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Echocardiology Utilization

Guidelines for utilization of cardiac echo in MGH inpatients with stroke/TIA.

Prior to making any medical decisions, please view our disclaimer.

Echo Not Needed Outpatient Echo Justified if Performed Within 7-10 Days After Discharge

Inpatient Echo Necessary
Established atrial fibrillation, with previous cardiac workup

(Note: for new atrial Fibrillation or new congestive heart failure: obtain a Cardiology consultation - they will determine the need for an inpatient echo)
Patient in whom stroke treatment will not change regardless of the echo result, however, echo still needed for assessing recurrent stroke risk

(Note: Date and time of echo appointment must be clearly indicated in the discharge summary. Echo should be performed before the scheduled appt. in the outpatient stroke clinic. If the patient is being discharged to another facility, the resident and primary care physician should arrange to be notified of echo results by telephone or E-mail.)

Multiple arterial territory stroke on brain imaging
Typical lacunar stroke, without concern for other mechanism

Evidence for systemic venous clots or emboli
Documented severe parent vessel stenosis (e.g. severe ipsilateral ICA stenosis; vertebral artery stenosis and PICA infarct)

Stroke within 3 months after myocardial infarction, or new EKG changes
Stroke clearly associated with a non-cardiac interventional procedure

Suspicion for cardiomyopathy or congestive heart failure
Carotid or vertebral artery dissection Suspicion for infective endocarditis (fever, risk factors such as IVDA) or non-infective endocarditis (cancer, DIC, elevated ESR, positive antiphospholipid antibodies)

Stroke from CNS vasculitis High suspicion for ASA/PFO, e.g. embolic appearing stroke in a patient with DVT/PE, high risk for DVT, known hypercoagulable state, age < 55, or migraine- associated stroke (Bubble study should be performed for these indications)

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The MGH Neurology Department placed 4th in US News Neurology / NeuroSurgery rankings for 2013-14.

Educational Video

Still from the Stroke Evaluation simulation

This video simulation of an Emergency stroke evaluation illustrates the care of patients with acute stroke by the MGH Acute Stroke team.