Appropriate TTE -
♥ Initial evaluation of HF based on Signs/Symptoms/Test results
♥ Known HF with decompensation without a clear precipitant
♥ To guide therapy eg Candidate for ICD etc. Inappropriate TTE -
♥ Known HF with decompensation due to a clear precipitant (eg dietary or medication non-compliance)
♥ Routine surveillance of LV function in a patient who had a TTE within the past year
1. Diagnosis of endocarditis (either native or prosthetic valve) Appropriate TTE -
♥ Fever and a positive blood culture or new murmur. Inappropriate TTE -
♥ Transient fever with NO bacteremia or new murmur.
♥ Transient bacteremia from a documented non-endovascular source or infection (eg UTI, skin abscess). 2. Follow up of known endocarditis Appropriate TTE -
♥ Patient at high risk of developing a complication (eg abscess) or clinical status changes (eg heart failure, heart block). Inappropriate TTE -
♥ Routine surveillance of a vegetation when patient management will not change.
Rule out cardiac causes of light headedness or syncope Appropriate TTE -
♥ Patient with actual syncope or clinical symptoms and signs suggestive of a cardiac cause of lightheadedness (eg murmur or aortic stenosis or hypertrophic cardiomyopathy or signs/symptoms of heart failure). Inappropriate TTE -
♥ Patient did not have actual syncope (ie no loss of consciousness) and has no other symptoms or signs of cardiac disease.
Cardiac Murmur or known Valvular Disease Appropriate TTE -
♥ Reasonable suspicion of valvular disease on exam (eg diastolic murmur, murmur 3/6, other findings on exam).
♥ Known valvular disease with a change in clinical status (eg HF, syncope) on cardiac exam.
♥ No change in cardiac exam or clinical status with known mild stenosis/regurgitation with a TTE within 3 years; or moderate/severe stenosis/regurgitation within the past year. Inappropriate TTE -
♥ No change in cardiac exam or clinical status, prior TTE did not reveal valvular disease.
♥ Known trace regurgitation, mild stenosis/regurgitation with TTE within 3 years or moderate/severe stenosis/regurgitation with a TTE within the past year.
♥ No other symptoms or signs of disease on exam (eg benign flow murmur).
Appropriate TTE -
♥ Unexplained TIA/stroke without evidence of cerebrovascular disease and in whom a clinical therapeutic decision (eg anticoagulation or cardiac intervention) will depend on the results of echocardiography.
♥ TIA/stroke concurrent with a cardiac ischemic event or systemic emboli event.
♥ Suspected infective endocarditis or cardiac mass. Inappropriate TTE -
♥ A known cause of cardiac source already exists and TEE would not change management. This may include known cardiac arrhythmia (eg atrial fibrilation), low left ventricular ejection fraction, significant congestive heart failure, or known cardiac thrombus or valvular source of emboli.
Emergent - within 24 hours - defined by:
♥ Hemodynamically unstable patients with suspected certain cardiac conditions (eg pericardial effusion with tamponade, mechanical complications, post myocardial infarction). Urgent/Semi Urgent - within 7 days - defined by:
♥ Critically ill patients that do not meet the definition of emergent, and patients with conditions that could deteriorate rapidly (eg symptomatic aortic stenosis). Scheduled/Non Urgent - within 30 days - defined by:
♥ All patients who do not fall into the previous categories (eg assessment of murmurs in asymptomatic individuals, assessment of left ventricular mass).
♥ Abbotsford Regional Hospital Address: Medical Imaging, 32900 Marshal Rd, Abbotsford, BC, V2S 0C2 Phone: 604-851-4868 Fax: 604-870-7518 ♥ Burnaby Hospital Address: Medical Imaging, 3935 Kincaid St, Burnaby, BC, V5G 2X6 Phone: 604-412-6271 Fax: 604-412-6181 ♥ Eagle Ridge Hospital Address: Medical Imaging, 475 Guildford Way, Port Moody, BC V3H 3W9 Phone: 604-469-3172 Fax: 604-469-3209 ♥ Jim Pattison Outpatient Care and Surgery Centre Address: Medical Imaging, 9750 - 140 St, Surrey, BC V3T 0G9 Phone: 604-582-4550 Loc.763939 Fax: 604-582-3766 ♥ Langley Memorial Hospital Address: Medical Imaging, 22051 Fraser Highway, Langley, BC V3A 4H4 Phone: 604-533-6405 Fax: 604-533-6456 ♥ Peace Arch Hospital Address: Medical Imaging, 15521 Russell Ave, White Rock,BC V4B 2R4 Phone: 604-535-4510 Fax: 604-535-4559 ♥ Ridge Meadows Hospital Address: Medical Imaging, 11666 Laity St, Maple Ridge, BC V2X 5A3 Phone: 604-463-1849 Fax: 604-466-7939 ♥ Royal Columbian Hospital Address: Nuclear Medicine/Medical Imaging, 330 E. Columbia St., New Westminster, BC V3L 3W7 Phone: 604-520-4244 Fax: 604-520-4803 ♥ Surrey Memorial Hospital Address: Medical Imaging, 13750 96th Ave, Surrey, BC V3V 1Z2 Phone: 604-582-4550 Loc.763939 Fax: 604-582-3766
♥ Plan to arrive 15 minutes early to give yourself adequate time for parking.
♥ An interpreter must accompany patients who do not speak fluent English or exam may be cancelled.
♥ Children and other third parties are not permitted in the examination room. Please ensure that children under the age of 12 have someone to look after them during your exam or we will not be able to do your exam.
**Please bring your Care Card, WorkSafe BC or ICBC information and Photo Identification**