Videos
Watch Dr Andy McCoye discussing the management of the common cardiology complaint of palpitations. The video covers case examples and advice on who can be treated in primary care and who needs to be referred on as well as giving advice on how to produce a good referral:
Further advice is available on the following website: http://www.heartrhythmalliance.org/aa/uk/
Top Ten hints: Cardiology
1. Palpitations: Ideally do blood tests including TFTs, calcium, FBC to exclude anaemia, 12 lead ECG and holter/24 hour tape via community providers before referral, and please attach the full report to the referral.
2. Cardiac sounding stable chest pain: Ideally do an ECG at earliest possible opportunity and start aspirin, statin and GTN at time of referral if sounds like a good story for angina. Please attach a good quality, readable scan of any 12 lead ECGs taken as these are not stored at STH. There is no rapid access chest pain service at STH (though the option still exists on ERS). Instead, if your patient has chest pain of recent (4 week or less) origin, please refer directly as an urgent referral, not through CASES.
3. Breathlessness: Ideally check ECG, CXR, spirometry and blood tests to exclude anaemia and do NTproBNP before referral.
4. Syncope: Ideally patients who sound like vasovagal syncope or POTS, encourage a teaspoon of table salt and 2.5litres of fluid per day at time of seeing.
5. Atrial fibrillation: Ideally use Sheffield AF guidelines and assess CHADS2VASC and HASBLED scores and anticoagulate at soonest opportunity.
6. Hyperlipidaemia: Ideally use the Sheffield lipid guidelines before considering referral to secondary care and refer to biochemistry lipid clinic run by Dr Delaney and colleagues.
7. Hypertension: Ideally treatment in primary care following NICE guidance unless multiple intolerances, very high BP, very young, secondary cause likely or resistance to treatment. The majority of referrals for hypertension are assessed by Prof Peter Jackson’s clinic in General Medicine rather than cardiology, so please ask your secretary to re-refer directly there (under General Medicine and Named Clinician on the e-Referral system). If there are no recent U&E, urine ACR or ECG reports please arrange these to assess end organ damage.
8. Murmurs: Ideally if a new murmur then investigate with an open access echocardiogram. If referring someone with possible worsening of known valve disease it is helpful to get an up to date echo by same pathway.
9. Heart failure: Ideally if new symptoms of suspected heart failure, perform blood tests including NT pro BNP, ECG and chest x-ray and follow Sheffield heart failure pathway
10. Patients with an exacerbation of known coronary artery disease or previous revascularisation: ideally do blood tests to exclude non-cardiac causes of worsening e.g. anaemia and uptitrate or add antianginals at time of referral.