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.

  • syncope with any red flags: 
    • exertional onset
    • chest pain
    • persistent hypotension (systolic blood pressure <90 mmHg)
    • severe persistent headache
    • focal neurological deficits
    • preceded by or associated with palpitations
    • known ischaemic heart disease or reduced left ventricle (LV) systolic function
    • associated with supraventricular or paroxysmal atrial fibrillation
    • pre-excited QRS (delta waves) on electrocardiogram (ECG)
    • suspected malfunction of pacemaker or implantable cardioverter defibrillator
    • associated injury
    • occurs while supine or sitting
    • complete heart block
  • recurrent syncope/pre-syncope in preceding 24 hours

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

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • uninvestigated syncope/near syncope without red flags; containing concerning findings on echocardiogram (Echo)/holter monitor reports

Category 2 — appointment clinically indicated within 90 days

  • recurrent syncope previously investigated with undetermined cause

Category 3 — appointment clinically indicated within 365 days

  • nil

For more on outpatient referrals, see the general referral information page.

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.

  • identifies as Aboriginal and/or Torres Strait Islander
  • relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
  • interpreter requirements
  • description of symptoms, frequency, duration and risk factors
  • alleviating factors/ strategies
  • presence of red flag symptoms
  • relevant medical history
  • details of all treatments offered and efficacy
  • family history of cardiac disease or sudden cardiac death, sudden infant death syndrome, or sudden unexplained death
  • postural (lying/standing or sitting/standing) blood pressure (BP)
  • identified impaired left ventricular function confirmed on imaging (magnetic resonance imaging, echocardiogram, or myocardial perfusion scanning (MPS))
  • previous Electrocardiograms (ECGs)
  • complete blood examination (CBE)
  • urea, electrolytes, creatinine (UEC)
  • liver function tests (LFTs)
  • blood sugar levels
  • estimated glomerular filtration rate (eGFR)
  • serum magnesium
  • thyroid stimulating hormone (TSH)

Additional information to assist triage categorisation

  • use/frequency of alcohol, tobacco and other drugs
  • holter monitor (only useful for daily symptoms)
  • relevant investigations and reports e.g. echocardiograms (Echo)
  • chest X-ray, include company and accession number

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.

Syncope unrelated to suspected cardiac origins should be further investigated to exclude alternative diagnosis such as epilepsy and postural hypotension before referring for specialist cardiology services input.

Clinical resources

Consumer resources