Cardiology Statewide CPC Seeded CPC

Red flags — send to ED

If you believe your patient requires immediate attention, refer to the emergency department (via ambulance if necessary) or seek emergent medical advice. Emergency features are not Category 1.

Angina / myocardial ischaemia / chest pain

• 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 concerning features: severe or ongoing chest pain; ischaemic chest pain lasting ten minutes or more; recurrent chest pain new at rest or with minimal activity; chest pain with severe dyspnoea; syncope / pre-syncope; respiratory rate > 30; tachycardia > 120; systolic BP < 90 mmHg; heart failure / suspected pulmonary oedema; ST elevation or depression; complete heart block; new left bundle branch block

Atrial fibrillation / flutter

• Haemodynamic instability
• Shortness of breath
• Chest pain
• Syncope / pre-syncope / dizziness
• Evidence of pre-excited QRS (delta waves)
• Neurological deficit indicative of TIA / stroke
• Uncontrolled tachycardia / heart rate despite medical therapy

Heart failure

• NYHA Class IV heart failure
• Ongoing chest pain
• Significant orthopnoea / PND
• Oxygen saturation < 90%
• Clinical and/or radiographic signs of acute pulmonary oedema
• Haemodynamic instability: pre-syncope / syncope / severe dizziness; altered level of consciousness; heart rate > 120; systolic BP < 90 mmHg with hypoperfusion; systolic BP < 80 mmHg irrespective of symptoms
• Significant pulmonary or pedal oedema
• Recent myocardial infarction (within 2 weeks)
• Pregnant patient
• Signs of myocarditis
• Signs of acute decompensated heart failure

Early discussion with the patient’s usual heart failure team is advised for local care protocols.

Hypertension

• Hypertensive emergency (BP > 220/140)
• Severe hypertension with systolic BP > 180 mmHg plus headache, confusion, blurred vision, retinal haemorrhage, reduced consciousness, seizures, proteinuria, papilloedema, signs of heart failure, or chest pain
• Suspected pregnancy-induced hypertension or pre-eclampsia: refer to an ED that offers obstetric services where possible

Murmur

• New murmur with 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 (endocarditis, acute rheumatic fever)
• Signs of heart failure

Palpitations

• Chest pain
• Shortness of breath
• Loss of consciousness
• Syncope / pre-syncope
• Persisting tachyarrhythmia on ECG

Supraventricular tachycardia

• Unresolved acute SVT with syncope, severe dizziness, ongoing chest pain, increasing shortness of breath, hypotension, signs of cardiac failure, or ventricular rate > 120 bpm

Syncope / pre-syncope

• Exertional onset
• Chest pain
• Persistent hypotension (systolic BP < 90 mmHg)
• 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
• Evidence of pre-excited QRS (delta waves) on ECG
• Suspected malfunction of pacemaker or ICD
• Absence of prodrome
• Associated injury
• Occurs while supine
• Seizures

Emergency is not Category 1 — ED fax numbers