Pre-operative 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 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.pdf (scot.nhs.uk) (NHS Highland intranet access required)