Medical same day emergency care (MSDEC) referrals to Cardiology

Emergency

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

• Cardiac nurses (Tel: ext. 12536) from Monday to Sunday, 08:00-20:00
• Cardiology registrar (Tel: ext. 12065) available at all hours

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 from 20:00-08:00, call the cardiology SpR on call (Tel: ext. 12065) 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. Patients should remain in SDEC overnight
• If the patient is deemed well enough for discharge prior to cardiology review, then they should be referred via an outpatient pathway

Non-urgent referrals

Do not refer patients for an outpatient appointment via PICS, contact the cardiology consultant's secretary to arrange an outpatient appointment.

• Consultant directory: Cardiology

Sub-speciality referrals and investigations

Suspected heart failure

• Refer patients with suspected heart failure via PICS (Request > Heart failure referral)
• Patients should have a confirmed diagnosis of heart failure on a prior echo, ideally within the last 12 months
• Where possible, patients should be seen by the Heart Failure team while they are an inpatient or while in theMSDEC
• Heart failure nurses are available from Monday to Friday from 07:30-17:30. PICS is the preferred method or the heart failure mobile via Switchboard
• Patients with clinical signs of decompensated heart failure with fluid overload and congestion should not routinely be sent home with diuretics and an outpatient echo appointment prior to senior review

Echocardiograms

• Submit a request via PICS (Request > Transthoracic Echocardiography (TTE) – Standard)
• Only request an echocardiogram if advised by the registrar or consultant
• These can be done same day (if appropriate and depending on capacity) or as SDEC returners

Echocardiogram timings (further action may be required based on urgency)

Emergency echocardiogram (required within less than 24 hours)

• Contact Joe Bradley (available on Monday, Wednesday, Thursday and Friday between 08:00-17:30) on Tel: 07393 752 205
• Emergency echocardiogram out of hours:Consider admitting the patient for an inpatient echocardiogram and specialist review
• When is an emergency echo required?
• 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

Non-urgent requests

• Submit PICS request as above. Can be performed within six weeks in the Outpatient department or sooner as an SDEC returner if enough slots are available.
• When is a non-urgent echo required?
• 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)

What to include in echocardiogram request

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

Notes

• 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

Holter monitors

• 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 Holter monitors are available on SDEC, the patient will be booked for an outpatient appointment through the normal routes – advise them to await a phone call/appointment