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
Version 1.1