Indications

Indications

Each echocardiogram is performed at the request of a cardiologist. Not every situation is appropriate to prescribe an ultrasound exam. This page is created to show indications which are justified for echocardiography or not.

 

Evaluation of cardiac structure and function 
1 Symptoms or conditions potentially  related to suspected cardiac etiology including but not limited to chest pain, shortness of breath, palpitations, TIA, stroke, or peripheral embolic  event A
2 Prior testing that is concerning for heart  disease or structural abnormality including but not limited to chest X-ray, baseline scout images for stress echocardiogram, ECG, or cardiac biomarkers A
3 Infrequent APCs or infrequent  VPCs without other  evidence of heart  disease I
4 Frequent VPCs or exercise-induced VPCs A
5 Sustained or nonsustained atrial fibrillation, SVT, or VT A
6 Asymptomatic isolated sinus  bradycardia I
Lightheadedness/Presyncope/Syncope With TTE
7 Clinical symptoms or signs  consistent with a cardiac diagnosis known to cause lightheadedness/presyncope/syncope (including but not limited to aortic stenosis, hypertrophic cardiomyopathy, or HF) I
8 Lightheadedness/presyncope when there  are no other  symptoms or signs  of cardiovascular U
9 Syncope when there  are no other  symptoms or signs  of cardiovascular disease A
Evaluation of Ventricular Function With TTE
10 Routine  surveillance of ventricular  function with known CAD and  no change in clinical status or cardiac exam I
11 Routine  surveillance of ventricular  function with known CAD and  no change in clinical status or cardiac exam I
12 Evaluation  of LV function with prior ventricular  function  evaluation showing normal function (e.g., prior echocardiogram, left ventriculogram, CT, SPECT MPI, CMR) in patients in whom there  has  been no change in clinical status or cardiac exam I
Perioperative Evaluation With TTE
13 Routine  perioperative evaluation of ventricular  function with no symptoms or signs  of cardiovascular disease I
14 Routine  perioperative evaluation of cardiac structure and function prior to noncardiac solid organ transplantation U
Pulmonary Hypertension With TTE
15 Evaluation  of suspected  pulmonary hypertension including evaluation of right ventricular  function and estimated pulmonary artery pressure A
16 Routine  surveillance (<1 y) of known pulmonary hypertension without change in clinical status or cardiac exam I
17 Routine  surveillance (≥1 y) of known pulmonary hypertension without change in clinical status or cardiac exam A
18 Re-evaluation of known pulmonary hypertension if change in clinical status or cardiac exam  or to guide therapy A
Evaluation in an acute setting
19 Hypotension or hemodynamic instability of uncertain or suspected cardiac etiology A
20 Assessment of volume status in a critically ill patient A
Myocardial Ischemia/Infarction With TTE
21 Acute chest pain with suspected MI and  nondiagnostic ECG when a resting echocardiogram can  be performed during pain A
22 Evaluation  of a patient without chest pain but with other  features of an ischemic equivalent or laboratory markers indicative  of ongoing  MI A
23 Suspected complication of myocardial ischemia/infarction, including but not limited to acute mitral regurgitation, ventricular  septal defect, free-wall rupture/tamponade, shock, right ventricular  involvement, HF, or thrombus A
Evaluation of Ventricular Function after ACS With TTE
24 Initial evaluation of ventricular  function following ACS A
25 Re-evaluation of ventricular  function following ACS during recovery phase when results will guide  therapy A
Respiratory Failure With TTE
26 Respiratory failure or hypoxemia of uncertain etiology A
27 Respiratory failure or hypoxemia when a noncardiac etiology of respiratory failure has  been established U
Pulmonary Embolism With TTE
28 Suspected pulmonary embolism in order  to establish diagnosis
29 Known acute pulmonary  embolism to guide  therapy (e.g., thrombectomy and  thrombolytics) A
30 Routine  surveillance of prior pulmonary embolism with normal right ventricular  function and  pulmonary  artery systolic  pressure I
31 Re-evaluation of known pulmonary embolism after thrombolysis or thrombectomy for assessmentof change in right ventricular  function and/or pulmonary  artery pressure A
Cardiac Trauma With TTE
32 Severe deceleration injury or chest trauma when valve injury, pericardial effusion, or cardiac injury are possible or suspected A
33 Routine evaluation in the setting of mild chest trauma with no electrocardiographic changes or biomarker elevation I
Evaluation of valvular function
Murmur or Click With TTE
34  Initial evaluation when there  is a reasonable suspicion of valvular or structural heart  disease A
35 Initial evaluation when there are no other symptoms or signs of valvular or structural heart disease U
36 Re-evaluation in a patient without valvular disease on prior echocardiogram and  no change in clinical status or cardiac exam I
37 Re-evaluation of known valvular heart disease with a change in clinical status or cardiac exam or to guide  therapy A
Native valvular Stenosis with TTE
38 Routine  surveillance (<3 y) of mild valvular stenosis without a change in clinical status or cardiac exam I
39 Routine  surveillance (≥3 y) of mild valvular stenosis without a change in clinical status or cardiac exam A
40 Routine  surveillance (<1 y) of moderate or severe valvular stenosis without a change in clinical status or cardiac exam U
41 Routine  surveillance ((≥1 y) of moderate or severe valvular stenosis without a change in clinical status or cardiac exam A
Native valvular Regurgitation with TTE
42 Routine  surveillance of trace valvular regurgitation I
43 Routine  surveillance (<3 y) of mild valvular regurgitation without a change in clinical status or cardiac exam I
44 Routine  surveillance (≥3 y) of mild valvular regurgitation without a change in clinical status or cardiac exam U
45 Routine surveillance (<1 y) of moderate or severe valvular regurgitation without a change in clinical status or cardiac exam U
46 Routine  surveillance (≥1 y) of moderate or severe valvular regurgitation without change in clinical status or cardiac exam A
Prosthetic Valve With TTE
47 Initial postoperative evaluation of prosthetic valve for establishment of baseline A
48 Routine  surveillance (<3 y after valve implantation)  of prosthetic valve if no known or suspected valve dysfunction
49 Routine  surveillance (≥3 y after valve implantation)  of prosthetic valve if no known or suspected valve dysfunction A
50 Evaluation of prosthetic valve with suspected dysfunction or a change in clinical status or cardiac exam A
51 Re-evaluation of known prosthetic valve dysfunction when it would change management or guide therapy A
Infective Endocarditis (Native  or Prosthetic Valves)  With TTE
52  Initial evaluation of suspected infective endocarditis with positive blood cultures or a new murmur A
53 Transient fever without evidence of bacteremia or a new murmur I
54 Transient bacteremia with a pathogen not typically associated with infective endocarditis and/or a documented nonendovascular source of infection I
55 Re-evaluation of infective endocarditis at high risk for progression or complication or with a change in clinical status or cardiac exam A
56 Routine  surveillance of uncomplicated infective endocarditis when no change in management is contemplated U
Evaluation of intracardiac and  extracardiac structures and  chambers
57 Suspected cardiac mass A
58 Suspected cardiovascular source of embolus A
59 Suspected pericardial conditions A
60 Routine  surveillance of known small pericardial effusion with no change in clinical status
61 Re-evaluation of known pericardial effusion to guide  management or therapy A
62 Guidance of percutaneous noncoronary cardiac procedures including but not limited to pericardiocentesis, septal ablation, or right ventricular biopsy A
Evaluation of aortic  disease
63 Evaluation  of the ascending aorta  in the setting of a known or suspected connective tissue disease or genetic condition that predisposes to aortic aneurysm or dissection (e.g., Marfan syndrome) A
64 Re-evaluation of known ascending aortic dilation or history of aortic dissection to establish a baseline rate of expansion or when the rate of expansion is excessive A
65 Re-evaluation of known ascending aortic dilation or history of aortic dissection with a change in clinical status or cardiac exam  or when findings may alter management or therapy A
66 Routine  re-evaluation  for surveillance of known ascending aortic dilation or history of aortic I
Evaluation of hypertension, HF, or cardiomyopathy
Hypertension With TTE
67 Initial evaluation of suspected hypertensive heart  disease A
68 Routine  evaluation of systemic hypertension without symptoms or signs  of hypertensive heart  disease I
69 Re-evaluation of known hypertensive heart  disease without a change in clinical status or cardiac exam U
HF With TTE
70 Initial evaluation of known or suspected HF (systolic or diastolic) based on symptoms, signs,  or abnormal test  results A
71 Re-evaluation of known HF (systolic or diastolic) with a change in clinical status or cardiac exam  without a clear precipitating change in medication or diet A
72 Re-evaluation of known HF (systolic or diastolic) with a change in clinical status or cardiac exam  with a clear precipitating change in medication or diet U
73 Re-evaluation of known HF (systolic or diastolic) to guide  therapy A
74 Routine surveillance (<1 y) of HF (systolic or diastolic) when there is no change in clinical status or cardiac exam I
75 Routine surveillance (≥1 y) of HF (systolic or diastolic) when there is no change in clinical status or cardiac exam U
Device Evaluation (including Pacemaker, ICD, or CRT) with TTE
76 Initial evaluation or re-evaluation after revascularization and/or optimal  medical therapy to determine candidacy for device therapy and/or to determine optimal choice of device A
77 Initial evaluation for CRT device optimization after implantation U
78 Known implanted pacing device with symptoms possibly due  to device complication or suboptimal pacing device settings A
79 Routine  surveillance (<1 y) of implanted device without a change in clinical status or cardiac exam I
80 Routine  surveillance (≥1 y) of implanted device without a change in clinical status or cardiac exam I
Ventricular Assist Devices and Cardiac Transplantation With TTE
81 To determine candidacy for ventricular  assist device A
82 Optimization of ventricular  assist device settings A
83 Re-evaluation for signs/symptoms suggestive of ventricular  assist device-related complications A
84 Monitoring for rejection in a cardiac transplant recipient A
85 Cardiac structure and  function evaluation in a potential heart  donor A
Cardiomyopathies With TTE
86 Initial evaluation of known or suspected cardiomyopathy (e.g., restrictive, infiltrative, dilated,hypertrophic, or genetic cardiomyopathy) A
87 Re-evaluation of known cardiomyopathy with a change in clinical status or cardiac exam  or to guide therapy A
88 Routine surveillance (<1 y) of known cardiomyopathy without a change in clinical status or cardiac exam I
89 Routine surveillance (≥1 y) of known cardiomyopathy without a change in clinical status or cardiac exam U
90 Screening evaluation for structure and  function in first-degree relatives of a patient with an inherited  cardiomyopathy A
91 Baseline and  serial re-evaluations in a patient undergoing therapy with cardiotoxic agents A
Adult congenital heart  disease
92 Initial evaluation of known or suspected adult congenital heart  disease A
93 Known adult congenital heart  disease with a change in clinical status or cardiac exam A
94 Re-evaluation to guide  therapy in known adult congenital heart  disease A
95 Routine  surveillance (<2 y) of adult congenital heart disease following complete repair      I
+  without a residual structural or hemodynamic abnormality     
+  without a change in clinical status or cardiac exam
96 Routine  surveillance (≥2 y) of adult congenital heart disease following complete repair     U
+  without residual structural or hemodynamic abnormality    
+  without a change in clinical status or cardiac exam
97 Routine  surveillance (<1 y) of adult congenital heart disease following incomplete or palliative repair     U
+  with residual structural or hemodynamic abnormality    
+  without a change in clinical status or cardiac exam
98 Routine  surveillance (≥1 y) of adult congenital heart disease following incomplete or palliative repair    U
+  with residual structural or hemodynamic abnormality   
+  without a change in clinical status or cardiac exam
TEE
General Uses
99 Use of TEE when there  is a high likelihood of a nondiagnostic TTE due  to patient characteristics or inadequate visualization  of relevant  structures A
100 Routine  use  of TEE when a diagnostic TTE is reasonably anticipated to resolve all diagnostic and management concerns I
101 Re-evaluation of prior TEE finding for interval change (e.g., resolution of thrombus after anticoagulation, resolution of vegetation after antibiotic therapy)  when a change in therapy is anticipated A
102 Surveillance of prior TEE finding for interval change (e.g., resolution of thrombus after anticoagulation, resolution of vegetation after antibiotic  therapy)  when no change in therapy is anticipated I
103 Guidance during percutaneous noncoronary cardiac interventions including but not limited to closure device placement, radiofrequency ablation,  and percutaneous valve procedures A
104 Suspected acute aortic pathology including but not limited to dissection/transsection (not as initial test) A
105 Routine  assessment of pulmonary veins in an asymptomatic patient status post  pulmonary  vein isolation I
Valvular Disease
106 Evaluation  of valvular structure and  function to assess suitability for, and assist in planning  of, an intervention A
107 To diagnose infective endocarditis with a low pretest probability  (e.g., transient fever, known alternative source of infection, or negative blood cultures/atypical pathogen for endocarditis) I
108 To diagnose infective endocarditis with a moderate or high pretest probability (e.g., staph bacteremia, fungemia, prosthetic heart  valve, or intracardiac device) A
Embolic Event
109 Evaluation  for cardiovascular source of embolus with no identified noncardiac source A
110 Evaluation  for cardiovascular source of embolus with a previously  identified noncardiac source I
111 Evaluation  for cardiovascular source of embolus with a known cardiac source in which a TEE would not change management I
Atrial Fibrillation/Flutter
112 Evaluation  to facilitate clinical decision making  with regard to anticoagulation, cardioversion, and/or radiofrequency ablation A
113 Evaluation  when a decision has  been made to anticoagulate and  not to perform  cardioversion
Stress echocardiography for detection of CAD/Risk assessment:
Symptomatic or ischemic equivalent
114 Low pretest probability  of CAD I
  ECG interpretable and  able to exercise
115 Low pretest probability  of CAD A
  ECG uninterpretable or unable to exercise
116 Intermediate pretest probability  of CAD A
  ECG interpretable and  able to exercise
117 Intermediate pretest probability  of CAD A
  ECG uninterpretable or unable to exercise
118 High pretest probability  of CAD A
  Regardless of ECG interpretability  and  ability to exercise
Stress echocardiography for risk assessment:
Perioperative evaluation for noncardiac surgery without active cardiac conditions
Low-Risk Surgery With Stress Echocardiography
154 Perioperative evaluation for risk assessment I
Intermediate-Risk Surgery With Stress Echocardiography
155 Moderate to good  functional  capacity (≥4 METs) I
156 No clinical risk factors I
157 ≥ clinical risk factor  U
Poor or unknown  functional  capacity (<4 METs)
158 Asymptomatic <1 y post  normal catheterization, noninvasive test,  or previous revascularization I
Vascular Surgery With Stress Echocardiography
159 Moderate to good  functional  capacity (≥4 METs) I
160 No clinical risk factors I
161 ≥  1 clinical risk factor A
Poor or unknown  functional  capacity (<4 METs)
162 Asymptomatic <1 y post  normal catheterization, noninvasive test,  or previous revascularization I
Stress echocardiography for assessment of viability/ischemia
Ischemic Cardiomyopathy/Assessment of Viability With Stress Echocardiography
176 Known moderate or severe LV dysfunction A
Patient eligible for revascularization
Use of dobutamine stress only
Stress echocardiography for hemodynamics (includes  doppler during stress)
Chronic Valvular  Disease—Asymptomatic With Stress Echocardiography
177 Mild mitral stenosis I
178 Moderate mitral stenosis U
179 Severe mitral stenosis A
180 Mild aortic stenosis I
181 Moderate aortic stenosis U
182 Severe aortic stenosis U
183 Mild mitral regurgitation I
184 Moderate mitral regurgitation I
185 Severe mitral regurgitation U
  LV size and  function not meeting surgical criteria
186 Mild aortic regurgitation I
187 Moderate aortic regurgitation I
188 Severe aortic regurgitation U
  LV size and  function not meeting surgical  criteria
Chronic Valvular  Disease - Symptomatic With Stress Echocardiography
189 Mild mitral stenosis U
190 Moderate mitral stenosis A
191 Severe mitral stenosis I
192 Severe aortic stenosis I
193 Evaluation  of equivocal aortic stenosis A
Evidence of low cardiac output or LV systolic  dysfunction (‘‘low gradient aortic stenosis’’)
Use of dobutamine only
194 Mild mitral regurgitation U
195 Moderate mitral regurgitation A
196 Severe mitral regurgitation
  Severe LV enlargement or LV systolic  dysfunction
Acute Valvular  Disease With Stress Echocardiography
197 Acute moderate or severe mitral or aortic regurgitation
Pulmonary Hypertension With Stress Echocardiography
198 Suspected pulmonary  artery hypertension U
Normal or borderline elevated estimated right ventricular  systolic  pressure on resting echocardiographic study
199 Routine  evaluation of patients with known resting  pulmonary hypertension
200 Re-evaluation of patient with exercise-induced pulmonary hypertension to evaluate response to therapy U
Contrast use  in TTE/TEE or stress echocardiography
201 Routine  use  of contrast I
  All LV segments visualized  on noncontrast images
202 Selective use  of contrast A
≥2 contiguous LV segments are not seen on noncontrast images

 

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