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Home | Articles | Cardiac | Indications for Echocardiography

Indications for Echocardiography

Last updated 18th January 2024

Indications for Inpatient Echocardiography (based on BSE guidelines)

Appropriate triage categorization is dependent on accurate information being given in the request form. Inadequate information may lead to delay.

Category 1 (Emergency, to be done immediately)

  1. Likely acute pericardial tamponade (following interventional procedure including intracardiac catheter or pacing manipulation)
  2. Likely acute (massive) pulmonary embolism to inform a decision regarding thrombolysis
  3. ·Suspected aortic dissection

Category 2 (Result likely to change immediate management, to be done within 24 hours. Priority within that time to be discussed)

  1. Detection of high-risk complications of infective endocarditis where patient is haemodynamically unstable.
  2. Murmur following acute or recent myocardial infarction where papillary muscle rupture or ventricular septal rupture suspected
  3. Persistent hypotension of unknown cause, patient haemodynamically unstable and not responding to intensive care
  4. Suspected pericardial tamponade
  5. Suspected pericardial effusion or bleeding (including after serious chest trauma)
  6. Suspected heart failure with an NT-proBNP >2000

Category 3 (IP echo indicated, but not urgent)

  1. Clinically unstable arrhythmia
  2. ? Infective endocarditis – Staphylococcus aureus bacteraemia (SAB) positive blood culture.  Persistent bacteraemia of unknown source WITH a high clinical suspicion (meeting Dukes criteria).  Fever with no other positive Dukes criteria is not indicated routinely.
  3. Stroke with confirmed AF
  4. Confirmed acute myocardial infarction (STEMI and NSTEMI). Evaluation of cardiac chest pain with a normal ECG, no murmur or negative cardiac biomarkers is not indicated routinely.  
  5. Suspected heart failure and commenced on treatment. Have you done an NT-proBNP?
  6. Suspected cardiac syncope WITH significantly abnormal ECG +/- a murmur. Vaso-vagal or situational syncope is not indicated routinely.

Category 4 (Echo indicated but does NOT need as inpatient, request as routine outpatient)

  1. Incidental finding of a murmur during admission
  2. New AF in a clinically stable patient
  3. Review of known valve disease in an asymptomatic patient
  4. Minor cardiomegaly on CXR in absence of cardiac symptoms is not routinely indicated
  5. Suspected heart failure with a borderline NT-proBNP

Please note these are guidelines, if patient falls outwith these categories please contact the echo-cardiographers in Clinical Physiology department to discuss. 

Content updated by Hayley Birrell