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Guidance For Specific Conditions


Atrial fibrillation:

Patients with Atrial Fibrillation should have an ECHO to determine whether structural heart disease is present. Further ECHOs are not needed without a change in the clinical picture.

 

Assessment of Left Ventricular function:

Direct access Echocardiography is appropriate ifthere are symptoms of heart failure and the BNP is raised  but <2000 pg/ml  (please note the BNP values are age specific)

age <60 = >100pg/ml;  age 60-75 = >200pg/ml; age >75 = >400pg/ml.

If the BNP is greater than 2000pg/ml or the patient has had a previous myocardial infarction please refer to the Rapid Access Heart Function Clinic

 The Assessment of LV function with an ECHO is not appropriate if:

  • If the BNP is normal
  • There are minor radiographic cardiomegaly without a raised BNP
  • If other imaging modality shows normal function ( eg prev. echo, ventriculogram, MIBI, MRI)
  • (without a change in clinical picture of without additional evidence of structural heart disease)
  • For routine surveillance– unless there is a change in the clinical picture

 

Murmurs/Valve lesions/aortic root dimensions:

Innocent murmurs do not routinely need ECHO evaluation without additional evidence of structural heart disease(eg on history/exam/ECG/CXR)

Re-evaluation of murmur with a previously normal echois not necessarywithout a change in clinical picture

Routine surveillance of mild regurgitation is not necessary with an otherwise structurally normal heart

The timing of routine surveillance of other valve lesions/aotic root dimensions should be dictated by a cardiologist. 

For patients whose clinical status precludes intervention reassessment is not usually appropriate.

 

Prosthetic Valve lesions:

The cardiologists will determine the frequency of survelliance ECHOs.

Repeat ECHOs should not be requested in advance of this timescale unless there is a change in the clinical picture.

Repeat assessment in patients whose clinical status precludes re-intervention are not appropriate.

 

Congenital heart disease:

ECHOs should not be requested unless recommended by a cardiologist 

 

Pericardial effusion:

Routine surveillance of small, non haemodynamically significant  pericardial effusion is not necessary. The monitoring of larger effusions will be dictated by the cardiologists.

 

Preoperative assessment:

ECHOs are not routinely required for non high risk surgery unless there is evidence of structural heart disease on history/examination/ECG/CXR

ECHOs are not routinely required in known valvular disease if there is a previous echo cwithin time interval as recommended by RCHT guidelines/cardiologist unless there is a change in the clinical picture.

ECHOs are not routinely required for patient’s with known LV dysfunction  who have had a study within 12 months unless there is a change in the clinical picture.

 

References:

RCHT  cardiology follow up policy 2014

ESC  guidelines on non cardiac surgery 2014

ASC  Echo Appropriateness criteria -2011

BSE Indications for echocardiography -2006

 

Date reviewed                     05/07/2021

Next review due                  05/07/2022

Sifter name                         Elizabeth Fell / Bridgitte Wesson

Contributors                        Dr Louise Melley – Assistant Specialist Cardiology RCHT

 

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