By Julian Booker, MD
The first thing that must be stated about the echocardiography appropriate use guidelines is that they are just that…guidelines. They are designed to provide direction but still be vague enough to allow flexibility in their interpretation if needed. This flexibility is needed so as not to prevent us from ordering the test if you really need it. If you have been admitted to the hospital because of a heart related condition, this post is not for you because chances are you need another echo.
The good thing is that echocardiography is safe. It is a powerful imaging tool and your physician may become addicted to all the great information that it provides. Unfortunately, this combination can result in overuse.
Similar to stress testing, it can be difficult to cover all the situations where ordering an echocardiogram is important. You will see below the indications that are probably the clearest.
If you have a new or worsening murmur, new or worsening chest pain or other clinical findings that suggest a new or worsening cardiac condition then getting another echo is probably the right thing to do.
But what are some symptoms that could be related to a cardiac condition?
- An abnormal heart rhythm
- Dizziness or fainting spells
- Shortness of breath
- Chest pain
- Swelling (edema) in your legs or abdomen
- Unexpectedly low blood pressure or labile blood pressures
- High blood pressure is also a reason if your doctor thinks the heart muscle may be damaged or abnormally thickened.
- If you have had a stroke or TIA (mini stroke)
If your symptoms and physical examination are unchanged, then the indications for repeat echocardiography are a little fuzzier. Routine annual surveillance is generally discouraged although exceptions like moderate to severe mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation. Other exceptions include complex congenital heart disease and pulmonary hypertension. If you have mild valve disease or you have an artificial valve that is working normally, then every three years is good enough.
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