ECHOCARDIOGRAPHY
CLASS I
(1) Echocardiography is recommended for asymptomatic patients with diastolic murmurs, continuous murmurs, holosystolic murmurs, late systolic murmurs, murmurs associated with ejection clicks, or murmurs that radiate to the neck or back.
(2) Echocardiography is recommended for patients with heart murmurs and symptoms or signs of heart failure, myocardial ischemia/ infarction, syncope, thromboembolism, infective endocarditis, or other clinical evidence of structural heart disease.
(3) Echocardiography is recommended for asymptomatic patients who have grade 3 or louder midpeaking systolic murmurs.
CLASS IIa
(1) Echocardiography can be useful for the evaluation of asymptomatic patients with murmurs associated with other abnormal cardiac physical findings or murmurs associated with an abnormal ECG or chest X-ray.
(2) Echocardiography can be useful for patients whose symptoms and/or signs are likely noncardiac in origin but in whom a cardiac basis cannot be excluded by standard evaluation.
CLASS III
(1) Echocardiography is not recommended for patients who have a grade 2 or softer midsystolic murmur identified as innocent or functional by an experienced observer.
JACC Vol. 52, No. 13, 2008
September 23, 2008: e1-142