Cardiology referrals are among the most common and time-sensitive in medicine. They range from straightforward ECG queries to life-threatening emergencies such as ACS, arrhythmias, and decompensated heart failure. A good referral is concise, structured, and supported by key investigations, especially ECGs and troponins. Before contacting the cardiology team, ensure the patient is clinically stable, the initial work-up has been done, and you understand what you’re asking for (advice, review, or admission). Make sure you also have a thorough understanding of the history and examination findings. Clear communication and preparation not only streamline the process but also ensure prompt, safe management for patients with potentially serious cardiac disease.
Common referrals and what to have to hand:
- Chest pain / suspected ACS
-12-lead ECGs (initial + repeats, with times ideally).
-Troponin results + timing from onset.
-Observations & pain status (ongoing or settled).
-Risk factors & PMH: IHD, MI, PCI/CABG, diabetes, HTN, CKD.
-Current meds: antiplatelets, anticoagulants, GTN, beta-blocker.
-CXR if done. - Arrhythmia (AF, SVT, VT, Heart Block)
-ECG/rhythm strip and rate/rhythm interpretation.
-Symptoms: palpitations, syncope, chest pain, dyspnoea.
-BP / haemodynamic stability.
-Duration of episode (if known).
-Bloods: U&Es, Mg²⁺, K⁺, TSH.
-Medications: beta-blockers, antiarrhythmics, anticoagulants.
-Previous ECGs or known history of AF/pacing. - Heart failure
-Symptoms and severity: orthopnoea, PND, ankle swelling, SOB.
-Observations: O₂ sats, BP, JVP, crackles, oedema.
-CXR: pulmonary oedema / cardiomegaly.
-BNP or NT-proBNP.
-U&Es.
-Current diuretics & response so far.
-Echo findings.
-Weight trend (if inpatient). - Syncope / Collapse
-Event description: before, during, after.
-ECG + rhythm monitoring if captured.
-BP (lying and standing) and HR.
-PMH: cardiac disease, pacemaker, arrhythmia.
-Bloods: U&Es, glucose, troponin.
-Medications: antihypertensives, rate control, antiarrhythmics.
-Echo or previous cardiac investigations if available. - Pacemaker / Device Problems
-Device type & implant date (from card or notes).
-Symptoms: dizziness, syncope, palpitations.
-ECG: evidence of pacing/failure.
-CXR: lead position or new pneumothorax.
-Recent procedures or infections. - Pericarditis / Myocarditis
-ECG: widespread ST elevation or PR depression.
-Troponin & CRP.
-Echo: effusion or tamponade if known.
-Symptoms: chest pain (positional/pleuritic), fever, recent viral illness.
-Haemodynamic status. - Endocarditis
-Observations: temp trend, BP, HR, SpO₂.
-Blood cultures: at least 3 sets from separate sites before antibiotics (note times taken).
-Bloods: FBC, CRP, U&Es, LFTs.
-Recent procedures or sources of infection: dental, IVDU, lines, wounds.
-PMH: prosthetic valve, previous endocarditis, congenital heart disease.
-Echo: TOE vs TTE any findings (if done) – e.g vegetations, regurgitation, abscess.
-Current antibiotics and when started.
-Specialty involvement: microbiology, ID, or medicine consulted yet?
