Shortness of Breath: Why an Echocardiogram Is an Important Part of the Evaluation
Shortness of breath—also called dyspnea—is one of the most common reasons people seek medical care. It can appear suddenly or develop gradually over time, and it may occur with activity, at rest, or when lying flat. While shortness of breath can have many causes, heart disease is a critical condition that must be evaluated and ruled out early.
One of the most important tools in this evaluation is echocardiography.
Important Safety Note
Active or severe chest pain is a medical emergency.
If you are experiencing new, worsening, or ongoing chest pain, chest pressure, shortness of breath, dizziness, nausea, or pain radiating to the arm, jaw, neck, or back, call 911 or seek emergency care immediately.
This article is for educational purposes only and is not a substitute for emergency medical evaluation. Do not delay urgent care based on online information or normal test results.
Why Shortness of Breath Shouldn’t Be Ignored
Shortness of breath can significantly impact quality of life and may signal an underlying problem with the heart, lungs, or circulation. Symptoms may include:
Difficulty breathing with exertion
Feeling winded during routine activities
Needing to sleep upright or use extra pillows
Waking up short of breath at night
Fatigue or reduced exercise tolerance
Because symptoms can overlap between cardiac and non-cardiac conditions, imaging plays a key role in identifying the cause.
Common Causes of Shortness of Breath
Shortness of breath may be related to:
Cardiac causes
Heart failure (systolic or diastolic)
Valvular heart disease
Cardiomyopathy
Pulmonary hypertension
Pericardial effusion
Prior heart attack with reduced heart function
Non-cardiac causes
Lung disease (asthma, COPD, pneumonia)
Blood clots in the lungs
Anemia
Deconditioning
Anxiety or panic disorders
Because cardiac causes are often treatable but progressive, early evaluation is essential.
How Echocardiography Helps Identify Cardiac Causes
An echocardiogram is a non-invasive ultrasound exam that allows clinicians to assess how the heart is functioning in real time. Unlike an EKG—which looks at electrical activity—echocardiography shows structure, motion, and blood flow.
An echocardiogram can evaluate:
Heart pumping function (ejection fraction)
Diastolic function (how well the heart relaxes and fills)
Valve structure and severity of disease
Chamber size and wall thickness
Pulmonary pressures
Fluid around the heart
These findings help determine whether shortness of breath is related to heart failure, valve disease, or elevated pressures in the lungs.
When an Echocardiogram Is Commonly Recommended
Your healthcare provider may order an echocardiogram if shortness of breath is accompanied by:
Swelling in the legs or abdomen
Fatigue or exercise intolerance
Chest discomfort
A heart murmur
Abnormal physical exam findings
History of hypertension, diabetes, or heart disease
Unexplained symptoms despite normal EKG or chest X-ray
In many cases, echocardiography provides clarity when other tests are inconclusive.
Why Early Cardiac Imaging Matters
Delaying cardiac imaging can allow underlying conditions to progress unnoticed. Identifying heart-related causes of shortness of breath early can:
Guide appropriate treatment sooner
Prevent worsening symptoms or hospitalization
Improve long-term outcomes
Provide reassurance when cardiac causes are ruled out
Echocardiography is safe, painless, and does not involve radiation, making it an ideal first-line imaging tool.
