Echocardiography 
Echocardiography is an essential tool in the examination of cardiac patients. It provides important information about the structure (atria, ventricles, and valves) and function of the heart. Echocardiography can be performed at a physician's appointment or at the cardiology outpatient clinic, where it is typically one of the routines of each appointment.
Echocardiography is also performed in the cardiology wards, the cardiac evaluation ward, and the emergency departments. In addition to the cardiology clinic, echocardiography is routinely performed in operating rooms, intensive care units, and any other places where cardiac patients are treated.
During echocardiography, an ultrasound probe is moved around on the chest. The patient is asked to lie down on his/her left side, and a physician (a cardiologist or a physician specialising in cardiology) performs the echocardiography. Ultrasound scanning does not involve radiation, heat, or other uncomfortable sensations, and it is not contraindicated by diseases or pregnancy. Patients do not need to prepare for regular echocardiography (see transoesophageal echocardiography below).
Echocardiography is used to determine the structure of the heart and to make important measurements. The wall thickness of the left ventricle (the strongest section of the myocardium) is measured, as is its size during systole (contraction) and diastole (rest). The difference between systolic and diastolic size is calculated to determine ejection fraction (EF), which reveals how efficiently your heart is pumping. The diastole and relaxation period of the left ventricle can also be measured. When the left ventricle contracts, blood flows through the aortic valve at the root of the aorta and to the aorta. Aortic stenosis and aortic valve regurgitation/prolapse are easily detected using echocardiography. Echocardiography is also used to assess the mitral valve function. Routine measurements include measuring the size of the left atrium. Echocardiography is also applied to determine the structure and function of the right side of the heart (right atrium, tricuspid valve, right ventricle, and pulmonary valve).
Scarring resulting from myocardial infarction is visible in an ultrasound scan. The cause of heart failure and its degree of severity can also be determined using echocardiography. Echocardiography is often performed on stroke patients to determine any abnormal cardiac structures, such as blood clots, which could have caused the stroke. Echocardiography is also used to detect endocarditis associated with a severe infection. Echocardiography is often performed on patients with valvular disease to monitor the proper functioning of an implanted heart valve prosthesis. In monitoring congenital heart disease, echocardiography is indispensable. On the cardiac assessments ward, ultrasound is typically used in connection with other procedures.
Transoesophageal echocardiography
Good ultrasound visibility cannot be achieved in all patients. This can be caused by the extensive size of the patient, obesity, or pulmonary disease. In some cases, the differentiating power of echocardiography is simply not sufficient when scanning is done on the chest. In such cases, ultrasound scanning is performed through the oesophagus (transoesophageal echocardiography). The throat is anaesthetised and an ultrasound probe is passed down the oesophagus. Unlike regular echocardiography, transoesophageal echocardiography is somewhat uncomfortable. For the patient, it is similar to gastroscopy. The patient is instructed not to eat or drink anything for a minimum of four hours before the examination. The patient receives a written invitation to transoesophageal echocardiography. Although uncomfortable, the examination provides an excellent view of the cardiac structures. Transoesophageal echocardiography is typically performed to detect inflammatory changes in the valves, or blood clots in the atrial auricles, or to analyse structural abnormalities (e.g. valvular diseases) in more detail.