The Purple Book

ECHO (Echocardiography)

Triaging inpatient ECHO's

CHEST PAIN

• ✘ Evaluation of cardiac chest pain with a normal ECG, no murmur and negative cardiac biomarkers
• ☛ Following confirmed AMI to assess infarct size, LV function and complications
• ☛☛ Murmur following a recent myocardial infarction
• ☎ Chest pain with haemodynamic instability
• ☎ Assessment of suspected type I aortic dissection often in conjunction with cross-sectional imaging

SUSPECTED HEART FAILURE

• ☛☛ Patients admitted for suspected heart failure commenced on inpatient treatment
• ☎ Cardiogenic shock as judged by an appropriately senior clinician
• ☎ Return of circulation following cardiac arrest

SYNCOPE

• ✘ No murmur detected or documented malignant arrhythmias
• ✘ Vaso-vagal or situational syncope
• ☛☛ Murmur detected clinically
• ☛☛ Arrhythmia-associated syncope
• ☛☛ Significantly abnormal ECG e.g. LBBB, RBBB or LVH

ARRHYTHMIAS

• ✘ Fast AF without hypotension or suspicion of structural heart disease
• ✘ Symptomatic ectopics (defer to outpatient following Holter monitoring)
• ☛☛ Arrythmia associated with hypotension
• ☛☛ VT or VF

SUSPECTED OR ESTABLISHED PULMONARY EMBOLISM

• ✘ Asymptomatic or minimally symptomatic patient post therapy for CTPA confirmed Pulmonary Embolism
• ✘ Pre-discharge to evaluate for features of persisting right ventricular overload in clinically stable patients (defer to 3 months)
• ☛☛ Re-evaluation where cardiovascular compromise or symptoms persist following initial therapy
• ☎ To establish right heart function in clinically unstable patients to facilitate therapy decisions