Ultrasound Options
Transthoracic Echocardiogram (1 hour): comprehensive evaluation of heart chambers, valves, and great vessels utilizing 2-dimensional ultrasound images and Doppler for quantification of ejection fraction, pulmonary arterial pressure, valve regurgitation and/or stenosis, etc.
• Good test for follow-up of heart valve replacement, medical management of heart failure or cardiomyopathy,
coronary artery disease, and in patients with other conditions or receiving treatment that may affect their cardiovascular health (i.e., autoimmune disorders, chemotherapy).
Transesophageal Echocardiogram (2 hours): cardiac ultrasound images are obtained from a small ultrasound probe on the end of an endoscopic instrument that is passed down the esophagus while the patient is under conscious sedation.
• Superior image quality is made possible due to the close proximity of the esophagus to the heart structures.
• This test is preferred for close evaluation of heart valves when endocarditis or prosthetic valve dysfunction is suspected, for clear delineation of anatomy in patients with congenital heart defects or for a suspected cardiac source of embolism.
Bilateral Carotid Artery Duplex (1 hour): Ultrasound images with Doppler flow evaluation of all the major extracranial arteries, including the common carotid, internal and external carotid, vertebral and subclavian arteries if indicated.
• Common indications may include but are not limited to carotid bruit, source of embolism following transient ischemic attack or cerebrovascular accident, and follow-up of endarterectomy.
Abdominal Aortic Ultrasound(1 hour): Ultrasound images and measurements are obtained by imaging through
the anterior abdomen.
• Test requires the patient to fast for at least four hours and is best if scheduled in the early morning due to interference with bowel gas.
• Indications include family history of aneurysm, follow-up known AAA, pulsatile/palpable aorta on examination, and multiple risk factors for aneurysm.
• Medicare has approved a screening AAU for patients over 65 years of age with certain risks as part of their welcome to Medicare physical.
Renal Artery Doppler(1 hour): Comprehensive Doppler evaluation of renal artery blood flow, images obtained from the anterior abdomen and both flanks.
• This test requires the patient to fast for at least four hours, preferably overnight, and is scheduled as early in the morning as possible due to interference from bowel gas.
• Appropriate indications include refractory hypertension and abdominal bruit upon auscultation.
Peripheral Arterial Physiologic Testing (1 hour): Comprehensive evaluation of either the upper or lower extremity arterial system for symptoms of limb pain or signs of diminished blood flow).
• Testing may include ankle-brachial indices, Doppler waveform evaluation, segmental pressures, pulse volume recordings, and exercise ankle-brachial indices.
Peripheral Venous Physiologic Testing (1 hour): Evaluation of outflow of blood from the venous system in the upper or lower extremities, along with evaluation for venous reflux or chronic venous insufficiency using air plethysmography.
Venous Duplex (1 hour): Ultrasound imaging of the upper or lower extremity venous system to rule out deep
venous thrombosis or to evaluate for chronic venous insufficiency.
• Appropriate indications are acute unilateral extremity swelling accompanied with pain and redness, or chronic bilateral extremity swelling.
Arterial Vasospastic Maneuver (1 hour):Test involves blood pressures and temperature readings of the upper extremity digits before and after exposure to extreme cold.
• This test is helpful with the diagnosis of vasoconstriction in patients who experience symptoms associated with Raynaud’s phenomenon (intermittent cyanosis or pallor of the digits following cold or emotional distress.
Thoracic Outlet Testing (1 hour):Evaluation of arterial flow in the patient’s extremities, in various positions, associated with thoracic outlet syndrome.
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These are general rules to assist you in ordering tests for your patients. For more information, please see the web sites for the American College of Cardiology at www.acc.org, or the American Heart Association at http://www.americanheart.org/.