Supraventricular tachycardia
+ Emergency
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 in with haemodynamic compromise
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 (adult)
- 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 (paediatric)
- 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)
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
+ Useful management information
- If isolated in the absence of syncope/ haemodynamic compromise:
- reassure
- consider vagolytic manoeuvres
- Consider holter monitor if frequent (daily or second daily)
- Consider event recorder if infrequent
+ Minimum referral criteria
Does your patient meet the minimum referral criteria?
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Category 1
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Concerning features - if below concerning features are present, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region:
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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If your patient does not meet the minimum referral criteria
- Consider other treatment pathways or an alternative diagnosis
- If you still need to refer your patient:
- Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
- Please note that your referral may not be accepted or may be redirected to another service
+ Standard referral information to be included in all referrals
Patient's Demographic Details
- Full name (including aliases)
- Date and country of birth
- Residential and postal address including whether patient resides at an aged care facility
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Name of delegate and contact details (Department of Corrective Services)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Any special needs, access requirements and/or disability relevant to the referral
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner
Relevant clinical information about the condition
- Presenting symptoms (evolution and duration)
- Physical findings
- Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
- All conservative options that have been pursued unsuccessfully prior to referral
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
- Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- A comprehensive capture of information in relation to MSH Referral Criteria
Reason for request
- To establish a diagnosis
- For treatment or intervention
- For advice and management
- For specialist to take over management
- Reassurance for GP/second opinion
- For a specified test/investigation the GP can't order, or the patient can't afford or access
- Reassurance for the patient/family
- For other reason (e.g. rapidly accelerating disease progression)
- Clinical judgement indicates a referral for specialist review is necessary
Clinical modifiers
- Impact on employment
- Impact on education
- Impact on home
- Impact on activities of daily living functioning – low/medium/high
- Impact on ability to care for others
- Impact on personal frailty or safety
- Identifies as Aboriginal and/or Torres Strait Islander
Other relevant information
- Willingness to have surgery (where surgery is a likely intervention)
- Choice to be treated as a public or private patient
- Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
Essential referral information
Without this information the referral will be rejected
- Medication history
- ELFTs, FBC, TSH results
- All available ECGs (including an ECG showing SVT if possible)
+ Additional referral information for referrals
- Details of relevant signs and symptoms
- Details of all treatments offered and efficacy
- Relevant previous medical history and co-morbidities
- Caffeine intake, alcohol intake and drug use (including recreational drugs)
- Echocardiogram report
- Stress test report
- CXR report
Out of catchment
West Moreton Health is responsible for providing a public health service to people who reside within its catchment area. To appropriately manage demand for service we do not accept referrals from outside this catchment area. If your patient does live outside the West Moreton Health area and it is deemed socially or clinically necessary for their care to be received in the West Moreton Health Service, inclusion of information regarding their particular medical and/or social factors will assist with the triaging of your referral.
Feedback
To provide feedback about contents on this website or general referral questions please email WM-CPC@health.qld.gov.au or phone 3413 7402.
Last updated: Thursday, November 22, 2018
