Indications for Emergent Transthoracic Echocardiogram within the UW System

1.     Suspected mechanical complication after MI

2.     Suspected aortic dissection with equivocal CT (usually go straight to a TEE but can check TTE while waiting for attending to come in)

3.     Suspected acute native or prosthetic valve dysfunction

4.     Cardiac transplant donor

5.     Suspect purulent pericarditis. 

6.     Suspected direct cardiac trauma, acute-hemodynamically significant valve dysfunction, etc.

7.     Suspected tamponade

8.     A CT surgery or cardiology fellow/attending request

9.     When warranted by other clinical circumstances (e.g. they really want it) 

Echocardiographic Signs of Tamponade

1.     It’s a clinical diagnosis, so look at the patient!  Make the primary team check a pulsus.

2.     Right atrial collapse in late diastole: sensitive, but not specific

3.     Right ventricular collapse in early diastole: sensitive for tamponade unless RV pressures are significantly elevated or pericardial effusion is focal (post-op)

4.     Left atrial collapse in diastole.

5.     Inspiratory decrease in mitral inflow > 20% or expiratory decrease in tricuspid inflow > 40%.

6.     Failure of inspiratory collapse of the IVC by more than > 50% is very sensitive, but not specific. 

MEASUREMENT REFERENCES