Draft for consultation only
Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- new murmur with any red flags:
- haemodynamic instability
- persistent or progressive shortness of breath (New York Heart Association Class III – IV)
- chest pain
- neurological deficit indicative of transient ischaemic attack/stroke
- fever or other symptoms suggestive of infection (e.g. endocarditis, acute rheumatic fever)
signs of heart failure (HF)
- suspected endocarditis
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
- The Queen Elizabeth Hospital (08) 8222 6000
Northern Adelaide Local Health Network
- Lyell McEwin Hospital (08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
- Noarlunga Hospital (08) 8384 9222
Category 1 — appointment clinically indicated within 30 days
- murmur with heart failure (HF) symptoms without red flags
- severe valve stenosis or regurgitation as described on echocardiogram (Echo) report without red flags
- moderate valve stenosis or regurgitation as described on Echo report with normal ventricular function, and no pulmonary hypertension.
Category 2 — appointment clinically indicated within 90 days
- moderate valve stenosis or regurgitation as described on echo report with normal ventricular function, and no pulmonary hypertension
- patients needing an Echo
Category 3 — appointment clinically indicated within 365 days
- asymptomatic murmur
For information on referral forms and how to import them, please view general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.
- description of symptoms, frequency, duration and risk factors
- details of all treatments offered and efficacy
- presence of red flags
- people identifying as Māori, Aboriginal and/or Torres Strait Islander - increased risk of acute rheumatic fever and rheumatic heart disease
- past medical history (including acute rheumatic fever/rheumatic heart disease) and comorbidities
- family history of cardiac disease or sudden cardiac death
- complete blood examination (CBE)
- urea, electrolytes, creatinine (UEC)
- liver function tests (LFTs)
- blood sugar levels
- estimated glomerular filtration rate (eGFR)
- thyroid stimulating hormone (TSH)
Additional information to assist triage categorisation
- echocardiogram (Echo)
- chest X-ray
- electrocardiogram (ECG)
- fasting lipids
- gestational and development history, stage and estimated date of delivery (if appropriate)
- use/frequency of alcohol, tobacco and other drugs
Clinical management advice
Patients who have been seen by a specialist cardiologist previously, are encouraged to be referred back to their care for further review.
Where structural heart disease is suspected consider echocardiogram (Echo). There is limited capacity to offer an Echo only option and the report will be sent to referrer without cardiology input. Patients can subsequently be referred for review in the event of a significant finding.
- European Society of Cardiology (ESC) — 2021 Management of Valvular Heart Disease Clinical Practice Guidelines