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 Red flags
- Chest pain that is:
- severe or ongoing
- lasting ten minutes or more
- new at rest or with minimal activity
- associated with severe dyspnoea
- associated with syncope / pre-syncope
- 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 Red flags
- haemodynamic instability
- shortness of breath
- chest pain
- syncope/pre syncope/dizziness
- known Wolff-Parkinson-White
- neurological deficit indicative of TIA/stroke
Heart failure
- Acute or chronic heart failure with any of the following Red flags
- 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 Red flags
- 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 Red flags
- 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
Palpitations
- Palpitations with any of the following Red flags
- 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 Red flags
- 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 Red flags
- 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
- Not all patients have to be seen by a cardiologist if the general practitioner is comfortable caring for the patient.
- In patients with new onset atrial arrhythmias (<48 hours), consider a fast track approach via telephone contact with the nearest cardiology service for consideration of earlier cardioversion to minimize the burden of atrial arrhythmia.
Minimum Referral Criteria
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Category 1
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Absence of Red flags - if below red flags 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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Essential referral information
Without this information the referral will be returned
- Details of relevant signs and symptoms
- Details of all treatments offered and efficacy
- Past medical history and comorbidities
- Family history of cardiac disease or sudden cardiac death
- FBC, ELFTs, TSH results
- Include available ECGs, in particular those demonstrating the arrhythmia
Additional Referral Information
- Any investigations relevant to any co-morbidities
- Other investigations (if available) eg echocardiogram report, CXR report, holter monitor report, sleep study report
- History of smoking, alcohol intake and drug use (including recreational drugs)
- Coagulation studies, fasting lipid results
- CHA2DS2 VASC score
Clinical Override
Clinical override of referral criteria may be requested in the following situations:
- Inability to include essential referral information. If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons.
- Patient does not meet minimum referral criteria. If the patient does not meet the criteria for referral but the referring practitioner believes that the patient requires specialist review.
- Presence of clinical modifiers. The presence of clinical modifiers (as listed above in Standard referral information) may impact on the categorisation of a patient.
Include the reason for request for clinical override as part of the referral. Referrals are reviewed by the triaging specialist who determines the most appropriate course of action.
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.