Pre-operative indications for echocardiography

Warning

Audience

  • All NHSH 
  • Secondary Care only 
  • Adults only 

 

Preoperative indications for echocardiography

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Notes

  • Abnormal ECG 
    LBBB, LVH with strain (anterolateral ST depression +/- T inversion) or pathological Q waves are predictive of LVSD. 
    If there has been no change in 12-lead ECG Since the last echo, a clinically relevant change in LV function is very unlikely.  
  • Newly detected AF 
    Preoperative echo is not routinely indicated, if there are no symptoms or signs of heart failure
  • Biomarkers
    Hs-cTnI or NT-proBNP can be measured in high-risk cases to stratify the risk of perioperative death and CV complications 
  • Valves 
    Echo surveillance interval depends on severity of valve disease on last echo; at discretion of cardiology/echo department.  

Simple congenital1

  • Eg: surgically repaired ASD and VSD with normal post-op echo.

Complex congenital2

  • More complex congenital cardiac pathology such as Tetralogy of Fallot or Transposition of the great arteries. 
  • Suggest discussion with Cardiologist in this patient group if Consultant Anaesthetist has concerns. 

Surgical risk estimate according to type of surgery or intervention 

Low-risk: < 1% Intermediate-risk: 1 to 5%  High-risk: > 5%
  • Superficial surgery
  • Breast 
  • Dental
  • Endocrine: thyroid
  • Eye
  • Reconstructive 
  • Carotid: asymptomatic (CEA or CAS) 
  • Gynaecology: minor
  • Orthopaedic: minor (meniscectomy)
  • Urological: minor (TURP) 

 

  • Intraperitoneal splenectomy, hiatal hernia repair, cholecystectomy
  • Carotid: symptomatic (CEA or CAS)
  • Peripheral arterial angioplasty
  • Endovascular aneurysm repair 
  • Head and neck surgery 
  • Neurological or orthopaedic: major (hip and spine surgery) 
  • Urological or gynaecological: major 
  • Renal transplant 
  • Intra-thoracic: non-major 

 

  • Aortic and major vascular surgery 
  • Open lower limb revascularisation or amputation or thromboembolectomy 
  • Duodeno-pancreatic surgery 
  • Liver resection, bile duct surgery 
  • Oesophagectomy 
  • Repair of perforated bowel
  • Adrenal resection 
  • Total cystectomy
  • Pneumonectomy 
  • Pulmonary or liver transplant 
  • Surgical risk estimate is a broad approximation of 30-day risk of cardiovascular death and myocardial infarction that takes into account only the specific surgical intervention, without considering the patient's comorbidities.
  • Sourced from ESC/ESA guidelines on non cardiac surgery: cardiovascular assessment and management and adapted from Grace et al.

Echocardiography request form

Echocardiography Request Form.pdf (scot.nhs.uk) (NHS Highland intranet access required)

ABBREVIATIONS

Abbreviation  Meaning 
ASD  atrial septal defect 
CAS  carotid 
CEA  carotid endarterectomy 
CXR  chest x-ray
CVD  cardiovascular disease 
ECG  echocardiogram 
Hs-cTnI high sensitivity cardiac troponin I
LBBB left bundle branch block
LVH  left ventricular hypertrophy 
LVSD  left ventricular systolic dysfunction 
NT-proBNP n-terminal pro b-type natriuretic peptide 
VSD  ventricular septal defect 

 

Editorial Information

Last reviewed: 14/03/2024

Next review date: 31/03/2027

Author(s): Anaesthetic Department .

Version: 1.1

Reviewer name(s): Christopher Attwood, Senior Echocardiographer .

Document Id: TAM627

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