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Medical same day emergency care (MSDEC) referrals to Cardiology

How to refer

If a patient needs further input from Cardiology, please refer via the following methods:

Cardiology emergency

If you suspect a cardiology emergency or need to speak directly with the Cardiology team, please contact: 

  • cardiac nurses via switchboard from Monday to Sunday, 08:00 - 20:00 
  • cardiology registrar via switchboard who will be available at all hours 

Non-urgent referrals, Monday to Sunday (all hours)

  • Refer all patients via PICS (Requests > Cardiology Review Referral
  • Between Monday to Sunday from 08:00-20:00, referrals will be triaged by cardiology nurses and the patient will be reviewed accordingly
  • Cardiac nurses do not need to be routinely called to be informed of the referral
  • Between Monday to Sunday 20:00-08:00, call the Cardiology SpR on call via switch for further advice 
  • If the referral is not urgent and outside the above hours, but you feel the patient needs to stay in for an inpatient review, the referral will be triaged in the morning and the Cardiology team will review in MSDEC during normal working hours
  • Do not refer patients for an outpatient appointment via PICS, contact the Cardiology consultant's secretary to arrange an outpatient appointment

Suspected heart failure

Refer patients with suspected heart failure via PICS (Request > Heart failure referral).

How to request an echocardiogram in MSDEC

  • Submit a request via PICS (Request > Transthoracic Echocardiography (TTE) – Standard) 
  • Emergency echocardiogram: 
    • Contact Joe Bradley (available on Monday, Wednesday, Thursday and Friday between 08:00-17:30) on 07393 752 205
  • Emergency echocardiogram out of hours: 
    • Consider admitting the patient for an inpatient echocardiogram and specialist review 
  • Urgent requests (required within next two weeks): 
    • Submit a PICs request as above, select the urgency and in additional information provide the relevant information needed to ensure the echo is performed promptly as an SDEC returner, indicating the time frame you would like to echo to be completed. The requests will be triaged and booked by Joe Bradley into an available SDEC returner slot, advise the patients that they will receive a phone call to arrange an echo appointment for his next available time slot. 
  • Non-urgent requests: 
    • can be performed within six weeks in the Outpatient department or sooner as an SDEC returner if enough slots are available. 
  • Only request an echocardiogram if advised by the registrar or consultant 
  • Ensure the following have been completed and included to request an echocardiogram: 
    • ECG, weight, height 
    • Bloods: FBC, U+Es, CRP, TFTs, calcium, magnesium, troponin (if relevant), NT-proBNP, d-dimer (if relevant) 
    • CXR 
    • Correct contact details including an address and contact details 
  • Please note: 
    • Patients with suspected heart failure (based on symptoms and signs) require an echo to confirm the diagnosis but if they already have an echo showing left ventricular dysfunction, they do not need another 
    • If an echocardiogram has already been performed, repeat only if there is a discrepancy between previous result and current clinical presentation, or if a new or worsening murmur is apparent 
  • If the request is out of hours, please consider admitting the patient for monitoring 

Echocardiogram timings

Emergency (less than 24 hours)

  • Acute decompensated Heart failure (NYHA III-IV)
  • Suspected large volume pericardial effusion/tamponade
  • AF with adverse features (needs adequate rate control first)
  • Suspected cardiomyopathy or moderate-severe valvular heart disease with adverse features
  • Pulmonary embolism with right heart strain
  • Aortic dissection
  • Tachy/bradyarrhythmia with adverse features* 

Urgent (less than two weeks)

  • Suspected Heart failure with BNP > 2000ng/L
  • AF with suspected stable heart failure
  • Suspected stable moderate-severe valvular heart disease
  • Suspected cardiomyopathy without adverse features
  • tachy/bradyarrhythmia detected on holter monitor without adverse features
  • Pregnant women without adverse features*

Non-urgent (less than six weeks)

  • Suspected heart failure with BNP 400-200ng/L
  • Pericardial disease
  • Newly diagnosed AF without adverse features
  • Suspected valvular heart disease without adverse features*
  • Abnormal ECG (i.e. hypertension related LVH or unexplained bundle branch block without adverse features)

How to request Holters

  • Submit a request via PICS (Request > Ambulatory ECG Monitoring), selecting 24, 48 or 72 hours as required
  • SDEC has a small number of Holter monitors available with selected nurses/ECT’s able to fit them. If available, the patient can be given the Holter whilst on SDEC and told to return them to SDEC at the relevant time
  • If no Holters are available on SDEC, the patient will be booked for an outpatient appointment through the normal routes

Last reviewed: 23 April 2025