Patient guide · Cardiology
Contrast echocardiography, microbubble contrast for LV opacification and myocardial perfusion.
A contrast echocardiogram is a heart ultrasound scan given with tiny microbubbles (contrast dye) injected into a vein. The bubbles fill the main pumping chamber so it shows up clearly on the scan. It helps when a standard echo is unclear, when a clot needs to be ruled out, or during a stress echo.
Reviewed 2026-07-30 by Pulse Atlas Editorial Board, · 6-minute read · Next review 2027-07-30
Why patients choose us
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The right hands
We match you with a consultant cardiologist who does contrast echo regularly. The person who scans and reads is the one who gives you the answer.
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Often answers same-day
A contrast echo is a short add-on to a standard echo scan. You can usually talk through the findings at the same visit.
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Independent, and free
No clinic pays us. That means our recommendation is impartial and costs you nothing.
Key facts
What contrast echocardiography is — and isn’t.
It is a short, safe add-on to a standard echo. It has one main job. It fills the left ventricle with contrast so we can answer questions a plain echo cannot.
| Aspect | In one line |
|---|---|
| Definition | A heart ultrasound scan given with tiny microbubbles (contrast dye) so the heart chambers show up clearly. |
| Contrast agents | SonoVue, Definity or Optison — the licensed microbubble contrast dyes used in the UK. |
| Primary purpose | It sharpens the outline of the left ventricle (the main pumping chamber) when a standard echo is unclear. |
| Detects | It finds LV blood clots (thrombus) and apical thickening that a plain echo can miss. |
| Stress echo | It also improves stress-echo scans by filling the left ventricle with contrast. |
| Safety | The safety record is excellent. Serious reactions are rare. |
How it’s done
From cannula to report — what happens, in order.
Seven steps, usually completed in a single visit lasting under an hour.
Phase 1 · Preparation
Consultation and IV access
Phase 2 · The study
Baseline echo, contrast, views, perfusion
Phase 3 · Report
Same-day discussion
- 01
Preparation
Cardiology consultation
A consultant cardiologist checks why you need the scan. They review any earlier imaging and take your consent for the contrast study.
- 02
Preparation
Peripheral IV line inserted
A small cannula (a thin plastic tube) goes into a vein, usually inside the elbow. The microbubble contrast is given through this line.
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The study
Baseline echocardiogram
The team records a standard echo scan through the chest wall before any contrast is given.
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The study
Contrast injected during scanning
They inject SonoVue, Definity or Optison — either as a slow push or a steady drip — while the scan continues.
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The study
Multiple views recorded
They capture three standard views of the left ventricle while it is filled with contrast. This shows how the heart walls move and how the chamber is shaped.
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The study
Contrast myocardial perfusion
Specialist centres can also use a technique called flash-replenishment imaging. This checks the blood flow to the heart muscle itself.
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Report
Structured written report
The reporting cardiologist writes up the findings. If needed, they arrange further imaging, blood-thinning treatment or a team (MDT) review.
Typical time on the day: 45–60 minutes. Written report: same day.
What it shows
What contrast echocardiography can — and can’t — answer.
It shows the inner heart lining, clots, and the tip of the heart. Specialist centres can also check blood flow to the heart muscle. Here are the findings we see most, plus the one red flag that changes the pathway straight away.
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LV opacification
Microbubble contrast fills the left ventricle. The inner lining of the chamber then shows up as a clear, sharp outline.
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Regional wall-motion abnormality
Contrast makes it easier to see parts of the heart wall that move weakly or not at all after a heart attack.
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Apical hypertrophic cardiomyopathy
Apical HCM (thickening at the tip of the heart) is easily missed on a plain echo. Contrast shows the typical spade-shaped chamber.
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LV thrombus
Contrast echo is the standard bedside test for finding blood clots at the tip of the left ventricle.
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LV non-compaction
This is a condition with deep grooves in the heart muscle. Contrast fills these grooves so they can be seen clearly.
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Cardiac tumours or masses
The way contrast fills a lump inside the heart helps show whether it has a blood supply, has none, or is a clot.
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Myocardial perfusion defect
A specialist scanning technique (flash-replenishment imaging) can spot areas of the heart muscle with poor blood flow.
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Red flag: LV thrombus + AF or reduced LVEF — anticoagulation pathway
A confirmed clot together with atrial fibrillation or a weak heart pump triggers immediate blood-thinning treatment.
Next steps
What follows contrast echocardiography.
Your next step depends on what the scan shows. Whether it is normal or finds a clot, a heart-muscle problem or reduced blood flow, we agree the plan with heart-failure, imaging and interventional teams as needed.
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Reassurance if normal
A normal contrast echo — with a clear view of the left ventricle and no clot — is genuinely reassuring about the heart’s shape and pumping.
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Optimise heart-failure therapy
If the scan confirms a weak heart pump, the team builds up your heart-failure medicines to the recommended target doses.
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Anticoagulation for LV thrombus
A confirmed clot in the left ventricle means starting a blood thinner, usually a vitamin-K antagonist such as warfarin. Follow-up scans track the clot.
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Cardiac MRI for confirmation
If the echo is unclear, a cardiac MRI scan with gadolinium dye can confirm a clot and give more detail about the heart muscle.
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Coronary angiography for perfusion defect
If part of the heart muscle has poor blood flow, you may need a coronary angiogram (an X-ray or CT scan of the heart arteries) to find the blocked vessel.
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ICD referral for high-risk cardiomyopathy
Some patients with HCM, non-compaction or heart-attack-related muscle disease are referred to be assessed for an implantable defibrillator (ICD).
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Genetic counselling for HCM / NCM
A confirmed diagnosis of HCM or non-compaction cardiomyopathy triggers genetic counselling and screening tests for close family members.
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Structured cardiology follow-up
Repeat scans and clinic visits track heart-pump function, clot resolution and your response to treatment over time.
Red flags and cautions
When contrast echocardiography needs extra care.
There are nine situations where the decision to use contrast needs a second look. Please flag any of these before you attend.
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Anaphylaxis to microbubble contrast
Severe allergic reactions are rare but do happen. Tell us about any past reaction to SonoVue, Definity or Optison before the scan.
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Right-to-left shunt with contrast
A known right-to-left shunt (a hole between the heart chambers) can allow microbubbles to travel around the body. This slightly raises the risk.
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Recent acute coronary syndrome
A heart attack or unstable angina in the last 24–48 hours needs sign-off from a senior cardiologist before contrast can be used.
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Severe pulmonary hypertension
Severe high blood pressure in the lung arteries means contrast is used more carefully and with closer monitoring.
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Unstable arrhythmia
Any unstable irregular heart rhythm needs to be controlled first before a planned contrast echo.
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Pregnancy (relative)
Microbubble contrast is generally avoided in pregnancy. It is only used when the benefit clearly outweighs the risk.
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Uncontrolled hypertension for stress
High blood pressure must be treated and controlled before a contrast stress echo can go ahead.
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Concurrent PFO
A known patent foramen ovale (a small hole between the top heart chambers) should be flagged. Bubbles can cross this hole into the body’s main blood supply.
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Contraindicated with respiratory failure
Severe breathing failure or ARDS is a reason not to use commercial microbubble contrast.
Sources
Every claim on this page is traceable.
Guidance drawn from NICE and the major echocardiography societies.
- 01 Reference
British Society of Echocardiography. Guidelines and minimum dataset for contrast echocardiography.
British Society of Echocardiography. Guidelines and minimum dataset for contrast echocardiography.
- 02 Reference
European Association of Cardiovascular Imaging. Recommendations for the clinical use of ultrasound-enhancing agents.
- 03 Reference
American Society of Echocardiography. Guidelines for the use of echocardiographic contrast agents.
American Society of Echocardiography. Guidelines for the use of echocardiographic contrast agents.
- 04 Reference
NICE. Contrast echocardiography guidance and technology appraisals.
NICE. Contrast echocardiography guidance and technology appraisals.
Frequently asked
Everything we get asked about contrast echocardiography.
Quick answers on safety, indications, the difference from a bubble study, thrombus and the role of cardiac MRI.
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What is contrast echocardiography?
Contrast echocardiography is a heart ultrasound scan given with a licensed microbubble dye — SonoVue, Definity or Optison. The microbubbles fill the left ventricle so the inner border shows up clearly. In specialist centres, contrast can also check blood flow to the heart muscle.
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Why would I need contrast echocardiography?
The most common reasons are: poor image quality on a standard echo, a suspected blood clot in the left ventricle, apical hypertrophic cardiomyopathy, left ventricular non-compaction, working out what a lump inside the heart is, and improving stress-echo scans.
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Is microbubble contrast safe?
SonoVue, Definity and Optison have an excellent safety record. Side effects are very uncommon. Serious reactions such as anaphylaxis are rare. Current guidelines support routine use when the scan is clinically needed.
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How is contrast echocardiography different from a bubble study?
A bubble study uses shaken salt water to look for holes between the heart chambers (right-to-left shunts). A contrast echo uses licensed microbubbles that pass through the lungs and fill the left ventricle. This lets us assess the heart’s structure and function.
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What happens if LV thrombus is found?
A confirmed clot in the left ventricle needs immediate blood-thinning treatment. This is usually a vitamin-K antagonist such as warfarin, given for at least three to six months. Repeat scans check that the clot has cleared.
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Do I need a cardiac MRI as well?
A cardiac MRI can add to the picture. It is useful when findings are unclear. It gives more detail about the heart muscle (using gadolinium dye), and helps in HCM, non-compaction, clot and infiltrative heart-muscle disease.
Related tests
Looking for a different test?
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Bubble echocardiogram
Agitated-saline contrast echo for right-to-left shunt and PFO detection.
Learn more -
Cardiac MRI
Detailed structural and tissue characterisation of the heart without radiation.
Learn more -
Cardiac stress testing
Exercise or pharmacological stress to unmask inducible ischaemia.
Learn more -
All tests
Browse every test and procedure we arrange.
Learn more -
Hypertension
Related condition guide.
Learn more -
Atrial Fibrillation
Related condition guide.
Learn more -
Coronary Angioplasty
Related treatment option.
Learn more -
Coronary Artery Disease Treatment
Related treatment option.
Learn more
In practice, in London
The London pathway for contrast echocardiography
With contrast echocardiography in London, the real question is usually about how quickly you get the report, and who reads it. Availability itself is rarely the issue. NHS provision is good but under pressure on capacity. Private London clinics tend to have shorter waiting lists and longer appointment slots. You see the same specialists, but with more time. For people who have been going round in circles with their GP, that first proper conversation is often what moves things forward.
A private contrast echo pathway in London usually looks like this. First, an initial consultation. Then any scans booked at a nearby site (most within Zone 1 or 2). Finally, a written report sent to you and your GP within a few days. The consultants we work with hold NHS posts alongside their private lists. That keeps the standards consistent across both. For contrast echo, the gap between a routine report and a sub-specialist read is where private care earns its keep.
Fit matters more than most people expect. The right consultant depends on what you actually need. That might be a second opinion, a firm diagnosis, a route into treatment, or reassurance that nothing has been missed. We match on that — not on who has the biggest brochure. If a test is not the right next step, we will say so before you book anything.
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