The ARDMS AE Adult Echocardiography examination evaluates sonographers on the mastery of cardiovascular ultrasound physics, instrumentation, and hemodynamics. Candidates demonstrate technical proficiency in M-mode, two-dimensional, and multi-gated Doppler imaging, including pulsed-wave, continuous-wave, and color-flow mapping techniques. Assessment criteria encompass the systematic identification of valvular pathology, myocardial contractility, diastolic function, and congenital anomalies using standard apical, parasternal, subcostal, and suprasternal acoustic windows. Practitioners must interpret complex spectral waveform morphologies, calculate volumetric flow parameters, and apply continuity equations to quantify valvular stenosis and regurgitation severity. The exam ensures clinicians maintain rigorous clinical standards for diagnostic accuracy, image optimization, and echocardiographic artifact recognition.