Murmur
Adult

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Angina / myocardial ischaemia / chest pain

Suspected acute coronary syndrome
Suspected pulmonary embolism or aortic dissection
Suspected or confirmed endocarditis, myocarditis or pericarditis or pericarditis
Suspected ischaemic chest pain within 24 hours that is associated with any of the following concerning features:
- Severe or ongoing chest pain
- Ischemic chest pain lasting ten minutes or more
- Recurrent chest pain that is new at rest or occurring with minimal activity
- Chest pain accompanied by severe dyspnoea
- Chest pain associated with any of the following clinical signs:
  - syncope / pre-syncope
    o respiratory rate > 30 breaths per minute
  - tachycardia >120
  - systolic BP < 90mmHg
  - heart failure / suspected pulmonary oedema
  - ST elevation or depression
  - complete heart block
    o new left bundle branch block

Atrial fibrillation / flutter

Atrial fibrillation / flutter with any of the following concerning features:
- Haemodynamic instability
- Shortness of breath
- Chest pain
- Syncope/pre-syncope/dizziness
- Evidence of pre-excited QRS (delta waves)
- Neurological deficit indicative of TIA/stroke
- Uncontrolled Tachycardia/heart rate despite medical therapy

Aortic Disease

Suspected chest pain within 24 hours that is associated with any of the following concerning features:
- Severe or ongoing chest pain
- Ischemic chest pain lasting ten minutes or more
- Recurrent chest pain that is new at rest or occurring with minimal activity
- Chest pain accompanied by severe dyspnoea
- Chest pain associated with any of the following clinical signs:
  - syncope / pre-syncope
  - respiratory rate > 30 breaths per minute
  - tachycardia >120 bpm
  - systolic BP < 90mmHg
  - heart failure / suspected pulmonary oedema
  - ST elevation or depression
  - complete heart block
  - new left bundle branch block

Heart Failure

Acute or chronic heart failure with any of the following concerning features:
- NYHA Class IV heart failure
- Ongoing chest pain
- Significant orthopnoea/PND
- Oxygen saturation < 90%
- Clinical and/or radiographic signs of acute pulmonary oedema
- Haemodynamic instability:
  - pre-syncope / syncope / severe dizziness
  - altered level of consciousness
  - heart rate > 120 beats per minute
  - systolic BP < 90mmHg with symptoms of hypoperfusion
  - systolic BP < 80mmHg irrespective of symptoms
Significant pulmonary or pedal oedema
Recent myocardial infarction (within 2 weeks)
Pregnant patient
Signs of myocarditis
Signs of acute decompensated heart failure

NB: Early discussion with the patient’s usual heart failure team would be advised for local care protocols

Hypertension

Hypertensive emergency (BP>220/140)
Severe hypertension with systolic BP >180mmHg with any of the following concerning features:
- Headache
- Confusion
- Blurred vision
- Retinal haemorrhage
- Reduced level of consciousness
- Seizures
- Proteinuria
- Papilloedema
- Signs of heart failure
- Chest pain

If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible.

Murmur

New murmur with any of the following concerning features:
Haemodynamic instability
Persistent or progressive shortness of breath (NYHA Class III – IV)
Chest pain
Syncope / pre-syncope / dizziness
Neurological deficit indicative of TIA/stroke
Abnormal ECG (e.g. LV hypertrophy, AF, LBBB, RBBB)
Fever or constitutional symptoms suggestive of infection (eg endocarditis, acute rheumatic fever)
Signs of heart failure

Palpitations

Palpitations with any of the following concerning features:
- chest pain
- shortness of breath
- loss of consciousness
- syncope / pre-syncope
- persisting tachyarrhythmia on ECG

Supraventricular tachycardia

Unresolved acute supraventricular tachycardia with any of the following concerning features
- Syncope
- Severe dizziness
- Ongoing chest pain
- Increasing shortness of breath
- Hypotension
- Signs of cardiac failure
- Ventricular rate >120 bpm

Syncope/pre-syncope

Syncope with any of the following concerning features:
- Exertional onset
- Chest pain
- Persistent hypotension (systolic BP <90mmHg)
- Severe persistent headache
- Focal neurological deficits
- Preceded by or associated with palpitations
- Known ischaemic heart disease or reduced LV systolic function
- Associated with SVT or paroxysmal atrial fibrillation
- Evidence of pre-excited QRS (delta waves) on ECG
- Suspected malfunction of pacemaker or ICD
- Absence of prodrome
- Associated injury
- Occurs while supine
- Seizures

Useful Management Information

If structural heart disease is suspected an echocardiogram should be arranged.

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Murmur with heart failure symptoms without and of the following concerning features: Haemodynamic instability Persistent or progressive shortness of breath (NYHA Class III-IV ) Chest pain Syncope/pre-syncope/dizziness Neurological deficit indicative of TIA/stroke Abnormal ECG (e.g. LV hypertrophy, AF, LBBB, RBBB) Fever or constitutional symptoms suggestive of infection (e.g. endocarditis, acute rheumatic fever) Signs of heart failure Murmur with heart failure symptoms without concerning features* Severe valve stenosis or regurgitation as described on echo report without concerning features* Stenosis or regurgitation with left ventricular dysfunction and/or pulmonary hypertension without concerning features* Previous valve surgery with new heart failure symptoms without concerning features* New or worsening heart failure symptoms in patient with a history of rheumatic heart disease without concerning features*
Category 2 (appointment within 90 calendar days)	Moderate valve stenosis or regurgitation as described on echo report with normal ventricular function, and no pulmonary hypertension
Category 3 (appointment within 365 calendar days)	Asymptomatic murmur not previously investigated.
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: 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.

Standard Referral Information

Reason for request

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

Relevant clinical information about the condition

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
All conservative options that have been pursued unsuccessfully prior to referral
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
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

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.)

Essential Referral Information

Details of relevant signs or symptoms
Details of all treatments offered and efficacy
Past medical history (including acute rheumatic fever/rheumatic heart disease) and co-morbidities
Family history of cardiac disease or sudden cardiac death (if relevant)
FBC
ELFTs
TSH results
Fasting Lipids results

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral

Additional Referral Information

Echocardiogram report
CXR report
Gestational and development history (if appropriate)
History of smoking, alcohol intake and drug use (including recreational drugs)
ECG
Aboriginal and/or Torres Strait Islander or Maori/Pacific Islander/ Refugee status
Functional class (NYHA Class )
For eligible patients*, include a CVD risk score (%) from within the past 5 years, using the 2023 Australian CVD risk calculator

*Eligible = ages 45–79 years (inclusive) or 30–79 years (inclusive) for Aboriginal and Torres Strait Islander peoples.

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Medical Objects Account: GQ42150009Z

HealthLink EDI: Qldgchsd

Internal Referrals

Cardiology qhRefer

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Rohan Jayansinghe

Medical Director Cardiology

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

MurmurAdult