From the Guidelines
An echocardiogram is typically ordered as a diagnostic test to evaluate the structure and function of the heart, especially in cases of suspected cardiac emergencies, such as acute chest pain, acute dyspnea, or hemodynamic instability, as recommended by the European Association of Cardiovascular Imaging 1. The test uses ultrasound technology to create moving images of the heart, allowing physicians to observe the heart's chambers, valves, and surrounding structures in real-time without radiation exposure.
- Specific indications for an echocardiogram include:
- Symptoms like chest pain, shortness of breath, heart murmurs, or suspected heart failure
- Monitoring known heart conditions, such as aortic stenosis or aortic regurgitation, as outlined in the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease 1
- Evaluating the effectiveness of cardiac treatments
- Screening patients with risk factors for heart disease Different types of echocardiograms include:
- Transthoracic (standard)
- Transesophageal (more detailed)
- Stress echocardiograms (to assess heart function during exercise) No special preparation is typically needed for a standard echocardiogram, though patients may need to fast before certain specialized versions of the test. The decision to order an echocardiogram should be based on the patient's clinical presentation and medical history, with the goal of improving morbidity, mortality, and quality of life outcomes, as emphasized by the European Association of Cardiovascular Imaging recommendations 1.
From the Research
Echocardiogram Ordering
An echocardiogram is ordered for various reasons, including:
- To rule out a diagnosis (38.2%) 2
- To evaluate cardiac function and hemodynamics in patients with coronary artery disease and acute myocardial infarction 3
- To assess left ventricular systolic function, diastolic function, and myocardial and coronary perfusion in patients with chest pain or dyspnea 3
- To evaluate valvular heart disease, particularly when there is a mismatch between resting transthoracic echocardiography findings and symptoms during activities of daily living 4
- To detect impaired left ventricular performance, regional wall abnormalities, and other signs of coronary artery disease 5
- To diagnose heart failure with preserved ejection fraction (HFpEF) and distinguish it from other clinical conditions 6
Common Indications
Some common indications for ordering an echocardiogram include:
- Acute chest pain or dyspnea
- Suspected coronary artery disease or myocardial infarction
- Valvular heart disease
- Heart failure with preserved ejection fraction (HFpEF)
- Evaluation of cardiac function and hemodynamics in patients with various cardiac conditions
Physician Perceived Impact
Physicians perceive echocardiography as having a significant impact on patient management, with: