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• Guidelines for the clinical application of echocardiography have been formulated by the American College of Cardiology and the American Heart Association in collaboration with the American Society of Echocardiography.

Cardiovascular Disease in the Newborn

  • • To monitor normally occurring physiologic changes during the transitional circulation of the newborn.

    • Helps define structural anomaly, if present.

    • Helps determine hemodynamics and ventricular function.

    • To assess the presence and degree of pulmonary artery hypertension in premature infants with respiratory failure related to lung disease.

    • Doppler echocardiography can show ductal patency as well as amount and direction of shunting.

    • Cyanosis in newborns without evidence of severe lung disease but whose chest radiograph, ECG, and extremity blood pressures are abnormal.

    • Arrhythmias, nonimmune hydrops, and sepsis.

    • Chromosomal abnormalities and certain extracardiac anomalies.

Murmurs in Infants and Children

  • • Innocent heart murmurs do not warrant echocardiography.

    • • Still’s murmur.

      • Flow murmur of the pulmonary artery.

      • Peripheral pulmonic stenosis.

      • Supraclavicular murmur.

      • Systolic flow murmur.

    • Maintain low threshold for obtaining echocardiogram in children with a murmur and abnormal results on accompanying studies (eg, ECG, chest radiograph).

    • Diastolic murmur or gallop.

Acquired Heart Disease

  • • Examples include Kawasaki disease, rheumatic fever, myocarditis, and endocarditis.

    • Provides important information regarding the following:

    • • Chamber sizes.

      • Valve and ventricular function.

      • Pericardial involvement.

      • Presence of intracardiac masses.

    • Can also be used for serial evaluation throughout the disease process and to determine whether therapy is effective.

Systemic Disease

  • • To evaluate patients with connective tissue diseases, such as Marfan syndrome and Ehlers-Danlos syndrome, which are associated with valve prolapse, aortic root dilation, and dissection.

    • To assess ventricular function in patients with certain neuromuscular disorders, such as Duchenne’s muscular dystrophy, that can affect the heart muscle.

    • To assess left ventricular hypertrophy and dysfunction in children with chronic renal disease and long-standing systemic hypertension.

    • To obtain baseline and serial echocardiograms to assess for cardiomyopathy in patients receiving chemotherapeutic agents, which can be cardiotoxic.

    • Useful in additional disease processes including HIV, serial assessment for rejection in cardiac transplant patients, and screening of patients with a family history of cardiomyopathy.

    • Newly diagnosed thromboembolic disease.

    • • Searches for sources of thrombus and potential intracardiac shunts.

      • Routine transthoracic echocardiogram is often inconclusive and therefore, a contrast study may be necessary.

      • If either study is inconclusive, a transesophageal echocardiogram may be necessary.

Arrhythmia

  • • Determines whether there is associated structural heart disease (eg, Ebstein’s anomaly, mitral valve prolapse, and cardiac tumors).

    • Evaluates cardiac function (ie, myocarditis, cardiomyopathy).

    • If tachycardia has been present for an extended period of time, an echocardiogram may help determine whether an intracardiac thrombus is present and if ventricular ...

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