Medical Oncologist
Before you start
Why you need an echo or heart test first
Because one family of chemotherapy drugs can weaken the heart's pumping action in a small proportion of people, and the team needs to know how your heart works before any of it is given. It is not because anything is wrong with your heart. The echo is ordered from the treatment plan, not from anything found in you.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
Why do they want a heart test before chemotherapy?
Because one family of chemotherapy drugs can weaken the heart's pumping action in a small proportion of people, and the team needs to know how your heart is working before any of it is given. That starting figure is what every later check is compared against.
It is not because anything is wrong with your heart. The echo is ordered from the treatment plan, not from anything found in you, and most people who have one have never had a heart problem in their lives.
An echo is a scan, not a procedure
It is an ultrasound of the heart done with gel and a probe on the chest, while you lie on your side. Nothing is injected, nothing is swallowed, there is no radiation and you can eat beforehand. It is over in well under an hour.
A MUGA is the other version of the same question
Some units use a MUGA scan instead, which does involve a small injection of a tracer. Either answers the same question. Which one you get usually depends on what your hospital has available rather than on anything about your case.
Ask for a copy of the report, not just the verbal result. You will want the starting figure later in the course.The words on the report
What the terms in the echo report mean
- Ejection fraction
- The share of blood the main pumping chamber pushes out with each beat. It is the figure the oncologist is looking for, and it is reported as a percentage. A healthy heart does not empty completely, so a number well short of a hundred is entirely normal.
- Left ventricle
- The main pumping chamber, and the one the drugs in question can affect. Most of the report is about how well it fills, how thick its wall is and how strongly it squeezes.
- Baseline
- Your own starting figure, taken before any treatment. The later value only means something next to this one, which is why the test is done first rather than during.
- Valves
- The doors between chambers. The report comments on all of them, and mild leaks are extremely common, usually lifelong, and generally of no consequence for chemotherapy.
- Diastolic function
- How well the heart relaxes and fills between beats. This is often reported as mildly impaired in older people and in those with long-standing blood pressure. It is noted, not usually acted on.
- ECG
- A different and much quicker test, done with stickers on the chest. It looks at the rhythm and the electrical pattern rather than the pumping action. Most people have both.
Not sure whether this applies to you?
Ask an oncologistOn the day
What the appointment is actually like
This is one of the easiest tests in the whole workup, and one of the most worried about.
No preparation
Eat and drink normally, take your usual medicines, and wear something that opens at the front. No fasting, no injection for a standard echo, no recovery time and nothing that stops you driving home.
Take with you
- Your file and any earlier heart reports
- The list of medicines you take
The test itself
You lie on your left side while gel and a probe are moved across your chest. It is painless, though the probe presses firmly between the ribs. You may be asked to hold your breath briefly. The screen noises are the blood flow, not a problem.
The wait for the report
Often the same day, sometimes the next. The person performing it will usually not interpret it for you, which people read as bad news and is simply how the job is divided. Your oncologist explains it.
Ask before leaving
- When the report reaches your oncologist
- Whether you need a printed copy
Getting it repeated
If your plan includes those drugs, the test is usually repeated part way through the course and sometimes after it finishes. Ask at the start when yours is due so it can be booked rather than chased.
!
Tell your team the same day about these
During or after treatment: breathlessness that is new or worse, particularly lying flat · swelling of the ankles or legs · waking at night short of breath · a racing or irregular heartbeat · chest pain or tightness · sudden unexplained weight gain over a few days · fainting. These are worth reporting promptly rather than waiting for the next appointment. Chest pain or severe breathlessness means going to the nearest emergency department now.
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If the result is below normal
What happens when the heart figure is low
It very rarely means no treatment. Far more often it means a different drug, a modified plan, or treatment alongside a cardiologist. Finding it now is precisely why the test exists, and it is a much better outcome than finding it three cycles in.
A different drug class
There is usually more than one reasonable plan for a given situation. If the first choice includes a drug that is hard on the heart, the team can often reach the same goal with something else. Ask what the alternative costs you in terms of effect and side effects.
Treatment for the heart first
A cardiologist may start medicines to support the pumping action, and chemotherapy begins once things have improved. This adds time, and the time is generally well spent.
Closer monitoring during the course
More frequent echoes, and clear instructions about what to report. Take those instructions seriously — heart effects picked up early are far more treatable than ones noticed late.
Things you can do yourself
Keep blood pressure and sugar controlled, take the heart medicines you have been given exactly as prescribed, stop smoking, and report new breathlessness rather than putting it down to the chemotherapy. These matter more than most people realise.
Never stop or change a heart or blood pressure medicine on your own because you are starting chemotherapy. Ask.Commonly believed
Four things people assume when an echo is ordered
"They must have found a heart problem."
The test is ordered from the treatment plan, not from anything found in you. If your plan includes a drug class that can affect the pumping action, everyone on it gets a baseline reading, including people with no history of heart trouble at all.
"A low ejection fraction means chemotherapy is impossible."
It usually means a different drug, a modified plan, or treatment given alongside a cardiologist. A low starting figure is information the team plans around. Cancelling treatment altogether on this basis is uncommon.
"The echo will hurt, or involve radiation."
A standard echo is an ultrasound: gel, a probe, no needles, no radiation, nothing swallowed. The probe presses firmly between the ribs, which is uncomfortable rather than painful. A MUGA scan does use a small tracer injection.
"Any heart effect from chemotherapy is permanent."
Some changes recover once the drug is stopped, particularly when caught early and treated. Others persist. This is exactly why the baseline test and the repeat checks exist, and why new breathlessness is worth reporting rather than tolerating.
Questions we are asked
Common questions about the heart test
Does everyone on chemotherapy need an echo?
No. It is needed when the plan includes a drug class that can affect the heart's pumping action, and for people who already have heart disease or long-standing blood pressure. Ask whether yours is a plan that requires one.
How should I prepare for it?
You do not need to. Eat normally, take your usual medicines, and wear a top that opens at the front. There is no fasting and no recovery period, so you can go straight on to another appointment afterwards.
What is a normal ejection fraction?
A healthy heart never empties completely, so the normal range sits comfortably below a hundred. Your report will state the range the laboratory uses. What matters more is your own starting figure and whether it changes later.
The technician would not tell me anything. Is that bad?
No, it is how the job is divided. The person performing the scan records images; a cardiologist reports them and your oncologist interprets them alongside your plan. Silence during the test is routine and means nothing.
Will the test be repeated during treatment?
Usually yes if your plan includes those drugs, often part way through and sometimes after the course ends. Ask when yours is due so it can be booked in advance rather than chased at the last minute.
Can I have it done outside the hospital?
Often yes, and it may be quicker or cheaper. Ask your team first, because they may want a particular format or their own department for the baseline so later scans are directly comparable. Take the printed report with you.
I already take heart medicines. Should I stop them?
No. Never stop or change a heart or blood pressure medicine on your own because chemotherapy is starting. Bring every box to the appointment and let the oncologist and cardiologist decide together what continues.
How soon after the echo can treatment start?
Once the report reaches your oncologist and the other results are in, which is often within days. The echo is rarely the step that holds things up; waiting for an appointment slot for it more often is, so book it early.
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Sources
- Cancer Research UK — Tests before chemotherapy
- Macmillan Cancer Support — Echocardiogram
- National Cancer Institute — Chemotherapy to Treat Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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