Booking An Echo – A Physician’s Quick Guide

Booking an Echo – A Physician’s Quick Reference Guide

Appropriate Use Criteria – Summarized

Abbreviations:             A = Appropriate       M = May Be Appropriate          R = Rarely Appropriate

If you are a physician booking an echocardiogram for the following ASE and Choosing Wisely Canada guidelines apply

  • PALPITATIONS AND ARRYTHMIAS 1 – 8

  • ECG FINDINGS 9 – 27

  • CHEST PAIN 28 – 38

  • MURMUR 39 – 41

  • OTHER SIGNS AND SYMPTOMS 42 – 48

  • PRIOR TEST RESULTS 49 – 61

  • SYSTEMIC DISORDERS 62 -87

  • FAMILY HISTORY OF CARDIOVASCULAR DISEASE 88 -104

  • OUTPATIENT NEONATES WITHOUT POST-NATAL CARDIOLOGY EVALUATION 105 -112

PALPITATIONS AND ARRYTHMIAS the following ASE and Choosing Wisely Canada guidelines apply:

  1. Palpitations with family history of cardiomyopathy A
  2. Palpitations with family history at a young age (before the age of 50 years) of sudden cardiac arrest or death and/or pacemaker or implantable defibrillator placement A
  3. Palpitations in a patient with known cardiomyopathy A
  4. Palpitations with abnormal ECG M
  5. Palpitations in a patient with known channelopathy M
  6. Palpitations with no other symptoms or signs of cardiovascular disease, a benign family history, and no recent ECG R
  7. Palpitations with no other symptoms or signs of cardiovascular disease, a benign family history, and a normal ECG R

ECG FINDINGS; the following ASE and Choosing Wisely Canada guidelines apply:

Abbreviations:             A = Appropriate       M = May Be Appropriate          R = Rarely Appropriate

  1. Supraventricular tachycardia A
  2. Ventricular tachycardia A
  3. Syncope with abnormal ECG A
  1. Syncope with family history at a young age (before the age of 50 years) of sudden cardiac arrest or death and/or pacemaker or implantable defibrillator placement A
  2. Syncope with family history of cardiomyopathy A
  3. Unexplained post-exertional syncope A
  4. Exertional syncope A
  5. PVCs after the neonatal period M
  6. PVCs in the prenatal or neonatal period M
  7. Syncope with family history of channelopathy M
  8. Unexplained pre-syncope M
  9. PACs in the prenatal or neonatal period R
  10. PACs after the neonatal period R
  11. Sinus bradycardia R
  12. Sinus arrhythmia R
  13. Syncope with or without palpitations and with no recent ECG R
  14. Syncope with no other symptoms or signs of cardiovascular disease, a benign family history, and a normal ECG R
  15. Probable neurocardiogenic (vasovagal) syncope R
  16. Syncope or pre-syncope with a known non-cardiovascular cause R

CHEST PAIN; the following ASE and Choosing Wisely Canada guidelines apply:

  1. Exertional chest pain A
  2. Non-exertional chest pain with abnormal ECG A
  3. Chest pain with family history of sudden unexplained death or cardiomyopathy A
  4. Chest pain with other symptoms or signs of cardiovascular disease, a benign family history, and a normal ECG M
  1. Chest pain with family history of premature coronary artery disease M
  2. Chest pain with recent onset of fever M
  3. Chest pain with recent illicit drug use M
  4. Chest pain with no other symptoms or signs of cardiovascular disease, a benign family history, and a normal ECG R
  5. Non-exertional chest pain with no recent ECG R
  6. Non-exertional chest pain with normal ECG R
  7. Reproducible chest pain with palpation or deep inspiration R

Abbreviations:             A = Appropriate       M = May Be Appropriate          R = Rarely Appropriate

MURMUR the following ASE and Choosing Wisely Canada guidelines apply:

 

  1. Pathologic murmur A
  2. Presumptively innocent murmur with signs, symptoms, or findings of cardiovascular disease A
  3. Presumptively innocent murmur with no symptoms, signs, or findings of cardiovascular disease and a benign family history R

 

OTHER SIGNS AND SYMPTOMS; the following ASE and Choosing Wisely Canada guidelines apply:

  1. Central cyanosis A
  2. Signs and symptoms of endocarditis in the absence of blood culture data or a negative blood culture A
  3. Symptoms and/or signs suggestive of congestive heart failure, including but not limited to respiratory distress, poor peripheral pulses, feeding difficulty, decreased urine output, edema, and/or hepatomegaly A
  4. Chest wall deformities and scoliosis pre-operatively M
  5. Unexplained fever without other evidence for cardiovascular or systemic involvement M
  6. Fatigue with no other signs and symptoms of cardiovascular disease, a normal ECG, and a benign family history R
  7. Isolated acrocyanosis R

PRIOR TEST RESULTS; the following ASE and Choosing Wisely Canada guidelines apply:

  1. Abnormal chest X-ray findings suggestive of cardiovascular disease A
  2. Genotype positive for cardiomyopathy A
  3. Desaturation based on pulse oximetry A
  4. Abnormal ECG without symptoms A
  5. Previously normal echocardiogram with a change in cardiovascular status and/or a new family history suggestive of heritable heart disease A
  6. Chromosomal abnormality known to be associated with cardiovascular disease A
  7. Positive blood cultures suggestive of infective endocarditis A
  8. Abnormal barium swallow or bronchoscopy suggesting vascular ring A
  9. Abnormal cardiac biomarkers A
  10. Chromosomal abnormality with undefined risk for cardiovascular disease M
  11. Known channelopathy M
  12. Previously normal echocardiogram with no change in cardiovascular status or family history R
  13. Elevated anti-streptolysin O titers without suspicion for rheumatic fever R

Abbreviations:             A = Appropriate       M = May Be Appropriate          R = Rarely Appropriate

SYSTEMIC DISORDERS; the following ASE and Choosing Wisely Canada guidelines apply:

  1. Prior to or during chemotherapy in cancer A
  2. Sickle cell disease and other hemoglobinopathies A
  3. Connective tissue disorder such as Marfan, Loeys Dietz, and other aortopathy syndromes A
  4. Suspected connective tissue disorder A
  5. Clinically suspected syndrome or extracardiac congenital anomaly known to be associated with congenital heart disease A
  6. Human immunodeficiency virus infection A 67
  7. Suspected or confirmed acute rheumatic fever A
  8. Stroke A
  9. Systemic lupus erythematosis and autoimmune disorders A
  10. Muscular dystrophy A
  11. Suspected pulmonary hypertension A
  12. Storage diseases, mitochondrial and metabolic disorders A
  13. Abnormalities of visceral or cardiac situs A
  14. Systemic hypertension A
  15. Renal failure A
  16. Cancer without chemotherapy M
  17. Obesity with obstructive sleep apnea M
  18. Obesity with other cardiovascular risk factors M
  19. Hepatic disorders M
  20. Failure to thrive M
  21. Unexplained sudden death before the age of 50 years M
  22. Obesity without other cardiovascular risk factors R
  23. Diabetes mellitus R
  24. Lipid disorders R
  25. Seizures, other neurologic disorders, or psychiatric disorders R
  26. Gastrointestinal disorders, not otherwise specified R

Abbreviations:             A = Appropriate       M = May Be Appropriate          R = Rarely Appropriate 

FAMILY HISTORY OF CARDIOVASCULAR DISEASE IN PATIENTS WITHOUT SIGNS OR SYMPTOMS AND WITHOUT CONRIMED CARDIAC DIAGNOSIS; the following ASE and Choosing Wisely Canada guidelines apply:

  1. Hypertrophic cardiomyopathy A
  2. Non-ischemic dilated cardiomyopathy A
  3. Other cardiomyopathies A
  4. Genetic disorder at high risk for cardiovascular involvement A
  5. Marfan or Loeys Dietz syndrome A
  6. Heritable pulmonary arterial hypertension A
  7. Connective tissue disorder other than Marfan or Loeys Dietz syndrome M
  8. Congenital left-sided heart lesion, including but not limited to mitral stenosis, left ventricular outflow tract obstruction, bicuspid aortic valve, aortic coarctation, and/or hypoplastic left heart syndrome M
  9. Congenital heart disease other than the congenital left-sided heart lesions M
  10. Idiopathic pulmonary arterial hypertension M
  11. Unexplained sudden death before the age of 50 years M
  12. Premature coronary artery disease before the age of 50 years R
  13. Channelopathy R
  14. Unspecified cardiovascular disease R
  15. Disease at high risk for cardiovascular involvement, including but not limited to diabetes, systemic hypertension, obesity, stroke, and peripheral vascular disease R
  16. Pulmonary arterial hypertension other than idiopathic and heritable R
  17. Consanguinity R

OUTPATIENT NEONATES WITHOUT POST-NATAL CARDIOLOGY EVALUATION; the following ASE and Choosing Wisely Canada guidelines apply:

  1. Maternal phenylketonuria A
  2. Maternal infection during pregnancy or delivery with potential fetal/neonatal cardiac sequelae A
  3. Suspected cardiovascular abnormality on fetal echocardiogram A
  4. Maternal diabetes with no prior fetal echocardiogram M
  5. Maternal autoimmune disorder M
  6. Maternal diabetes with a normal fetal echocardiogram M
  7. Maternal teratogen exposure M
  8. Isolated echogenic focus on fetal ultrasound R