Murmur

ADULT

  • 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.

    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 (PDF, 101kB))
      • 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

    • Refer to HealthPathways for assessment and management information or local guidelines if available
    • If structural heart disease is suspected an echocardiogram should be arranged
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Murmur with heart failure symptoms without any of the following concerning features:
    • haemodynamic instability
    • persistent or progressive shortness of breath (NYHA Class III – IV (PDF, 101kB))
    • 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
  • Severe valve stenosis or regurgitation as described on echo report without concerning features
  • Stenosis or regurgitation with left ventricular dysfunction and/or pulmonary hypertension without concerning features
  • Previous valve surgery with new heart failure symptoms without concerning features
  • New or worsening heart failure symptoms in patient with a history of rheumatic fever or rheumatic heart disease without concerning features
Category 2
(appointment within 90 calendar days)
  • Moderate valve stenosis or regurgitation as described on echo report with normal ventricular function, and no pulmonary hypertension
Category 3
(appointment within 365 calendar days)
  • Asymptomatic murmur not previously investigated

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • General referral information

3. Additional referral information Useful for processing the referral

  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • Past medical history (including acute rheumatic fever / rheumatic heart disease) and comorbidities
  • Family history of cardiac disease or sudden cardiac death
  • FBC, ELFTs, TSH, fasting lipids results
  • ECG
  • Echocardiogram report
  • CXR report
  • Include if appropriate gestational and development history
  • History of smoking, alcohol intake and drug use (including recreational drugs)
  • Aboriginal or Torres Strait Islander or Maori/Pacific Islander / Refugee status (increased risk of acute rheumatic fever and rheumatic heart disease)
  • Functional class (NYHA Class (PDF, 101kB))
  • For eligible patients*, include a CVD risk score (%) from within the past 5 years, using the 2023 Australian CVD risk calculator

    • *Eligible = ages 45–79 years (inclusive) or 30–79 years (inclusive) for Aboriginal and Torres Strait Islander peoples.

4. Request

  • Patient's demographic details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring practitioner details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    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
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    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
    • 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.)

  • 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.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 28 September 2026

© State of Queensland (Queensland Health) 2023

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