From the Guidelines
A transthoracic echocardiogram (TTE) is recommended for patients with chest pain when there is suspicion of cardiac causes, particularly when other initial tests like ECG and cardiac enzymes are inconclusive. This recommendation is based on the most recent and highest quality study, which emphasizes the importance of prompt TTE in acute chest pain settings to evaluate for wall motion abnormalities, valvular dysfunction, pericardial effusion, or aortic dissection 1. The test is non-invasive, using ultrasound to visualize heart structures and function, taking approximately 30-45 minutes to complete. Patients should expect to lie on their left side while a technician applies gel and moves a transducer across the chest. No special preparation is needed, though fasting for 4 hours may improve image quality.
Key Indications for TTE in Chest Pain
- Evaluation of acute chest pain in patients with suspected myocardial ischemia, non-diagnostic ECG, and cardiac necrosis biomarkers 1
- Evaluation of patients with underlying cardiac disease (valvular, pericardial, or primary myocardial disease) 1
- Evaluation of patients with chest pain and hemodynamic instability unresponsive to simple therapeutic measures 1
- Evaluation of chest pain in patients with suspected acute aortic syndromes, myocarditis, pericarditis, or pulmonary embolism 1
Benefits of TTE in Chest Pain
- Provides crucial information to guide treatment decisions for patients presenting with chest pain 1
- Allows for the assessment of CAD risk and may help to guide clinical decision-making 1
- Can visualize and aid in the differential diagnosis among the numerous causes of acute chest pain, such as acute aortic dissection, pericardial effusion, stress cardiomyopathy, and hypertrophic cardiomyopathy 1
Limitations of TTE in Chest Pain
- May have limitations in visualizing certain structures and may be affected by body habitus 1
- Should not delay the initiation of treatment, and the performance of echocardiography should be prompt and efficient 1
From the Research
Transthoracic Echo for Chest Pain
- Transthoracic echocardiography (TTE) is a valuable non-invasive tool that can help in diagnosing and treating patients presenting with chest pain 2.
- National Institute for Health and Care Excellence (NICE), European Society of Cardiology (ESC) and American Heart Association (AHA) guidelines state that echocardiography can help in the diagnosis of acute coronary syndromes and also in ruling out other serious conditions 2.
- TTE is essential in assessing patients with chest pain, making the correct diagnosis and offering the right treatment 2.
Role of Urgent Transthoracic Echocardiography
- Urgent transthoracic echocardiography can be used to evaluate patients presenting with acute chest pain, and can help identify conditions such as acute coronary syndrome, pulmonary embolism and aortic dissection 3.
- Two-dimensional echocardiography is a safe, painless and rapid test that can be performed in the Emergency Department to ensure a correct diagnosis and identify other complications 3.
Optimal Triage of Patients with Acute Chest Pain
- Transthoracic echocardiography represents the first-line imaging modality for evaluating patients with acute chest pain due to its bedside feasibility, non-invasiveness, and wide availability 4.
- A practical approach to acute chest pain in the Emergency Department should improve patient outcomes and reduce healthcare system costs 4.
Clinical Imaging in Patients Experiencing Chest Pain
- Transthoracic echocardiography is the first-line imaging tool for patients admitted to the emergency department for chest pain, as it is rapidly and widely available, bedside feasible and cost-effective 5.
- Contrast enhanced computed tomography and cardiac magnetic resonance can also be used in specific cases, such as suspected pulmonary embolism or acute coronary syndrome, according to the pre-test risk assessment and clinical status 5.