From the Guidelines
Echocardiograms are indicated for patients with acute chest pain, acute dyspnoea, haemodynamic instability, or new murmurs, as they provide valuable information for diagnosing and managing cardiac conditions. The European Association of Cardiovascular Imaging recommends the use of echocardiography in these situations, as outlined in their 2013 guidelines 1.
Indications for Echocardiography
- Acute chest pain: evaluation of acute chest pain in patients with suspected myocardial ischaemia/infarction and non-diagnostic ECG and cardiac enzymes, and when resting echocardiogram can be performed during the pain 1
- Acute dyspnoea: distinguishing cardiac vs. non-cardiac aetiology of dyspnoea in patients in whom clinical and laboratory findings are ambiguous 1
- Haemodynamic instability: for differential diagnosis of the cause of hypotension or shock, by detecting cardiac or non-cardiac aetiologies 1
- New murmur: in patients with cardiac murmurs and symptoms or signs of or suggestive of heart failure, myocardial ischaemia/infarction, syncope, thromboembolism, infective endocarditis, or clinical evidence of structural heart disease 1
The American College of Cardiology and American Heart Association also provide guidelines for the clinical application of echocardiography, including indications for patients with chest pain, pericardial disease, and valvular heart disease 1. However, the most recent and highest quality study is the 2013 European Association of Cardiovascular Imaging guidelines 1, which provides a comprehensive overview of the indications for echocardiography.
In clinical practice, echocardiograms are essential for monitoring patients with known heart disease, following up after cardiac procedures or surgeries, and evaluating cardiac complications from systemic diseases. They provide real-time images of the heart without radiation exposure, allowing clinicians to visualize chamber size, wall thickness, contractile function, valve structure and function, and blood flow patterns. Different types of echocardiograms may be selected based on the specific clinical question being addressed.
From the Research
Indications for Echocardiogram
The indications for an echocardiogram are varied and include:
- Evaluation of chest pain, particularly in patients with suspected coronary artery disease 2
- Diagnosis and assessment of valvular heart disease 3
- Evaluation of left ventricular function and detection of regional wall motion abnormalities in patients with ischemic heart disease 4
- Diagnosis and management of heart failure, including assessment of ventricular function and detection of structural heart disease 5
- Evaluation of patients with atypical chest pain, to identify those at risk for cardiac events 6
Specific Conditions
Echocardiography is useful in the evaluation of:
- Acute coronary syndrome, to assess ventricular function and detect regional wall motion abnormalities 2
- Myocardial infarction, to evaluate left ventricular function and detect signs of ischemia or infarction 4
- Valvular heart disease, to assess the severity of the disease and monitor its progression 3
- Heart failure, to guide treatment and monitor disease progression 5
Clinical Applications
Echocardiography has a range of clinical applications, including:
- Non-invasive assessment of cardiac function and hemodynamics 2
- Detection of cardiac structural abnormalities, such as wall motion abnormalities and valvular disease 3, 4
- Guidance of treatment in patients with heart failure 5
- Prognostic value in patients with coronary artery disease and heart failure 6, 5