Indications for echocardiography

1. ECHOCARDIOGRAPHY
BY MANDE SAMUEL
BDUE 2014-2016
ECUREI

2. indications
• symptoms, signs or previous tests that indicate possible structural
heart disease
● heart murmurs when associated with symptoms or when structural
heart disease is suspected, and the follow-up of those with known
significant valvular stenosis or regurgitation
● prosthetic valves (except asymptomatic patients with mechanical
valves or those in whom no further intervention would be
undertaken)
● suspected or proven infective endocarditis
● known or suspected ischaemic heart disease (e.g. diagnostic stress
echo,assessment following myocardial infarction)
● known or suspected cardiomyopathy

3. indications
• ● suspected pericarditis or pericardial effusion,
and follow-up of patients
• with known moderate or large pericardial
effusions (or small effusions
• if there has been a clinical change)
• ● suspected or possible cardiac masses (and
follow-up of patients
• following surgical excision of a cardiac mass)
• ● pulmonary disease (with cardiac involvement)
• ● pulmonary hypertension

4. indications
● thromboembolism
● neurological disorders (with cardiac involvement)
● arrhythmias (with suspected/possible structural heart
disease)
● syncope (with suspected/possible structural heart
disease)
● hypertension (if left ventricular hypertrophy
(LVH)/dysfunction or aortic coarctation are suspected)
● aortic disease (e.g. monitoring of aortic root
dimensions in Marfan syndrome)
● known or suspected congenital heart disease.

5. Standard windows and views
1) Left parasternal window
Parasternal long axis
view
(Parasternal right
ventricular (RV) inflow
view)
(Parasternal RV outflow
view)
Parasternal short axis view
2) (Right parasternal
window)
3) Apical window
Apical 4-chamber view
Apical 5-chamber view
Apical 2-chamber view
Apical 3-chamber (long axis)
view
4) Subcostal window
Subcostal long axis view
Subcostal short axis view
5) Suprasternal window
Aorta view.

6. Left parasternal window
• The left parasternal window is located to the
left of the sternum, usually in the third or
fourth intercostal space.
• From the left parasternal window a number of
views can be obtained.

7. Parasternal long axis view
• To obtain the view with the probe in the left
parasternal window, rotate the probe so that
the probe’s ‘reference point’ (sometimes a
‘dot’) is pointing towards the patient’s right
shoulder.

8. Parasternal long axis view

9. In this view:
● Use 2-D M-mode to:
Assess structure and mobility of the aortic valve. The right
and non-coronary cusps are visible and normally have a
central closure line – an eccentric closure line suggests
bicuspid aortic valve.
• measure the aortic root dimensions and inspect the
ascending aorta;do not forget to look at the descending
aorta as it runs behind the left atrium (LA) – this is a useful
landmark for assessing a pericardial/pleural effusion
• assess structure and mobility of the mitral valve – in this
view, the A2 and P2 segments are visible
• measure LA dimensions

10. • measure LV dimensions and assess function (anteroseptum
and
posterior (also known as inferolateral) wall)
• measure RV dimensions and assess function
• assess the pericardium and check for any pericardial (or
pleural) effusion.
● Use colour Doppler to:
• assess the aortic valve for stenosis or regurgitation
• examine mitral valve inflow and check for regurgitation
• check for flow acceleration in the left ventricular outflow
tract (LVOT) in association with septal hypertrophy
• check the integrity of the interventricular septum (IVS).