Download Open Access Echo Request Wansbeck

OPEN ACCESS ECHO – WANSBECK GENERAL HOSPITAL
All sections to be completed and returned to the Cardiology Department.
NHS Number must be complete or the form will be returned. GP practice details must be clear or stamped.
Patient Details
Full Name
NHS No
GP Details
GP
Hospital No
Practice
D.O.B
Address
Postcode
Postcode
Tel No
Tel No
Clinical Details (this section must be complete)
Assessment of Cardiac (LV) Function
Typical questions asked will be…
 Why is the patient breathlessness?
 Is this heart failure?
 Is the left ventricle impaired?
 Is this oedema cardiac impaired?
 Does this breathlessness COAD patient also
have heart failure?
 Patient has had MI
How impaired is the left ventricle?
Is there a left ventricular aneurysm?

Is there evidence of intra-cardiac thrombus?
Principal Management Implications:
Accurate Diagnosis?
ACE therapy?
Warfarin – assessment of needs
Assessment of Cardiac Murmur
Typical questions asked will be…
 What is this murmur?
 Is this murmur haemodynamically important?

Is this know lesion (adversely) affecting cardiac
function?
Principal Management Implications:
Accurate Diagnosis
Referral Cardiologist?
Assessment of Cardiac Murmur
Typical questions asked will be…
 What is aetiology of atrial fibrillation?
 Do ECHO findings suggest high thrombogenic
potential?
 How severe is underlying cardiac pathology?
Principal Management Implications:
Warfarin – assessment of needs
Assessment adequacy of other Rx
Referral Cardiologist?
Send to: Open-Access ECHO, Cardiology Department, Wansbeck General Hospital,
Woodhorn Lane, Ashington, NE63 9JJ