From the Guidelines
An echocardiogram is warranted for patients experiencing symptoms such as chest pain, particularly those with suspected myocardial ischemia, non-diagnostic ECG and cardiac necrosis biomarkers, and those with underlying cardiac disease, as recommended by the most recent guidelines 1. The symptoms that warrant an echocardiogram include:
- Chest pain with suspected myocardial ischemia, non-diagnostic ECG and cardiac necrosis biomarkers
- Underlying cardiac disease, such as valvular, pericardial or primary myocardial disease
- Haemodynamic instability unresponsive to simple therapeutic measures
- Suspected acute aortic syndromes, myocarditis, pericarditis or pulmonary embolism These symptoms are based on the recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association 1, as well as the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines 1. The use of echocardiography in these cases can help diagnose conditions such as heart valve disease, cardiomyopathy, heart failure, congenital heart defects, and complications from heart attacks, and can lead to timely interventions that may prevent disease progression and improve outcomes. It's worth noting that the guidelines do not recommend echocardiography for patients with chest pain for which a non-cardiac aetiology is apparent, or for patients with a confirmed diagnosis of myocardial ischaemia/infarction 1. In terms of the diagnostic value of echocardiography, it provides real-time images of the heart's structure and function, allowing physicians to assess heart chamber size, wall thickness, valve function, blood flow patterns, and ejection fraction (how well the heart pumps blood) 1. Overall, the decision to perform an echocardiogram should be based on the individual patient's symptoms and medical history, and should be guided by the most recent and relevant clinical guidelines, such as those published in 2021 by the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines 1.
From the Research
Symptoms that Warrant an Echocardiogram (Echo)
The following symptoms may warrant an echocardiogram:
- Chest pain or discomfort at rest, which is the most common presenting symptom of acute coronary syndromes (ACS) and affects approximately 79% of men and 74% of women presenting with ACS 2
- Dyspnea (shortness of breath), which can be a symptom of ACS, especially in women, and can occur in isolation or in combination with chest pain 2
- Nonspecific symptoms such as fatigue, weakness, or dizziness, which can be associated with ACS or other cardiac conditions 2
- Symptoms suggestive of acute pulmonary embolism (APE), such as chest pain, shortness of breath, or cough, which can mimic ACS 3
- Symptoms of acute heart failure, such as shortness of breath, fatigue, or swelling in the legs, which can be precipitated by ACS 4
Clinical Scenarios that May Require an Echo
Certain clinical scenarios may require an echocardiogram, including:
- Patients with suspected ACS, especially those with high-risk features such as ST-segment elevation or depression on electrocardiogram (ECG) 2
- Patients with APE, especially those with high-risk features such as elevated troponin or ECG changes suggestive of myocardial ischemia 3
- Patients with acute heart failure, especially those with suspected ACS as a precipitant 4
- Patients with chest pain who are at low risk for ACS, but may still require further testing to rule out other cardiac conditions 5
Diagnostic Considerations
When evaluating patients with symptoms that may warrant an echocardiogram, consider the following:
- ECG findings, such as ST-segment elevation or depression, which can suggest ACS or other cardiac conditions 2, 3
- Cardiac biomarkers, such as troponin, which can be elevated in patients with ACS or other cardiac conditions 2, 3
- Imaging techniques, such as echocardiogram, which can help diagnose cardiac conditions such as ACS, APE, or heart failure 4