Feature | April 08, 2013

Transesophageal Echocardiograms on Patients With Known Clots May Be Overused

The American Society of Echocardiography releases list of “Five Things Physicians and Patients Should Question”

Transesophageal Echocardiogram

April 8, 2013 — The American Society of Echocardiography (ASE) has released a list of five interventions whose appropriateness physicians and patients should discuss as part of Choosing Wisely, an initiative of the ABIM Foundation, along with Consumer Reports. Fifth on the list, they ask that patients and their doctors talk about the real need for a transesophageal echocardiography (TEE) if the patient’s clot treatment is not likely to be modified.


Avoid TEE to detect cardiac sources of embolization, if a source has been identified and patient management will not change.


TEE involves taking echo pictures from within the body to allow the imaging device to be placed directly next to the heart, so the quality of the images is enhanced and allows for identification of possible sources of a stroke including blood clots within the heart. Placing the imaging probe into the mouth and then advancing it into the esophagus of the patient on whom it is performed, is not without risk. In order to do this safely and comfortably, sedatives are administered and a local anesthetic is gargled in the mouth. Both the administration of these medications and placing of the probe in the esophagus are not entirely benign procedures, and, while complications rarely occur, there is a possibility of damage to the esophagus and choking or aspiration. Because of these risk factors, the procedure should only be done when the care of the patient will possibly change based upon the result.


When clots are thought to be the cause of a stroke and their source has been identified, blood thinners are usually started to prevent a second stroke. In some cases, doctors make the decision to use blood thinners such as warfarin or Coumadin even when there is no definite clot found. In other cases, these blood thinners are contraindicated due to a problem with bleeding. In both of these scenarios, further information about the cardiac source would not change the treatment thus even the small risk of the TEE is not justified.


For more information: www.choosingwisely.org, www.asecho.org


Related Content

ASE, guideline, holes in the heart, imaging strategies, cardiovascular ultrasound, echocardiography
News | Cardiovascular Ultrasound| July 31, 2015
The American Society of Echocardiography (ASE) released a new document describing various imaging strategies for...
Mercy Hospital Joplin, Toshiba, Aplio 300 Platinum ultrasound, tornado disaster
News | Ultrasound Imaging| July 30, 2015
After a tornado decimated the hospital only four years ago, Mercy Hospital Joplin in Joplin, Missouri, reopened its...
Epsilon Imaging, EchoInsight, ASE 2015, cardiac ultrasound image analysis
News | Cardiovascular Ultrasound| July 29, 2015
Epsilon Imaging Inc. announced that several studies were presented at the American Society of Echocardiography (ASE)...
Konica Minolta, Blue Moon Lifecycle Solutions, ultrasound, Sonimage, P3, HS1

Sonimage HS1 image courtesy of Konica Minolta

Technology | July 15, 2015
Konica Minolta Medical Imaging announced new Blue Moon Lifecycle Solutions designed to help customers minimize downtime...
Mindray, TE7 Touch Enabled Ultrasound System, point of care, POC
Technology | July 14, 2015
Mindray announced the release of its TE7 Touch Enabled Ultrasound System, which supports rapid and confident evaluation...
Accuro, handheld ultrasound, Rivanna Medical, spinal anesthesia guidance, FDA

Accuro image courtesy of Rivanna Medical

Technology | July 14, 2015
Rivanna Medical announced that it has received U.S. Food and Drug Administration (FDA) 510(k) clearance to market...
ASE, echocardiography, hypertension, document, EACVI, JASE, Thomas H. Marwick
Feature | Cardiovascular Ultrasound| July 07, 2015
A new document from the American Society of Echocardiography (ASE) provides detailed guidance for clinicians on how to...
Feature | Cardiovascular Ultrasound| July 07, 2015 | Dave Fornell, DAIC Editor
Here are a few observations on cardiovascular ultrasound advances I made while attending the 2015 American Society of...
Videos | Cardiovascular Ultrasound| June 29, 2015
Interview at the American Society of Echocardiography (ASE) annual meeting with Federico Asch, M.D., M.D., FACC, FASE
Feature | Cardiovascular Ultrasound| June 29, 2015 | Jon Brubaker, RCVT, MBA; Clinical Analyst, MD Buyline
The American Society of Echocardiography (ASE) Annual Scientific Sessions is the premier echocardiographic professional...
Overlay Init