Cardiology

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  Emergency

  If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols 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 chest pain within 24 hours with any of the following concerning features:
  • severe or ongoing chest pain
  • chest pain lasting ten minutes or more
  • recurrent chest pain that is new at rest or occurring with minimal activity
  • chest pain that is new at rest or with minimal activity
  • chest pain accompanied by severe dyspnoea
  • chest pain that is associated with any of the following clinical signs:
    • syncope / pre-syncope
    • respiratory rate > 30 breaths per minute
    • tachycardia >120 bpm
    • 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 hypertension (systolic BP >180) with known ischaemic heart disease or cardiomyopathy AND any of the following concerning features:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
    • signs of heart failure
    • chest pain
  • 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)
  • Murmur with cyanosis or heart failure
  • Syncope or seizures

  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
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  CPC in scope Not an exhaustive list

  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.

  • Angina / myocardial ischaemia / chest pain ADULT
  • Aortic Disease ADULT
  • Atrial fibrillation / flutter ADULT
  • Chest pain PAEDIATRIC
  • Genetic Heart Disease ADULT
  • Heart failure ADULT
  • Hypertension (cardiology) ADULT
  • Lipid disorders ADULT
  • Murmur ADULT
  • Murmur (Cardiology) PAEDIATRIC
  • Palpitations ADULT
  • Supraventricular tachycardia ADULT
  • Syncope / pre-syncope (Cardiology) ADULT
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  CPC out of scope

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

  There are no out of scope services for cardiology