Transthoracic Echocardiogram Denial Guidelines

Clinical Indications for TTE

• The European Association of Cardiovascular Imaging guidelines indicate that TTE is primarily indicated for patients with suspected heart failure with dyspnea, valvular heart disease with symptoms, abnormal cardiac examination findings, or hemodynamic instability 1, 2, 3, 4, 5
• The European Association of Cardiovascular Imaging recommends TTE for patients with symptoms such as dyspnea on exertion, chest discomfort, or palpitations 1, 2
• Patients with stable vital signs, no murmurs, and no signs of heart failure may not require TTE 1, 2, 3, 5

Diagnostic Approach for Asymmetric Edema

• For patients with asymmetric lower extremity edema without cardiac symptoms, duplex ultrasound of lower extremities to evaluate for venous insufficiency or deep vein thrombosis may be a more appropriate diagnostic approach 6
• The European Association of Cardiovascular Imaging suggests that TTE may not be necessary for patients with minimal symptoms and a normal cardiac examination 1, 2, 5

Potential Exceptions to TTE Denial

• The European Society of Cardiology guidelines suggest that expedited TTE may be warranted if the patient develops new onset dyspnea, cardiac murmurs, arrhythmias, signs of acute heart failure, or significant worsening of edema with systemic symptoms 1, 2, 3, 5