Do you routinely order a pre-operative TTE in patients with apparently compensated CHF, but who have not had an echocardiogram in some time?

In a patient with compensated CHF (with stable symptoms), I do not routinely order pre-operative echocardiograms for evaluation of ejection fraction. There are some situations in which it may be helpful for perioperative risk assessment, counseling, and management.

The 2024 ACC/AHA (American College ...

Often

Maybe.

I agree, the ACC/AHA guidelines recommend no pre-op echo in stable HF patients with known low EF.