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Palpitations

Red flags

Consider immediate referral of patients with any of the following:

Ventricular tachyarrhythmias are potentially more serious as they can rapidly compromise cardiac output. These arrhythmias are:

  • Ventricular tachycardia
  • Torsade de Pointes
  • Ventricular fibrillation

 

A small number of patients in AF/SVT may present as significantly compromised.

Concerning symptoms

  • Syncope
  • Severe dizziness
  • Ongoing chest pain
  • Increasing dyspnoea

Concerning signs

  • Ventricular rate >150bpm
  • Hypotension (systolic <90mmHg)
  • Clinical heart failure
  • A family history of sudden cardiac death

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Palpitations with any of the following:
    • other cardiac symptoms
    • haemodynamic disturbance
    • abnormal ECG

Category 2

Appointment within 90 days is desirable

  • No Category 2 criteria

Category 3

Appointment within 365 days is desirable

  • Palpitations that do not meet criteria for Emergency or Category 1

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • ECG at the time of palpitation (even if normal) may have important diagnostic clue
  • Refer to HealthPathways for assessment and management information if available

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • General referral information
  • Details of relevant signs and symptoms including duration and frequency of episodes
  • History of underlying cardiac disease
  • Family history of sudden cardiac death
  • ELFTs, TSH
  • All available ECGs (during episodes if possible)

Additional Referral Information (Useful for processing the referral)

  • Holter monitor report and all ECG tracings (useful if symptoms are present on almost a daily basis)
  • Echocardiogram report
  • Stress test report
  • Serum magnesium results
  • Caffeine intake, alcohol intake and drug use (including recreational drugs)
  • Aboriginal or Torres Strait Islander or Maori/Pacific Islander / Refugee status (increased risk of acute rheumatic fever and rheumatic heart disease)

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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