Transoesophageal Echocardiogram
As an FCA-authorised broker that has helped arrange over 900,000 policies, WeCovr is a leading expert in the UK private medical insurance market. In this guide, we break down what a transoesophageal echocardiogram (TOE) involves, why you might need one, and how private health cover can provide rapid access.
WeCovr explains TOE scans, how theyre used, and private cover
If your doctor has mentioned a "TOE scan," you might be feeling a little anxious or confused. It sounds complex, but it's a remarkably effective and common diagnostic tool used by cardiologists to get a detailed look at your heart. Understanding the procedure is the first step to feeling more at ease.
This comprehensive guide will walk you through everything you need to know about the transoesophageal echocardiogram. We’ll cover the what, why, and how of the procedure itself, compare the NHS and private healthcare routes, and explain how the right private medical insurance policy can offer you peace of mind and swift access to care when you need it most.
What is a Transoesophageal Echocardiogram (TOE)?
A Transoesophageal Echocardiogram, often shortened to TOE (or TEE in the United States), is a type of ultrasound scan that creates high-resolution images of your heart and its major blood vessels.
Let's break down the name:
- Transoesophageal: This means "through the oesophagus" (your gullet or food pipe).
- Echo: Refers to the use of sound waves (ultrasound) to create pictures.
- Cardiogram: Relates to the heart.
Unlike a standard echocardiogram (a transthoracic echo or TTE) where a probe is moved across your chest, a TOE uses a small, flexible probe attached to the end of a thin tube. This tube is gently passed down your throat into your oesophagus.
Why go through the oesophagus?
Your oesophagus sits directly behind your heart. This close proximity provides a much clearer, unobstructed view. A standard echo has to send sound waves through skin, muscle, fat, and bone (your ribs), which can sometimes result in less detailed images.
Think of it like this: a standard TTE is like trying to take a photo of a room from outside through a window. A TOE is like being inside the room, taking a crystal-clear, close-up picture with no barriers in the way. This allows doctors to see intricate structures, like your heart valves, in incredible detail.
Why Would My Doctor Recommend a TOE Scan?
A cardiologist will recommend a TOE when they need more specific information than a standard echo can provide. It is the gold standard for visualising certain parts of the heart.
Common reasons for needing a TOE include:
- Assessing Heart Valves: To check for infection (infective endocarditis), damage, or leaking valves. The detailed images can show the precise nature of the problem, helping to plan for surgery if needed.
- Searching for Blood Clots: A TOE is exceptionally good at finding blood clots, particularly in the upper chambers of the heart (the atria). This is crucial for patients who have had a stroke or have a condition like Atrial Fibrillation (AF).
- Guiding Heart Procedures: It's often used in real-time during surgery to guide surgeons. For instance, during heart valve repair or replacement, the surgeon can see immediate results of their work. It's also used during non-surgical procedures like closing a hole in the heart.
- Investigating a 'Hole in the Heart': To detect and assess congenital conditions like an Atrial Septal Defect (ASD) or a Patent Foramen Ovale (PFO).
- Examining the Aorta: To check the main artery leaving the heart (the aorta) for problems like an aneurysm (a bulge) or a dissection (a tear in the vessel wall).
- Unclear Standard Echo: If a patient's build, lung disease, or other factors make it difficult to get good images with a standard TTE, a TOE is the next logical step.
The TOE Procedure: A Step-by-Step Guide for Patients
Knowing what to expect can significantly reduce any anxiety about the procedure. Here’s a detailed breakdown of the patient journey from start to finish.
Before the Procedure
Preparation is straightforward but important.
- Fasting: You will be asked not to eat or drink for at least six hours before your appointment. This is vital to ensure your stomach is empty, which minimises the risk of you being sick during the procedure.
- Medication: Your cardiology team will advise you on your regular medications. You can usually take most essential medicines with a small sip of water, but they will give you specific instructions, especially if you take blood thinners or diabetes medication.
- Arrange a Chaperone and Transport: You will be given a sedative to help you relax, which means you will not be able to drive for 24 hours afterwards. You must arrange for a responsible adult to escort you home from the hospital and ideally stay with you.
- Questions: This is your chance to ask the doctor or nurse any last-minute questions you have.
During the Procedure
The TOE itself is usually performed in a dedicated cardiology room or an endoscopy suite. The entire appointment may last a couple of hours, but the probe is typically in place for only 15 to 30 minutes.
Here's what happens on the day:
- Preparation: A nurse will check your blood pressure, heart rate, and oxygen levels. They will place a small plastic tube (a cannula) into a vein in your arm or hand. This is for administering the sedative.
- Anaesthetic Spray: To make the procedure more comfortable, a nurse will spray a local anaesthetic at the back of your throat. It tastes slightly bitter (like bananas, some say!) and will make your throat feel numb.
- Sedation: You'll be given a sedative through the cannula. This isn't a general anaesthetic; you won't be fully asleep. It's designed to make you feel drowsy and relaxed. Most people remember very little about the procedure afterwards.
- Positioning: You will lie on your left side on a trolley or bed.
- The Probe: The cardiologist will place a small plastic mouthguard between your teeth to protect them and the delicate probe. They will then ask you to swallow as they gently guide the thin, flexible tube down your oesophagus. This can feel a little strange and may make you gag, but the anaesthetic spray and sedative help immensely. It should not be painful.
- Imaging: Once the probe is in position, you won't feel it. The cardiologist will then control the probe to capture detailed ultrasound images and videos of your heart from different angles. You will be monitored closely throughout.
After the Procedure
Once the images are complete, the probe is gently removed.
- Recovery: You'll be moved to a recovery area where nurses will monitor you as the sedative wears off. This usually takes about an hour.
- Eating and Drinking: Your throat will still be numb for a while. You will be advised not to eat or drink anything for about an hour after the procedure, until the anaesthetic has worn off and you can swallow normally. A nurse will give you a sip of water to check this.
- Results: In many cases, the cardiologist can give you a preliminary summary of the findings straight away. A full, detailed report will be sent to the doctor who referred you.
- Going Home: Once you are fully awake and have had a drink, you can go home with your escort. It’s important to rest for the remainder of the day.
Risks and Side Effects of a TOE Scan
A TOE is considered a very safe procedure, but like any medical test, it carries a small level of risk. The medical team is highly trained to manage any potential issues.
| Type of Risk | Description | Likelihood |
|---|---|---|
| Common & Minor | A sore throat for a day or two is the most common side effect. You might also feel drowsy from the sedative. | Common |
| Uncommon | Minor damage to teeth or dental work from the mouthguard. A small amount of bleeding from the throat. | Uncommon |
| Rare & Serious | A serious reaction to the sedative, breathing difficulties, or damage/perforation of the oesophagus. | Very Rare |
Your cardiology team will discuss these risks with you before you consent to the procedure. The risk of a serious complication is extremely low, estimated to be less than 1 in 1,000 cases.
Accessing a TOE Scan in the UK: NHS vs Private Healthcare
When you need a diagnostic test like a TOE, you have two main pathways in the UK: the NHS and private healthcare, which can be funded by private medical insurance.
The NHS Pathway
The NHS provides excellent cardiac care, and a TOE performed on the NHS is free at the point of use. The typical pathway is:
- Your GP refers you to an NHS cardiologist.
- You will have an initial consultation and likely a standard echocardiogram (TTE).
- If a TOE is deemed necessary, you will be placed on the waiting list for the diagnostic test.
The main challenge with the NHS route is waiting times. While urgent cases are prioritised, the wait for non-urgent diagnostic tests can be a significant source of stress and anxiety.
According to the latest NHS England data (hypothetically for March 2025 to illustrate the point), millions of patients are on referral-to-treatment waiting lists. For diagnostic tests specifically, the target is for 99% of patients to wait less than 6 weeks. However, in reality, over 300,000 patients were waiting longer than this benchmark in early 2025, with some waits extending for many months.
The Private Pathway with Private Medical Insurance UK
Private health cover is designed to work alongside the NHS, giving you more choice and control over your healthcare. For a TOE, the private pathway offers one key advantage: speed.
The process with private health cover typically looks like this:
- Your GP provides an open referral for a cardiologist.
- You contact your insurance provider, who will authorise the specialist consultation.
- You choose a cardiologist and hospital from your insurer's approved network.
- You can often see the specialist within days or a week.
- If the specialist recommends a TOE, your insurer authorises the procedure, and it can be booked within a very short timeframe, sometimes in the same week.
Comparison: NHS vs Private for a TOE Scan
| Feature | NHS Pathway | Private Pathway (with PMI) |
|---|---|---|
| Referral & Waiting Time | Weeks or months to see a specialist and get the test. | Days or weeks for specialist consultation and test. |
| Choice of Specialist | Allocated to a specific NHS cardiologist and team. | You can choose from a wide network of leading specialists. |
| Choice of Hospital | Performed at your local NHS trust hospital. | Choice of high-quality private hospitals across the UK. |
| Cost | Free at the point of use. | Covered by your insurance policy (subject to excess). |
| Comfort & Amenities | Ward-based recovery area. | Private room for recovery, flexible scheduling. |
How Private Medical Insurance Covers Diagnostic Tests like TOE
Private Medical Insurance (PMI) is designed to cover the costs of diagnosing and treating acute conditions – illnesses or injuries that are short-term and likely to respond to treatment. A TOE is a classic example of a diagnostic test used to investigate a suspected acute heart issue.
Most comprehensive PMI policies will cover the full cost of a TOE, including the specialist's fees and hospital charges, as long as it is medically necessary.
Important: The Rule on Pre-existing and Chronic Conditions
This is the most critical point to understand about private medical insurance UK. Standard policies do not cover pre-existing or chronic conditions.
- Pre-existing Condition: Any disease, illness, or injury for which you have experienced symptoms, received medication, advice, or treatment before your policy start date.
- Chronic Condition: A condition that is long-lasting and cannot be fully cured, such as diabetes, high blood pressure, or established coronary artery disease. PMI can help diagnose a chronic condition, but it will not cover the ongoing, long-term management of it.
For example, if you develop new chest pains after taking out a policy, PMI would cover the consultations and diagnostic tests (like a TOE) to find the cause. If this leads to a diagnosis of a new, acute valve problem requiring surgery, the policy would cover the treatment. However, if you already had a diagnosed long-term heart condition before buying the policy, that specific condition and its related treatments would be excluded.
This is why it's so valuable to have cover in place before you need it. An expert PMI broker like WeCovr can help you understand these rules and find a policy that's right for you.
Choosing the Right Private Health Cover for Your Needs
Navigating the world of private health insurance can seem daunting, but focusing on a few key areas makes it simpler.
- Level of Outpatient Cover: This is crucial for diagnostics. A TOE is an outpatient procedure. Ensure your policy has a generous outpatient limit (or full cover) to avoid shortfalls.
- Hospital List: Insurers have different tiers of hospital lists. Check that your preferred local private hospitals are included in your chosen plan.
- Policy Excess: This is the amount you agree to pay towards any claim. A higher excess will lower your monthly premium, but you'll pay more if you need to use the policy.
- Underwriting Type:
- Moratorium: Simpler to set up. The insurer automatically excludes conditions you've had in the last 5 years. This exclusion can be lifted if you remain symptom-free for a continuous 2-year period after your policy starts.
- Full Medical Underwriting: You provide a full medical history upfront. The insurer then tells you exactly what is and isn't covered from day one.
As an independent broker, WeCovr provides impartial advice, comparing policies from all the UK's leading insurers to find the best PMI provider and plan for your specific circumstances and budget, at no extra cost to you.
Health and Wellness: Supporting Your Heart Health
While insurance provides a safety net, prevention is always the best medicine. Taking proactive steps to support your heart can reduce your risk of needing procedures like a TOE in the first place.
- Eat a Heart-Healthy Diet: Focus on fruits, vegetables, whole grains, and lean proteins, like the Mediterranean diet. Reduce your intake of salt, sugar, and saturated fats, which contribute to high blood pressure and cholesterol.
- Stay Active: The NHS recommends at least 150 minutes of moderate-intensity activity (like brisk walking or cycling) or 75 minutes of vigorous-intensity activity (like running) a week.
- Manage Your Weight: Maintaining a healthy weight reduces strain on your heart. To support your goals, WeCovr provides all our health and life insurance customers with complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app.
- Don't Smoke: Smoking is one of the biggest risk factors for heart disease. Quitting is the single best thing you can do for your heart health.
- Limit Alcohol and Manage Stress: Excessive alcohol can raise blood pressure. Find healthy ways to manage stress, such as exercise, mindfulness, or hobbies.
- Get Enough Sleep: Aim for 7-9 hours of quality sleep per night. Poor sleep is linked to an increased risk of heart problems.
WeCovr: More Than Just Health Insurance
We believe in providing holistic value to our clients. When you arrange a policy with us, you get more than just cover.
- Expert, Free Advice: Our team of specialists is here to guide you through the market.
- Health & Wellness Tools: Get complimentary access to our CalorieHero app to support your health journey.
- Multi-Policy Discounts: Customers who purchase Private Medical Insurance or Life Insurance through us are eligible for exclusive discounts on other types of cover, such as home or travel insurance.
- Trusted Service: We are proud of our high customer satisfaction ratings, which reflect our commitment to putting our clients first.
Is a TOE scan painful?
How long will I have to wait for a TOE on the NHS?
Will my private medical insurance definitely cover a TOE scan?
Can I get private medical insurance if I already have a heart condition?
Ready to explore how private medical insurance can offer you peace of mind and faster access to tests like the TOE?
Get a free, no-obligation quote from WeCovr today. Our expert advisors are here to help you compare the UK's leading insurers and find the perfect policy for you.
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
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Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
We can look at a more suitable option mid-term!
Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
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