Echocardiograms use ultrasound to show the heart’s structure and function. However, the probe’s position changes how images are obtained and how the care team prepares the patient. Future cardiac sonographers must understand these differences.
At National Polytechnic College (NPCollege), we help students develop their cardiac imaging skills through our Cardiovascular Sonography program. Here, we explain the differences between transthoracic echocardiograms and transesophageal echocardiograms.
Key Takeaways
- A transthoracic echocardiogram (TTE) images the heart through the chest wall and is non-invasive.
- A transesophageal echocardiogram (TEE) uses a probe in the esophagus for clearer, more detailed images.
- Sonographers perform TTE exams and assist physicians during TEE procedures.
- NPCollege equips students with the technical and patient care skills needed for a career in Cardiac Sonography.
Transthoracic (TTE) vs. Transesophageal (TEE): The Basic Difference
The biggest difference between the two is the location of the probe. TTE uses an external probe, while TEE requires placing the probe closer to the heart through the esophagus, which is the tube connecting the mouth and the stomach.
These two types of echocardiograms have other differences as well:
- Invasiveness and patient prep: TTE is non-invasive and needs little preparation. Often, patients don’t have to fast or be sedated. TEE requires fasting and sedation because a probe passes down the throat.
- Image quality and clinical uses: TTE is the go-to first test and offers a broad assessment of heart function and valves. TEE provides a detailed assessment of selected structures, clots, or valve concerns, making it the go-to follow-up test.
- Procedure setting and care team: Sonographers perform TTEs in echo labs or at the bedside. A physician leads each TEE, supported by a sonographer and nurse, in an equipped procedure area or operating room.
What Is a Transthoracic Echocardiogram?
During TTE, the sonographer applies gel and moves a transducer across the chest, with the patient often lying on their left side. Standard imaging windows include parasternal views beside the breastbone and apical views near the heart’s tip. Subcostal views come from below the rib cage, while suprasternal views come from above the breastbone.
These positions provide complementary information about heart chambers and valves. TTE is widely used because it’s noninvasive and usually requires little preparation. However, ribs and air-filled lungs can limit visibility. Body characteristics may also affect image quality.
Cardiac Sonographer’s Role
Sonographers perform TTEs independently. They adjust settings for clear images and capture every required view and measurement. Then, they document the findings for the cardiologist.
What Is a Transesophageal Echocardiogram?
TEE uses a flexible probe passed through the mouth into the esophagus. The team usually numbs the throat and provides sedation. A trained physician then inserts and manipulates the probe. Because the esophagus sits directly behind the heart, sound waves bypass the ribs and lungs. The result is a much clearer view of the valves and upper chambers.
Physicians often use TEE to check for blood clots before a heart rhythm procedure or to look for infection on a valve. It also guides surgeons during some heart surgeries.
Cardiac Sonographer’s Role
During a TEE, the sonographer optimizes the ultrasound system as the physician maneuvers the probe. They also record images and help make sure the probe is properly cleaned afterward.
How Sonography Training at NPCollege Prepares Students for Cardiac Imaging
At NPCollege, our Cardiovascular Sonography program builds the technical knowledge both exams require. Blended lectures combine in-person and live-streamed sessions, while hands-on labs help students master standard echo views. Our coursework also covers patient safety, including infection control.
Clinical rotations then help students put those cardiac sonography skills into practice. You’ll learn to communicate clearly with patients and work as part of a cardiology team. Graduates can then pursue certification through the American Registry for Diagnostic Medical Sonography (ARDMS) and Cardiovascular Credentialing International (CCI).
Other services include:
- Financial aid, which is available to students who qualify
- Career services, which can help you with resume and interview prep and connect you to potential employers
Explore Cardiac Sonography at NPCollege
Are you interested in combining medical technology with patient care? NPCollege can help start you on the path to becoming an ultrasound tech. Our admissions team can help you discuss your goals and explore which of our programs is right for you. Contact us today to learn more about our Cardiovascular Sonography program and how you can earn a diploma in as few as 24 months.
Frequently Asked Questions About Transthoracic and Transesophageal Echocardiograms
Which exam is more common, TTE or TEE?
TTE is more common. It’s the standard first test for evaluating heart function and symptoms like shortness of breath because it’s non-invasive and quick. TEE is typically reserved for cases where a TTE doesn’t provide enough detail or when a specific question requires a closer look.
Does a TEE hurt?
Most patients feel little discomfort. Numbing spray helps reduce the gag reflex, and sedation helps patients stay relaxed throughout the procedure. Many don’t remember much afterward. However, a mild sore throat for a day or so is common.
How should patients prepare for a TEE?
Patients usually need to stop eating and drinking about six hours before the procedure. Because of sedation, they should arrange for someone to drive them home. After the test, patients should wait until their throat numbness wears off before eating or drinking.
Can a cardiac sonographer perform a TEE alone?
No. A physician, usually a cardiologist or anesthesiologist, inserts and guides the TEE probe. The sonographer supports the procedure by managing the ultrasound system and capturing images. This teamwork lets the physician focus on the probe while the sonographer focuses on image quality.
Do TTE or TEE use radiation?
Neither examination uses ionizing radiation to create images. Both use ultrasound waves. However, TEE may be performed during a separate cardiac procedure that uses X-ray guidance.