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Cardiology


If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

Chest pain (adult)

  • Suspected acute coronary syndrome
  • Suspected pulmonary embolism or aortic dissection
  • Suspected or confirmed endocarditis, myocarditis or pericarditis
  • Suspected ischaemic chest pain within 24 hours with any of the following concerning features:
    • severe or ongoing chest pain
    • chest pain lasting ten minutes or more
    • chest pain that is new at rest or with minimal activity
    • chest pain that is associated with severe dyspnoea
    • chest pain that is associated with syncope / pre-syncope
    • chest pain that is associated with any of the following signs:
      • respiratory rate > 30 breaths per minute
      • tachycardia >120
      • systolic BP < 90mmHg
      • heart failure / suspected pulmonary oedema
      • ST elevation or depression
      • complete heart block
      • new left bundle branch block 

 Atrial fibrillation

  • Atrial fibrillation / flutter with any of the following concerning features:
    • haemodynamic instability
    • shortness of breath
    • chest pain
    • syncope/pre syncope/dizziness
    • known Wolff-Parkinson-White
    • neurological deficit indicative of TIA/stroke

 Chest pain (paediatric)

  • Current chest pain with haemodynamic compromise
  • Acute onset chest pain from a potential cardiac cause

Heart failure

  • Acute or chronic heart failure with any of the following concerning features:
    • NYHA Class IV heart failure
    • ongoing chest pain
    • increasing shortness of breath
    • oxygen saturation < 90%
    • signs of acute pulmonary oedema
    • haemodynamic instability:
      • pre-syncope / syncope / severe dizziness
      • altered level of consciousness
      • heart rate > 120 beats per minute
      • systolic BP < 90mmHg
    • significant pulmonary or pedal oedema
    • recent myocardial infarction (within 2 weeks)
    • pregnant patient
    • signs of myocarditis
    • signs of acute decompensated heart failure

Hypertension

  • Hypertensive emergency (BP>220/140)
  • Severe hypertensive with systolic BP >180mmHg with any of the following concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
  • If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible.

Murmur (adults or children)

  •  New murmur with any of the following concerning features:
    • haemodynamic instability
    • persistent or progressive shortness of breath (NYHA Class III – IV)
    • chest pain
    • syncope / pre-syncope / dizziness
    • neurological deficit indicative of TIA/stroke
    • abnormal ECG (e.g. LV hypertrophy, AF, LBBB, RBBB)
    • fever or constitutional symptoms suggestive of infection (eg endocarditis, acute rheumatic fever)
    • signs of heart failure

Murmur (Infant)

  •  Infant <3 months with newly noted murmur and any of the following concerning features:
    • poor feeding
    • slow weight gain
    • weak or absent femoral pulses
    • post ductal (foot) oxygen saturation < 95%
    • respiratory signs (wheeze, recession or tachypnoea)
  • Suspected heart failure or endocarditis

Palpitations

  • Palpitations with any of the following concerning features:
    • chest pain
    • shortness of breath
    • loss of consciousness
    • syncope / pre-syncope
    • persisting tachyarrhythmia on ECG

 Supraventricular tachycardia

  • Unresolved acute supraventricular tachycardia with any of the following concerning features:
    • syncope
    • severe dizziness
    • ongoing chest pain
    • increasing shortness of breath
    • hypotension
    • signs of cardiac failure
    • ventricular rate >120         

Syncope / pre-syncope

  • Syncope with any of the following concerning features:
    • exertional onset
    • chest pain
    • persistent hypotension (systolic BP <90mmHg)
    • severe persistent headache
    • focal neurological deficits
    • preceded by or associated with palpitations
    • known ischaemic heart disease or reduced LV systolic function
    • associated with SVT or paroxysmal atrial fibrillation
    • pre-excited QRS (delta waves) on ECG
    • suspected malfunction of pacemaker or ICD
    • absence of prodrome
    • associated injury
    • occurs while supine or sitting 

Other

  • Pacemaker/ICD
    • delivery of 2 or more shocks by ICD in 24 hours
    • suspected pacemaker/defibrillator malfunction (with ECG evidence)
    • pacemaker/ICD device erosion
  • Bradycardia including any of the following:
    • symptomatic bradycardia
    • PR interval on ECG exceeding 300ms
    • second degree or complete heart block
  • Broad complex tachycardia
  • Suspected or confirmed endocarditis, myocarditis or pericarditis

Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section. 

The following are not routinely provided in a public Cardiology service.

There are no out of scope services for cardiology