Echocardiogram (Heart Ultrasound) in Singapore

An echocardiogram (an “echo”) is an ultrasound scan of the heart. It is painless, uses no radiation, and in about 30 to 45 minutes tells me more about how your heart is actually working than almost any other single test. I perform echocardiograms in the clinic at Mount Elizabeth Medical Centre, and in most cases we go through the result together the same day.

This page explains what an echo shows, which type you might need, what it costs in Singapore, and how to prepare.

What is an echocardiogram?

An echocardiogram uses high-frequency sound waves, the same technology used to scan a baby in pregnancy, to build moving pictures of the heart. A small probe is placed on the chest and the sound waves bounce back from the heart muscle, valves and blood to create images in real time.

It is different from an ECG (electrocardiogram). An ECG records the heart’s electrical activity on paper; an echo shows the structure and pumping of the heart itself. The two tests are complementary and are often done together.

What does an echo test show?

An echocardiogram answers the questions that matter most in cardiology:

• How well is the heart pumping? We measure the ejection fraction, the proportion of blood the left ventricle pushes out with each beat. A low ejection fraction is the hallmark of heart failure.
• Are the valves working? Echo shows valves that are narrowed (stenosis) or leaking (regurgitation), and how severe the problem is.
• Is the heart muscle thickened or enlarged? This can point to long-standing high blood pressure, cardiomyopathy or athletic adaptation.
• Has there been a previous heart attack? Areas of muscle that no longer move normally suggest previous damage.
• Is there fluid around the heart, a clot, or a hole between the chambers?
• Are the pressures in the lungs raised? Echo can estimate pulmonary artery pressure.

What an echo does not show well is the inside of the coronary arteries. If the question is “do I have blockages?”, the right tests are a CT coronary angiogram, a stress test or a stress echo.

What types of echocardiogram are available?

• Transthoracic echocardiogram (TTE). The standard scan through the chest wall. This is what most people mean by “an echo”, and it is done in the clinic.
• Stress echocardiogram. Images are taken at rest and again immediately after exercise on a treadmill (or after a medication that makes the heart work harder). Areas of muscle that move normally at rest but poorly under stress suggest a significant coronary narrowing. It is a good test for chest pain when a plain treadmill ECG is not enough.
• 3D echocardiography. Newer probes capture the heart in three dimensions, which improves the accuracy of chamber volume and valve measurements.
• Contrast echo. A small injection of contrast agent brightens the images when the chest wall or lungs make the standard pictures hard to read.
• Transoesophageal echocardiogram (TOE). A probe passed down the food pipe under sedation, giving very detailed pictures of the valves and the back of the heart. This is a hospital procedure rather than a clinic scan.

Who should have an echocardiogram?

I usually recommend an echo for:

• Breathlessness on exertion, or swelling of the ankles, where the heart may be the cause
• A heart murmur heard by your doctor
• Palpitations or an abnormal heart rhythm such as atrial fibrillation
• An abnormal ECG, or a chest X-ray showing an enlarged heart
• Long-standing high blood pressure, to check for thickening of the heart muscle
• After a heart attack, to assess how much muscle was affected
• A family history of cardiomyopathy or sudden cardiac death
• Before certain cancer treatments, and to monitor the heart during them
• As part of a comprehensive heart screening

What happens during the test?

You lie on a couch on your left side. The sonographer or I apply gel to the chest and move the probe over several positions to view the heart from different angles. You may be asked to hold your breath briefly or to breathe out. The scan takes 30 to 45 minutes and there is no recovery time: you can drive, work and eat normally afterwards.

Because the echo is done in the clinic, I review the images the same day and explain what they show. A written report is provided for your records and for your GP or insurer.

How much does an echocardiogram cost in Singapore?

In the private sector a transthoracic echocardiogram typically costs in the region of S$600-800, with a stress echo costing more because it combines a treadmill test with two sets of images. The consultation fee is separate. We will always quote the fee before you book.

Most Integrated Shield Plans and international insurers cover an echocardiogram when it is ordered to investigate symptoms or a known condition; cover for purely screening scans varies. Our staff can check your policy and arrange direct billing where your insurer allows it. See my guide to health insurance and cardiac care in Singapore for the details.

How do I prepare for an echocardiogram?

For a standard echo there is nothing to do: eat and take your medications as usual, and wear a top that is easy to remove. For a stress echo, avoid a heavy meal and caffeine for a few hours beforehand, bring comfortable shoes, and check with us whether any heart-rate medication (such as a beta-blocker) should be paused. My separate article on how to prepare for an echocardiogram goes through this step by step.

Book an echocardiogram

You do not need a referral to book an echocardiogram at a private clinic in Singapore, although a GP letter is helpful and some insurers require one. Because the scan is done in-house, a consultation, ECG and echo can usually be completed at a single visit.

If you would like to arrange this at the clinic, I see patients at the Harley Street Heart and Vascular Centre, Mount Elizabeth Medical Centre, Orchard. You can contact us online, message us on WhatsApp, or call +65 6235 5300. Most appointments are available within 1–2 days.

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Written by Dr Michael Ross MacDonald MB ChB, BSc (Hons), FRCP (UK), MD (Research), FESC (Europe). Senior Consultant Cardiologist at the Harley Street Heart and Vascular Centre, Singapore. About Dr MacDonald.

This page is general information, not a substitute for individual medical advice. If you have symptoms such as chest pain, breathlessness, or fainting, seek medical care promptly, and in an emergency call 995.

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