Heart health tips: Clinical indications of echocardiogram

Your doctor will suggest you an echocardiogram or an ultrasound of your heart to check the functioning of the heart and diagnose any abnormalities. Once the diagnosis of heart valve disease is confirmed, you need to seek appropriate treatment.

One with heart valve disease will have to go for regular follow-ups with the doctor and do echocardiograms from time to time to know if the disease is getting better or worse. Echocardiogram is a painless, noninvasive test or an ultrasound of the heart that doesn’t emit radiation but when do the doctors recommend this type of medical imaging of the heart?

In an interview with HT Lifestyle, Dr Shantanu Sengupta, MD, DNB, FACC, FASE Heart Failure Specialist at Sengupta Hospital and Research Institute in Nagpur, revealed that echocardiography is rapid, portable, safe and widely available while appropriate clinical indications of echocardiogram include:

1. Re-evaluation of known HF (systolic or diastolic) to guide therapy.

2. Routine surveillance (<1 y) of known pulmonary hypertension without change in clinical status or cardiac exam.

3. Re-evaluation of known pulmonary hypertension if change in clinical status or cardiac exam or to guide therapy.

4. Initial postoperative evaluation of prosthetic valve for establishment of baseline.

5. Suspected cardiovascular source of embolus.

6. 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.

7. 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.

8. Dengue fever

9. Pregnant patient with breathlessness

10. Obese persons

11. Patient with snoring history

12. Initial evaluation of suspected infective endocarditis with positive blood cultures or a new murmur.

According to Dr Uday Jadhav, Consultant Cardiologist at MGM New Bombay Hospital (FACC, FAHA, FSCCT, FESC, FRCP, FICC, FCSI, FIAE Professor at Faculty MGMIHS in Mumbai), appropriate use criteria (AUC) in echocardiography are essential tools for aligning the indications of echocardiography with the best clinical standards, improving clinical outcomes, and preserving healthcare resources. Appropriate use criteria as pr him includes:

1. Symptoms or conditions potentially related to suspected cardiac etiology including chest pain, shortness of breath, palpitations, TIA, stroke or peripheral embolic event.

2. Initial evaluation of suspected hypertensive heart disease.

3. Initial evaluation of ventricular function following ACS.

4. Sustained or non-sustained atrial fibrillation, SVT, or VT.

5. Initial evaluation of known or suspected HF (systolic or diastolic) based on symptoms, signs, or abnormal test results.

6. Initial evaluation when there is a reasonable suspicion of valvular or structural heart disease.

7. Clinical symptoms or signs consistent with a cardiac diagnosis known to cause lightheadedness/pre-syncope/syncope (including but not limited to aortic stenosis, hypertrophic cardiomyopathy, or HF)

8. Syncope when there are no other symptoms or signs of cardiovascular disease.

9. Suspected pericardial conditions.

10. 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.

11. Evaluation of a patient without chest pain but with other features of an ischemic equivalent or laboratory markers indicative of ongoing MI.

12. Known acute pulmonary embolism to guide therapy (eg. thrombectomy and thrombolytics).

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