, allowing the specialist to see the heart walls moving and the valves opening and closing in real time. Unlike a still X-ray image, this scan provides moving pictures that help your child’s cardiologist understand how the heart is structured and how well it is working.
The scan can show the size and arrangement of your child’s heart chambers, the walls between them and the major blood vessels connected to the heart. Doppler echocardiography also allows the specialist to assess blood flow through the heart, including its direction and speed, to see whether any changes are affecting how the heart functions.
Why Might Your Child Need an Echocardiogram?
An echocardiogram may be recommended when a heart murmur has concerning characteristics, cannot confidently be classified as innocent or occurs with symptoms or abnormal examination findings. Many healthy children with a typical innocent murmur do not require imaging, so hearing a murmur does not automatically mean that an echo is needed.
The scan may also be appropriate for unexplained breathlessness, reduced exercise tolerance, poor growth or concerning feeding, breathing or oxygen findings in a baby. Family screening is usually based on a confirmed condition in a close relative, such as cardiomyopathy or another inherited heart disorder, rather than a general family history of murmurs.
Clinical Tip
Bring any previous echocardiogram reports, ECG results, clinic letters, operation summaries and details of the exact heart condition diagnosed in a close relative. Comparison with earlier images and measurements can help the cardiologist determine whether a finding is new, stable or changing.
When Should You Seek Urgent Help Instead of Waiting for the Scan?
An echocardiogram is planned and should not delay emergency care. Call 999 if your child is not breathing, is unresponsive, has severe difficulty breathing or suddenly develops blue or grey lips, tongue, face or skin. On brown or black skin, colour changes may be easier to see on the lips, gums, inside the eyelids, palms or soles.
Call 999 if your child faints and cannot be woken within one minute, has not fully recovered, has difficulty speaking or moving, has been seriously injured, is shaking or jerking, faints during exercise or while lying down, or faints with chest pain or palpitations.
For worsening breathlessness, poor feeding, poor weight gain, persistent palpitations or reduced exercise tolerance without emergency features, contact NHS 111, your GP or your child’s cardiology team.
Can an Echo Detect Holes Between the Heart Chambers?
An echocardiogram can identify holes between the heart chambers, known as septal defects. It also shows how the defect affects blood flow through the heart.
- ASD: Detects openings between the upper heart chambers.
- VSD: Identifies openings between the lower pumping chambers.
- Detailed assessment: Shows the defect’s size, location and blood flow.
- Treatment planning: Helps determine whether monitoring or treatment is needed.
Some small ventricular septal defects, particularly muscular VSDs, may become smaller or close naturally as a child grows. Other septal defects may remain open and require monitoring or treatment depending on their size, location and effect on the heart.
Can an Echocardiogram Detect Valve Abnormalities?
An echocardiogram can help your child’s cardiologist check the four main heart valves and see whether they have formed normally and are working properly. The scan allows the specialist to watch how the valves open and close and understand how they affect blood flow through your child’s heart.
If a valve is narrower than expected, known as stenosis, Doppler measurements can show how quickly blood is moving through the valve and whether it is causing an obstruction. The scan can also identify leaking valves, unusual valve shapes or differences that have been present since birth, helping your child’s cardiologist decide whether ongoing monitoring or treatment is needed.
Can It Detect Narrowing in Heart Valves or Major Blood Vessels?
An echocardiogram can assess narrowing involving a heart valve, the area where blood leaves a ventricle or a major blood vessel connected to the heart. Doppler measurements help assess blood-flow velocity and estimate the pressure gradient across the narrowed area.
Conditions such as pulmonary stenosis, aortic stenosis and coarctation of the aorta may be identified or assessed with echocardiography. However, parts of the aortic arch or other vessels may not always be seen completely, so MRI, CT or cardiac catheterisation may be recommended when more detailed anatomical or pressure information is required.
Can It Detect Abnormal Blood Vessel Connections?
An echocardiogram can help your child’s cardiologist detect unusual connections between blood vessels and the heart. One example is a patent ductus arteriosus (PDA), where a normal connection from before birth remains open after delivery and allows extra blood flow towards the lungs.
The scan can assess the direction and significance of blood flow through a patent ductus arteriosus and whether it is affecting the heart or circulation. Echocardiography may also identify some abnormal pulmonary-vein or arterial connections.
Not every vessel or connection can always be seen clearly with a standard chest scan. MRI, CT or cardiac catheterisation may be needed when the anatomy is complex or the echo images are incomplete.
Can an Echo Measure Heart Size?
An echocardiogram can measure your child’s heart chambers, walls and major vessels. Because normal measurements change considerably as children grow, the results are compared with reference values adjusted for body size and may be expressed as a z-score.
The cardiologist will consider how the measurement was obtained and whether several related findings support the same conclusion. One measurement slightly outside a reference range does not automatically mean that your child has heart disease.
A chamber may become larger because of increased blood flow, valve problems or changes in how the heart muscle is working. Your cardiologist will look at these measurements together with other scan findings, and repeat echocardiograms can show whether any changes are improving, remaining stable or becoming more noticeable over time.
Can It Assess the Heart’s Pumping Function?
An echocardiogram can assess how effectively the heart’s ventricles contract and move blood around the body. The specialist examines heart-wall movement and may use measurements such as fractional shortening, ejection fraction or other function assessments appropriate for your child’s anatomy.
Reduced pumping function can occur with cardiomyopathy, myocarditis, significant valve disease or complex congenital heart conditions. No single measurement should be interpreted in isolation, so the result is considered alongside the complete scan, symptoms, ECG and other investigations.
Can an Echocardiogram Detect Cardiomyopathy?
An echocardiogram can help detect signs of cardiomyopathy by showing changes in the heart muscle, including differences in muscle thickness, chamber size, wall movement and pumping ability. This allows the specialist to assess whether the heart structure and function may suggest a specific type of cardiomyopathy.
Different cardiomyopathies can cause thickened heart muscle, enlarged chambers, reduced contraction or abnormal relaxation and filling. Echocardiography may identify these patterns, but it does not by itself determine the genetic cause or always distinguish one type from another.
The results are interpreted alongside the ECG, family history, clinical assessment and, where appropriate, cardiac MRI or genetic testing. In families with confirmed hypertrophic cardiomyopathy or a relevant genetic variant, an initially normal echocardiogram does not necessarily exclude the condition developing later. Periodic clinical screening may therefore be recommended according to the child’s age, the family diagnosis and specialist advice (Ommen et al., 2024).
Can It Assess Heart Relaxation and Filling?
Echocardiography can assess how the heart relaxes and fills between beats using blood-flow Doppler, tissue Doppler and measurements of chamber size and movement. These findings may provide information about diastolic function.
Interpretation in children is complex because normal filling patterns vary with age, heart rate, breathing and loading conditions. The cardiologist will therefore combine several measurements rather than diagnosing a filling abnormality from one result alone.
Can It Estimate Pressure and Blood Flow?
Doppler echocardiography can estimate pressure gradients across valves, vessels and openings by measuring blood-flow velocity. It can also identify findings that increase or reduce the likelihood of pulmonary hypertension, although the available Doppler signal and the reliability of pressure estimates vary between children.
An echocardiogram cannot directly measure pulmonary vascular resistance or every pressure within the heart and lungs. When pulmonary hypertension is strongly suspected and treatment decisions depend on precise haemodynamic information, cardiac catheterisation in a specialist paediatric centre may be required to confirm the diagnosis and guide management.
Can It Detect Fluid Around the Heart?
An echocardiogram can identify fluid within the space surrounding your child’s heart, known as a pericardial effusion. The scan can assess the fluid’s size and distribution and whether it is affecting how the heart chambers fill.
A small, stable collection may only need monitoring, while a larger or rapidly increasing effusion can place pressure on the heart and may require urgent treatment. Your child’s cardiologist will consider possible causes such as inflammation, infection, recent surgery or another medical condition and may recommend blood tests or further investigations.
Can It Assess the Coronary Arteries?
An echocardiogram can assess the origins and nearby sections of the coronary arteries, particularly in babies and younger children. The specialist may check whether the arteries arise from the expected location and measure them using reference values adjusted for the child’s body size.
Echocardiography is the principal initial imaging method used to assess and monitor coronary-artery changes in acute Kawasaki disease, including dilatation and aneurysms. However, the complete course of every coronary artery cannot always be seen clearly, particularly in older children or when more distal segments need assessment. CT, MRI, stress imaging or catheterisation may therefore be considered in selected cases.
Can It Detect Infection or Inflammation Affecting the Heart?
An echocardiogram can show effects of inflammation on the heart, including reduced pumping function, chamber enlargement, valve leakage or fluid around the heart. However, it cannot confirm myocarditis by itself, so assessment may also include an ECG, blood tests, cardiac MRI or other investigations (Law et al., 2021).
When infective endocarditis is suspected, echocardiography may identify valve abnormalities, new leakage, vegetations or complications affecting the tissue around a valve. However, echocardiography does not diagnose endocarditis in isolation.
Assessment also depends on symptoms, examination findings and blood cultures. A transoesophageal echocardiogram or another imaging technique may be required when clinical suspicion remains high but a standard transthoracic scan does not provide enough information (Delgado et al., 2023).
Can It Monitor a Known Heart Condition?
An echocardiogram can help monitor your child’s known heart condition and track changes over time. Repeat scans can show whether an opening is becoming smaller or closing, whether it remains unchanged, and whether valve function, heart-muscle thickness or pumping ability has changed.
Your child’s cardiologist can compare new scan results with previous measurements to see if the condition is improving, stable or progressing. Follow-up echocardiograms may also be needed after heart surgery or catheter procedures to check repairs, blood flow and any remaining narrowing or leakage.
What Can an Echocardiogram Not Detect?
An echocardiogram provides detailed information about heart structure, function and blood flow, but image quality can be affected by movement, body position, chest anatomy and the location of the structure being examined. Some parts of the major vessels or coronary arteries may require MRI, CT or catheterisation for complete assessment.
An echo is not the main test for recording intermittent heart-rhythm problems and cannot explain every episode of chest discomfort, palpitations, dizziness or fainting. A normal scan is reassuring about the structures that were adequately seen, but it does not rule out every rhythm condition, inherited disorder or non-cardiac cause of symptoms.
Myth vs Fact
| Myth | Fact |
| An echocardiogram can only detect holes in the heart. | The scan can assess chambers, septa, valves, major vessels, heart-muscle thickness, pumping function, blood flow and fluid around the heart. |
| A normal echocardiogram rules out every possible heart problem. | A normal scan is reassuring about the structures and functions that were adequately assessed, but rhythm conditions, early inherited disease and some blood-vessel abnormalities may require other investigations. |
| An abnormal finding always means that your child needs surgery. | Many minor findings require observation rather than treatment, and some small defects may become smaller or close as a child grows. The plan depends on the type of finding and its effect on the heart. |
| A longer scan means that a serious condition has been detected. | The scan may take longer because your child is moving, detailed measurements are required or certain structures are difficult to view. |
| An echo can identify an intermittent abnormal heart rhythm. | An echocardiogram examines structure and function. An ECG or longer rhythm monitor is usually needed to record abnormal rhythms. |
| Every murmur indicates something abnormal on an echocardiogram. | Many childhood murmurs are innocent and occur in children whose heart structure and function are normal. |
| Repeated echocardiograms expose your child to radiation. | Standard echocardiography uses ultrasound rather than X-rays and does not expose your child to ionising radiation. |
| One echocardiogram always gives a final diagnosis. | The cardiologist interprets the scan with your child’s symptoms, examination and medical history and may also require an ECG, blood tests, genetic assessment or more detailed imaging. |
Key Takeaways
- An echocardiogram assesses heart structure, valves, pumping function and blood flow.
- It can identify many congenital heart differences, but not every murmur or symptom requires a scan.
- Children’s measurements must be interpreted using age- and body-size-appropriate reference values.
- Echocardiography can suggest pulmonary hypertension, but direct pressure measurements may require cardiac catheterisation.
- A normal echo does not rule out every rhythm condition, inherited disorder or blood-vessel abnormality.
- The cardiologist may combine the result with an ECG, blood tests, MRI, CT, genetic testing or catheterisation.
- Do not wait for a planned echocardiogram if your child is not breathing, becomes unresponsive, has severe breathing difficulty, suddenly develops blue or grey lips, tongue, face or skin, cannot be woken within one minute after fainting, faints during exercise or while lying down, or does not recover normally after fainting.
Frequently Asked Questions
1. What conditions can an echocardiogram detect in children?
An echocardiogram can identify or assess many congenital and acquired heart conditions, including septal defects, valve abnormalities, narrowing, unusual blood flow, changes in heart-muscle thickness or pumping function and fluid around the heart. It may also assess coronary-artery changes in Kawasaki disease. Some diagnoses require additional tests or specialist imaging.
2. Can an echocardiogram detect a hole in my child’s heart?
Yes, an echocardiogram can detect openings between the heart chambers, such as atrial septal defects (ASDs) and ventricular septal defects (VSDs). The scan can show the size and location of the opening and assess whether it is affecting blood flow or putting strain on the heart.
3. Can an echocardiogram detect heart valve problems in children?
Yes, an echocardiogram can assess whether your child’s heart valves are opening and closing normally. It can identify narrowing of a valve, leaking valves or differences in valve structure that may affect how blood moves through the heart.
4. Can an echocardiogram show whether my child’s heart is working properly?
An echocardiogram can assess chamber size, heart-wall movement, valve function and how effectively the ventricles contract and fill. These findings provide important information about heart function, but they must be interpreted with your child’s symptoms, examination and other test results.
5. Can an echocardiogram detect cardiomyopathy in children?
An echocardiogram can identify patterns associated with cardiomyopathy, including thickened muscle, enlarged chambers, reduced contraction or abnormal relaxation. Further assessment with an ECG, cardiac MRI or genetic testing may be required, and some children with an inherited risk need repeat screening even after an initially normal scan.
6. Can an echocardiogram detect problems with blood flow?
Yes, Doppler echocardiography can show the direction and speed of blood moving through the heart and major blood vessels. This helps the cardiologist identify abnormal flow caused by valve problems, holes between chambers or narrowed areas.
7. Can a normal echocardiogram rule out all heart problems in children?
No. A normal echocardiogram is reassuring about the heart structures and functions that were clearly assessed, but it does not exclude every rhythm disorder, early inherited condition or abnormality outside the areas that ultrasound can show well. An ECG, rhythm monitor, MRI, CT or another test may still be appropriate.
8. Can an echocardiogram detect why my child has a heart murmur?
An echocardiogram can show whether a structural difference, valve problem or unusual blood flow is producing the murmur. However, not every murmur requires an echo because a trained clinician may confidently identify an innocent murmur in a healthy child who has no concerning symptoms or other abnormal examination findings.
9. Can an echocardiogram detect heart problems before symptoms appear?
Sometimes. Echocardiography may identify structural or functional changes before they cause noticeable symptoms and is used to monitor children with known heart conditions or a confirmed inherited risk. A general family history of heart problems does not automatically mean that screening is required; the exact family diagnosis should guide the decision.
10. Will my child need more tests after an echocardiogram?
It depends on the findings and your child’s symptoms. Some children need no further investigations after a reassuring scan, while others may require additional tests or follow-up imaging to provide more detailed information or monitor an existing condition.
Final Thoughts: Understanding What an Echocardiogram Can Reveal
An echocardiogram can provide valuable information about your child’s heart structure, function and blood flow, helping specialists identify or monitor a wide range of conditions. Understanding what the scan can detect may help you feel more informed and prepared when your child is referred for assessment.
If you are looking for a echocardiography in London, you can contact London Paediatric Clinic for specialist assessment and an explanation of whether echocardiography or another investigation is appropriate. A specialist can explain the findings clearly and advise whether any further tests or ongoing monitoring are needed.
References:
- NHS (2026) Echocardiogram. Available at: https://www.nhs.uk/tests-and-treatments/echocardiogram/
- NHS (2025) Congenital heart disease. Available at: https://www.nhs.uk/conditions/congenital-heart-disease/
- Evelina London Children’s Hospital (no date) Echocardiography. Available at: https://www.evelinalondon.nhs.uk/our-services/hospital/heart-services/treatments/echocardiography.aspx
- Lopez, L. et al. (2024) Guidelines for performing a comprehensive pediatric transthoracic echocardiogram: recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography, 37(2), pp. 119–170. Available at: https://pubmed.ncbi.nlm.nih.gov/38309834/
- Cantinotti, M. et al. (2024) Standardization in paediatric echocardiographic reporting and critical interpretation of measurements, functional parameters, and prediction scores: a clinical consensus statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology and the Association for European Paediatric and Congenital Cardiology. European Heart Journal – Cardiovascular Imaging, 25(8), pp. 1029–1050. Available at: https://academic.oup.com/ehjcimaging/article-abstract/25/8/1029/7687697
- Jone, P.-N. et al. (2024) Update on diagnosis and management of Kawasaki disease: a scientific statement from the American Heart Association. Circulation, 150(23), pp. e481–e500. Available at: https://pubmed.ncbi.nlm.nih.gov/39534969/
- Humbert, M. et al. (2022) ‘2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension’, European Heart Journal, 43(38), pp. 3618–3731. Available at: https://pubmed.ncbi.nlm.nih.gov/36017548/
- Sullivan, R.T. and Austin, E.D. (2024) ‘Pulmonary Hypertension in Children’, Clinics in Chest Medicine, 45(3), pp. 685–693. Available at: https://pubmed.ncbi.nlm.nih.gov/39069331/
- Ommen, S.R. et al. (2024) ‘2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy’, Journal of the American College of Cardiology, 83(23), pp. 2324–2405. Available at: https://pubmed.ncbi.nlm.nih.gov/38727647/
- NHS (2023) ‘Fainting’. Available at: https://www.nhs.uk/symptoms/fainting/
- NHS (2023) ‘Blue or grey skin or lips (cyanosis)’. Available at: https://www.nhs.uk/symptoms/blue-skin-or-lips-cyanosis/
- Law, Y.M. et al. (2021) ‘Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association’, Circulation, 144(6), pp. e123–e135. Available at: https://pubmed.ncbi.nlm.nih.gov/34229446/
- Delgado, V. et al. (2023) ‘2023 ESC Guidelines for the management of endocarditis’, European Heart Journal, 44(39), pp. 3948–4042. Available at: https://pubmed.ncbi.nlm.nih.gov/37622656/