Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Transthoracic and transoesophageal echocardiography
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
Use urgent bedside TTE for shock, suspected tamponade or major mechanical complication, but do not let imaging delay immediately necessary resuscitation or reperfusion. Suspected aortic dissection may require TOE or CT according to stability and local expertise.
Synopsis
Choose TTE or TOE for the clinical question, recognise urgent findings and interpret measurements in the context of image quality and loading conditions.
TTE is first-line for ventricular size and function, valve assessment, pulmonary-pressure estimates and pericardial fluid.
TOE places the probe near posterior cardiac structures and gives higher-resolution views of atria, valves and thoracic aorta.
A focused bedside echo answers a narrow emergency question; it is not a substitute for a complete accredited study.
Key red flags
Tamponade physiology
Pericardial effusion with right-sided chamber collapse, marked respiratory inflow variation and a plethoric IVC supports haemodynamic compromise; clinical shock determines urgency.
Investigation priorities
01
Comprehensive TTEFirst stepFirst line
First-line structural and haemodynamic assessment.
Management branches
Preferred routeNew murmur or suspected heart failure
Symptoms, signs, ECG or natriuretic peptide suggest structural disease
Request comprehensive TTE with a specific clinical question and relevant prior information.
Grade any lesion using multiple measures and relate it to ventricular response and symptoms.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.