Echocardiography · Sibiu

Echocardiography in Sibiu, with the liver, carotid arteries and thyroid checked in the same session

A heart ultrasound shows how your heart looks and how it works. In the same session we take a preliminary look at the liver, the carotid arteries and, when needed, the thyroid, at no separate cost.

Book an appointment 0771 193 295

The ultrasound scanner and examination chair at the Biocord practice, in natural light

What echocardiography is and what it shows about your heart

Echocardiography, also known as a heart ultrasound, is an ultrasound scan that shows the heart moving, in real time. You can see how it contracts, how it relaxes, how the valves open and close, and how the blood flows through them.

It is a non invasive test. No radiation, no injections and no pain. A probe glides over the skin of your chest with a little gel, and the image appears on the screen while the examination is happening.

It is not the same thing as an electrocardiogram. That one shows the electrical activity of the heart, meaning the rhythm. Echocardiography shows structure and function, meaning the walls, the valves and the pumping power. They are two different questions, and a full answer often needs both.

At the Biocord clinic, the heart ultrasound does not stop at the heart. In the same session we take a preliminary look at the liver, for signs of fatty change, at the carotid arteries, for atherosclerotic plaque, and, when your symptoms call for it, at the thyroid. All of this is part of the echocardiogram and is not charged separately, and the results go into your cardiometabolic picture rather than staying isolated observations.

“Preliminary” means exactly what it says. The assessment shows whether there is something worth following or investigating further. It does not replace a full vascular Doppler scan or an endocrinology consultation, and when you need one of those we tell you clearly and explain why.

An echocardiogram under way at the Biocord practice: the probe on the patient's chest, the image of the heart on the screen beside them

When an echocardiogram is indicated

Some indications start from a symptom, others from an abnormal result or from a diagnosis already made that needs following over time.

You get short of breath on exertion or when you lie flat
You tire quickly doing things you used to do without any trouble
A heart murmur was heard and has never been investigated
You have had high blood pressure for several years
You have palpitations or a known rhythm disorder
Your ankles have swollen or you have gained weight quickly from fluid
You have a diagnosed valve problem that needs following over time
You have had a heart attack, or there is heart disease in your family at a young age
You have fatty liver, prediabetes, metabolic syndrome or high cholesterol
You smoke, have diabetes, or have relatives who had a heart attack or stroke at a young age, and you want to know whether plaque has formed
You are about to start a treatment that requires an assessment of heart function

If right now you have chest pain that will not go away, severe difficulty breathing, or you have fainted, do not wait for an appointment. Call 112.

How the examination goes

You do not need any complicated preparation, and you leave with the explanation, not just with the images.

The short conversation beforehand
You tell me what symptoms you have, what treatments you are on and what tests you have already had. Without that context, the image stays just an image.
Getting into position
You lie down on the couch, usually on your left side, with your chest uncovered. Gel is applied, which can feel slightly cold, and a few electrodes are attached to follow your rhythm during the examination.
The scan itself
The probe moves over your chest, from several angles. Now and then I will ask you to hold your breath for a few seconds, for clearer images. It does not hurt, at most you feel some pressure between the ribs.
The liver, the carotids and the thyroid
In the same session we take a preliminary look at the liver, for signs of fatty liver, and at the arteries in your neck, for atherosclerotic plaque. When your symptoms call for it, we also look at the thyroid. These are natural parts of a cardiometabolic assessment, included in the echocardiogram, not tests charged separately.
The explanation and the conclusion
I tell you what I saw, in words you can repeat at home. What is normal, what needs watching, what changes in your treatment, and when it is worth repeating the scan.

What an echocardiogram actually shows

The first thing we look at is the pumping function of the left ventricle, expressed as the ejection fraction. It says what proportion of the blood in the ventricle is sent onwards with each beat. When it drops, the picture of heart failure appears, and treatment is built around that figure.

Then the thickness of the walls and the size of the chambers are measured. A thickened wall is the usual sign of blood pressure that has been left too high for too long, and a dilated chamber speaks of an old overload. Both show up before symptoms do, which is what makes them useful in prevention.

The valves are looked at in two ways: how they look and how they let the blood through. This is where the Doppler examination comes in, measuring the speed and direction of flow and showing whether a valve has narrowed, whether it lets blood leak back, and how significant that is.

We also assess the way the heart relaxes between beats, the estimated pressures in the pulmonary circulation, and whether there is fluid around the heart. Put together, all of this often explains a symptom that until then seemed to have no cause.

Fatty liver disease, the metabolic link we look for in the same session

Hepatic steatosis, that is fatty liver, means a build up of fat inside the liver cells. For a long time it was seen as a gastroenterology problem. Today we know that, in its metabolic form, it goes hand in hand with insulin resistance, with metabolic syndrome and with a higher cardiovascular risk.

Most of the time it causes no symptoms at all. It is found by chance, on a scan done for another reason, or it is suspected after slightly raised transaminases. That is exactly why it makes sense to look for it in someone who is coming in for their heart anyway.

On ultrasound, a liver with fat in it looks brighter than normal, and the appearance is described in rough grades, from a mild fat load up to a significant one, where the deeper structures become harder and harder to see. It is a visual judgement, useful as a signal, not an exact measurement.

It is important to be honest about what ultrasound can and cannot do. It sees the fat, but it does not say how much the liver has suffered, meaning it does not assess fibrosis. There are dedicated tests for that, such as elastography. If your results raise that kind of suspicion, I tell you clearly what comes next and where it is done.

The good news is that metabolic fatty liver disease is not a life sentence. It is one of the few situations where the liver can recover, over time, if the cause behind it changes. That is why we record it and follow it, rather than mentioning it in passing at the end of a report.

What actually changes if you have fatty liver

The strongest lever is still weight loss, done gradually. A modest but sustained reduction usually shows in the amount of fat in the liver, and when the loss is larger the rest of the metabolic picture improves as well. Consistency matters more than speed.

When it comes to food there is no magic list of things to avoid, but a few make the biggest difference: sweetened drinks and fruit juices, alcohol, ultra processed products, and large portions of sweets and refined starches. Those load the liver most directly, and cutting them back is something you feel.

On the other side of the scales are vegetables, pulses, fish, olive oil, nuts and wholegrains, in other words the Mediterranean pattern. It is not a diet you keep for three weeks, it is a way of eating you can carry on with for years.

Exercise helps even without a dramatic drop on the scales. Brisk walking done consistently, plus strength training, build muscle mass and improve the way the body uses insulin. Not enough sleep and untreated sleep apnoea pull in the opposite direction.

Alongside that, we treat the blood pressure, the cholesterol and the blood sugar. Not because it cures the liver, but because in someone with fatty liver disease the first danger is still the cardiovascular one.

The carotid arteries, a window onto atherosclerosis that has no symptoms yet

The carotid arteries are the large vessels on the sides of your neck that carry blood to the brain. Because they sit close to the skin, ultrasound shows them well, and the state of their walls says a lot about what is happening across the whole arterial system.

As part of the echocardiogram we take a preliminary look at them, with a precise aim: to see whether the wall has thickened or whether atherosclerotic plaque has formed. In other words, atherosclerosis that already exists but has not yet caused any symptom and does not show up in any blood test.

It matters because atherosclerosis does not confine itself to one vessel. A plaque seen in the neck can move you into a higher risk category than the usual calculation suggests, and where your risk sits decides how firmly cholesterol and blood pressure are treated.

Finding a plaque does not mean surgery, and it does not mean an event is coming. It usually means stricter targets for cholesterol and blood pressure and closer follow up. If the appearance raises the suspicion of a significant narrowing, you get a recommendation for a dedicated vascular Doppler scan, which measures exactly how narrow it is.

The thyroid, when heart symptoms start somewhere else

Thyroid hormones act directly on the heart. An overactive thyroid speeds up the rhythm and encourages palpitations and atrial fibrillation. An underactive one slows the rhythm, raises cholesterol and brings fatigue and fluid retention. Many symptoms that look cardiac actually start at the thyroid.

That is why, when your picture calls for it, we also take a preliminary look at the thyroid in the same session. The assessment looks for nodules, changes suggesting thyroiditis, or anything else that needs a dedicated endocrinology assessment.

Biocord is a cardiology clinic, not an endocrinology one. The assessment here does not make a thyroid diagnosis and does not replace blood tests, because ultrasound shows what the gland looks like, not how much hormone it makes. Fine needle biopsy and elastography are not done at the clinic. If something needs clearing up, you get a clear recommendation to see an endocrinologist.

Prices

Prices
Service	Price
Cardiology consultation + ECG	400 lei
Cardiology consultation + ECG + echocardiography	620 lei
Cardiology follow-up + ECG	300 lei
Echocardiographyincludes an orientative assessment of the liver, the carotid arteries and the thyroid	400 lei
Holter ECG monitoring24 hours	370 lei
Ambulatory blood pressure monitoring (ABPM)24 hours	370 lei
Exercise stress test on a cycle ergometer	450 lei
Body composition analysis	100 lei
Ankle-brachial index (ABI)with interpretation	100 lei
Electrocardiogram (ECG)	100 lei
ECG + SDS (sudden death screening)extended BTL assessment, for people up to the age of 35	150 lei
Intravenous Ferinject 500 mgmedication and medical supervision included	800 lei
Intravenous vitamin C (Pascorbin 7.5 g)product and medical supervision included	350 lei

You have seen the prices. Shall we go ahead?

Tell us what brings you to a cardiologist and we will suggest a time that works for you.

Book an appointment 0771 193 295

Frequently asked questions

Does an echocardiogram hurt, or involve radiation?

No. It is an ultrasound test, with no radiation, no injections and no real discomfort. At most you feel the cold gel and the pressure of the probe between your ribs. It can be repeated as often as it is needed.

What is the difference between an echocardiogram and an electrocardiogram?

An electrocardiogram records the electrical activity of the heart, so the rhythm and the way the impulse travels. Echocardiography shows structure and function, meaning the walls, the valves and the pumping power. One does not replace the other, they complete each other.

What does transthoracic Doppler echocardiography mean?

Transthoracic means the examination is done from the outside, with the probe on your chest, the usual form of a heart ultrasound. Doppler is the part that measures the flow of the blood, so we can see whether the valves let blood through normally or whether there is narrowing and leaking.

Do I need to come on an empty stomach?

For the heart no preparation is needed. Because the liver is assessed as well, it is better not to eat for a few hours beforehand, for a clearer image. Tell us at booking what you are coming in for and we will confirm what suits your case.

What do normal values mean on an echocardiogram?

The result is not read as a single good or bad number. The measurements are related to age, sex and body size, and the same value can be normal in one person and worth following in another. That is why you get an interpretation, not a list of figures.

Does an echocardiogram show whether the arteries of my heart are blocked?

Not directly. The coronary arteries are not seen on a standard heart ultrasound. It can raise the suspicion, when one area of the heart contracts more weakly, and from there the assessment continues with dedicated tests. For early atherosclerosis we also look at the carotid arteries, in the same session.

Is the carotid and thyroid check charged separately?

No. The preliminary check of the liver, the carotid arteries and the thyroid is part of the echocardiogram and is not charged extra.

Does it replace a full carotid Doppler scan?

No. It is a preliminary assessment that shows whether there is plaque or other changes worth investigating. If a narrowing needs to be measured exactly, we recommend a dedicated vascular Doppler scan and explain why.

If a thyroid nodule is found, what happens next?

Most thyroid nodules are benign. If its appearance needs clearing up, you get a recommendation for hormone blood tests and an endocrinology consultation, where it is decided whether follow up is enough or other tests are needed.

What is a stress echocardiogram?

It is a version in which the heart is scanned while it is under load, either through exercise or with medication, so we can see how it behaves under increased demand. It is a separate test from the resting one. Ask us by phone when you book, and we will tell you exactly what is needed in your case.

Do I need a referral letter?

Ask us by phone when you book and we will tell you exactly what is needed in your case, so you do not make the trip for nothing.

Why does a cardiologist look at the liver as well?

Because fatty liver disease very often comes together with insulin resistance, with metabolic syndrome and with dyslipidaemia, which are exactly the factors that load the heart. Found on ultrasound, it changes the tests we ask for next and the recommendations you get.

How long does an echocardiogram take and when do I get the result?

You get the explanation on the spot, at the end of the examination, together with the written conclusion. The exact length depends on what we are looking for and on the quality of the images, and at booking we will confirm how much time to set aside.