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← Section I · Physical Principles, Instrumentation, Examination Principles
I.O

Place (Role) of Echocardiography

3 cards

Notes

Choosing an echo modality

  • TTE (transthoracic) - first line for nearly all cardiac questions.
  • TEE - superior for LAA thrombus, small (< 3 mm) structures, aortic dissection, prosthetic MV, native/prosthetic endocarditis, intra-op guidance, structural interventions.
  • Stress echo - obstructive CAD, myocardial viability (dobutamine), functional MR/AS assessment.
  • Contrast echo - LV opacification when ≥ 2 of 6 basal or mid segments are poorly visualized; RH bubble study for shunt detection; myocardial perfusion in select centers.
  • 3D echo - mitral prolapse mapping, prosthetic dehiscence, structural intervention guidance.
  • Handheld / POCUS - bedside triage: pericardial effusion, gross LV function, IVC - not a substitute for a comprehensive study.

Appropriate use

  • Society-defined appropriate-use criteria (AUC) guide referral. Reduces unnecessary imaging.
  • Echo is often first-line because it is non-invasive, radiation-free, portable, and dynamic.

Complementary role

  • Echo complements cMRI (superior tissue characterization, cardiomyopathy typing), CT (coronary anatomy, aortic dimensions), nuclear (perfusion), and invasive hemodynamics.

Cards

  • basicI.O-001
    When should IV contrast be used for LV opacification?
    → When ≥ 2 of 6 basal or mid LV segments are poorly visualized on standard imaging (per ASE guidelines).
  • basicI.O-002
    First-line echo modality for suspected LAA thrombus prior to cardioversion?
    → TEE. TTE cannot reliably visualize the LAA.
  • basicI.O-003
    When is handheld / point-of-care echo (POCUS) appropriate?
    → Bedside triage of pericardial effusion, gross LV function, and IVC assessment. Not a substitute for a comprehensive study.