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Cardiology - Public Patients

Purpose

This  page contains information for general practitioners on how to refer patients aged 16 years and over to Cardiology services at Mater Hospital Brisbane

Service 

The Cardiology service is led by Dr Karam Kostner, who operates a state-wide tertiary service for the management and treatment of lipid disorders. The service offers a multidisciplinary approach to cardiac care including nurse-led clinics for heart failure optimisation and smoking cessation. Patients have access to allied health services including physiotherapy, psychology, social work, occupational therapy and dietetics. Due to being located on campus with the Mater Mother's Hospitals, the Cardiology service also offers specialised assessment and treatment for women with cardiac disorders in pregnancy.

Patients can also be referred directly by their GP to the Cardiovascular Investigations Unit for Echo, EST and Holters.

Other investigations performed on site by the Cardiac Investigations Unit include Stress Echo, Dobutamine Stress Echo, Transoespohageal Echo, ECG, Vascular Imaging such as Carotid and peripheral ultrasound, angiography and angioplasty and right heart catheters following review by a cardiologist. 

How to refer

If referral for care is indicated please list all of the General Referral Information and reason for request, and essential information as indicated below.

To refer, please fill in the Mater Adult Referral Form, available to download and embed into most major Practice Management software applications.

Referrals can be sent by:

Secure messaging        Medical Objects:   HM4101000R8

                                  HealthLink EDI:    materref                                                                                             

Fax                             07 3163 8548

Emergency

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department or seek emergency medical advice if in a remote region:

View list of conditions

  • Suspected pulmonary embolism
  • Suspected aortic dissection
  • Suspected acute coronary syndrome
  • Suspected ischaemic chest pain within 24 hours with any of the following red flags
    • Chest pain that is:
      • severe or ongoing
      • lasting ten minutes or more
      • new at rest or with minimal activity
      • associated with severe dyspnoea
      • associated with syncope / pre-syncope
      • associated with any of the following signs:
      • respiratory rate > 30 breaths per minute
      • tachycardia >120
      • systolic BP <90mmHg
      • heart failure / suspected pulmonary oedema
      • ST elevation or depression
      • complete heart block
      • new left bundle branch block
  • Atrial fibrillation / flutter with any of the following red flags
    • haemodynamic instability
    • shortness of breath
    • chest pain
    • syncope/pre syncope/dizziness
    • known Wolff-Parkinson-White
    • neurological deficit indicative of TIA/stroke
  • Broad complex tachycardia
  • Suspected or confirmed endocarditis, myocarditis or pericarditis
  • Acute or chronic heart failure with any of the following red flags
    • ongoing chest pain.
    • increasing shortness of breath.
    • oxygen saturation < 90%.
    • haemodynamic instability:
      • pre-syncope / syncope / severe dizziness
      • altered level of consciousness
      • heart rate > 120 beats per minute
      • systolic BP < 90mmHg
    • recent myocardial infarction (within 2 weeks)
    • pregnant patient
  • Hypertensive crisis characterised by systolic BP >180mmHg with any of the following red flags
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizures
    • proteinuria
    • papilloedema
  • Palpitations with any of the following red flags
    • ongoing chest pain or shortness of breath
    • loss of consciousness
    • syncope / pre-syncope
    • persisting tachyarrhythmia on ECG
  • Unresolved acute supraventricular tachycardia with any of the following red flags
    • syncope
    • severe dizziness
    • ongoing chest pain
    • increasing shortness of breath
    • hypotension
    • signs of cardiac failure
    • ventricular rate >120
  • Syncope with any of the following red flags
    • exertional onset
    • chest pain
    • persistent hypotension (systolic BP <90mmHg)
    • severe persistent headache
    • focal neurologic deficits
    • preceded by palpitations
    • associated injury
    • known ischaemic heart disease with reduced LV systolic function
    • prolonged QT interval (corrected on resting ECG)
  • Delivery of 2 or more shocks by ICD in 24 hours.
  • Bradycardia including any of the following:
    • symptomatic bradycardia
    • symptomatic first degree block
  • second degree or complete heart block

 

Scope of Service

Conditions in scope:

Adult Congenital Cardiac Disorders

Essential information (Referral will be declined without this)

  • General Referral Information
  • Cardiac history 
  • symptoms eg syncope, pre-syncope, palpitations, clamminess
  • Relevant Imaging
  • Previously peformed cardiac investigations (ECG, ECHO, stress test, chest x-ray)

Additional referral information (useful for processing the referral)

  • documentation from previous specialists if available

Other useful information for management (not an exhaustive list)

  • No additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Category is determined by severity of condition, symptoms and functional impact 

Category is determined by severity of condition, symptoms and functional impact 

Category is determined by severity of condition, symptoms and functional impact 

 

Angina / Myocardial Ischaemia / Chest Pain

Essential information (Referral will be declined without this)

  • General Referral Information
  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • Past medical history and comorbidities
  • Patient’s functional status
  • Family history of premature cardiac disease or sudden cardiac death
  • History of smoking and drug use (including alcohol)
  • FBC, ELFTs, fasting lipids, HbA1c (if diabetic) results
  • ECG

Additional referral information (useful for processing the referral)

  • Investigations relevant to significant comorbidities
  • Cardiovascular risk assessment score
  • Other investigations (if available) including CXR, cardiac imaging: stress ECG, stress echo or myocardial perfusion scan

Other useful information for management (not an exhaustive list)

  • For patients with probable stable angina, commence aspirin, nitro-lingual spray and B-blockers if no contraindication (ultimately may require ACE inhibitor and statin as well). Encourage risk factor modification and smoking cessation.
  • Chest pain that is atypical for myocardial ischaemia (ie not crushing or pressing; no radiation to neck, shoulder or arm,) occurring in patients with no or few coronary risk factors (TIMI scores of 0 or 1) is highly unlikely to be cardiac in origin and may be referred to a general physician rather than a cardiologist depending on local services.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

New recurrent cardiac chest pain without Red flags (see emergency section)

Prolonged, severe, worsening pattern of angina without Red flags (see emergency section) in patients with established coronary heart disease

Chronic suspected cardiac chest pain without Red flags (see emergency section) for investigation

No category 3 criteria

 

Atrial Fibrillation / Flutter

Essential information (Referral will be declined without this)

  • General Referral Information
  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • Past medical history and comorbidities
  • Family history of sudden cardiac death
  • History of smoking, alcohol intake and drug use (including recreational drug use)
  • FBC, ELFTs, TSH, coagulation studies, magnesium, fasting lipids results
  • All available ECGs (including ECG showing arrhythmia)
  • CHADS VASC score

Additional referral information (useful for processing the referral)

  • Any investigations relevant to any co-morbidities
  • Other investigations (if available) eg echocardiogram report, CXR report, holter monitor report

Other useful information for management (not an exhaustive list)

  • Not all patients have to be seen by a cardiologist if the general practitioner is comfortable caring for the patient
  • In patients with new onset atrial arrhythmias (<48 hours), consider a fast track approach via telephone contact with the nearest cardiology service for consideration of earlier cardioversion to minimize the burden of atrial arrhythmia.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

New atrial fibrillation/flutter without Red flags (see emergency section)

Recurrent paroxysmal atrial fibrillation / flutter

SVTChronic atrial fibrillation requiring management review (e.g. rate control, anticoagulation)

No category 3 criteria

 

Cardiac Conditions in Pregnancy

Essential information (Referral will be declined without this)

  • General Referral Information
  • Cardiac history
  • Symptoms e.g. syncope, pre-syncope, palpitations, clamminess
  • Relevant imaging
  • Previously performed cardiac investigations (ECG, ECHO, stress test, chest x-ray)
  • Pregnancy Details
    • gestational age
    • expected date of delivery
    • previous pregnancies

Additional referral information (useful for processing the referral)

  • Nil additional information

Other useful information for management (not an exhaustive list)

  • Nil additional information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – Urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Category is determined by stage of pregnancy and condition / symptoms / severity

Category is determined by stage of pregnancy and condition / symptoms / severity

Category is determined by stage of pregnancy and condition / symptoms / severity

 

Heart Failure

Essential information (Referral will be declined without this)

  • General Referral Information
  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • Relevant previous medical history and co-morbidities
  • Weight, height & BMI
  • Recent fluctuations in weight indicative of cardiac dysfunction (if known)
  • Smoking and alcohol history
  • New York Heart Association (NYHA) class
  • FBC, ELFTs, fasting lipids, HbA1c (if diabetic), TSH, urinalysis results
  • ECG
  • CXR report

 

Additional referral information (useful for processing the referral)

  • Sleep study report if OSA suspected
  • Stress test report (if performed)
  • Investigations relevant to co-morbidities
  • Respiratory function tests if patient a smoker, has COPD or asthma
  • Echocardiogram report
  • BNP results

Other useful information for management (not an exhaustive list)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Heart failure NYHA Class II-III with worsening symptoms but without Red flags (see emergency section)

 

 

 

 

Stable NYHA Class II heart failure

Chronic NYHA Class I heart failure with worsening symptoms

Newly diagnosed or suspected heart failure

No category 3 criteria

 

Hypertension

Essential information (Referral will be declined without this)

  • General Referral Information
  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • BP
  • Relevant previous medical history and co-morbidities
  • FBC, ELFTs, fasting lipids results
  • Urinalysis results
  • Urinary protein estimation results
  • CXR report
  • ECG

Additional referral information (useful for processing the referral)

  • Any investigations relevant to co-morbidities
  • Stress test report (if available)
  • Renal duplex report if renal artery stenosis suspected
  • Smoking and alcohol history

Other useful information for management (not an exhaustive list)

  • Consider testing for primary hyperaldosteronism, and phaeochromocytoma
  • Refer to HealthPathways for assessment and management information if available.
  • The Heart Foundation’s Hypertension Guidelines provide some additional guidance for patient management

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Severe persistent hypertension (>180/110) without Red flags (see emergency section)

 

 

Hypertension that is difficult to control

Medication intolerance

Changing pattern of hypertension

Suspected renal artery stenosis (consider referral to vascular if available)

Refractory hypertension patients on three or more medications with BP >140/90

No category 3 criteria

 

Heart Failure

Essential information (Referral will be declined without this)

  • General Referral Information
  • Blood Tests -  ELFTs, FBC, TFT, fasting lipid profile (includes HDL, LDL)
  • Medical history including height, weight and BMI
  • Symptoms e.g. syncope, pre-syncope, palpitations, clamminess

Additional referral information (useful for processing the referral)

  • Sleep study report if OSA suspected
  • Stress Test report (if performed) 
  • Inverstigations relevant to co-morbidities (eg. HbA1c if diabetic)
  • Respiratory function tests is patient is a smoker, has COPD or asthma
  • Cardiac Investigations – results of any investigations if available (ECG, ECHO, stress test, chest x-ray)
  • BNP results

Other useful information for management (not an exhaustive list)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

 

 Class IV Heart Failure 

 

 

 

 

Class III Heart Failure

Increasing symptoms of Heart Failure

 

 

Hypertension

Essential information (Referral will be declined without this)

  • General Referral Information
  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • BP
  • Relevant previous medical history and co-morbidities
  • FBC, ELFTs, fasting lipids results
  • Urinalysis results
  • Urinary protein estimation results
  • CXR report
  • ECG

Additional referral information (useful for processing the referral)

  • Any investigations relevant to co-morbidities
  • Stress test report (if available)
  • Renal duplex report if renal artery stenosis suspected
  • Smoking and alcohol history

Other useful information for management (not an exhaustive list)

  • Consider testing for primary hyperaldosteronism, and phaeochromocytoma
  • Refer to HealthPathways for assessment and management information if available.
  • The Heart Foundation’s Hypertension Guidelines provide some additional guidance for patient management

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Severe persistent hypertension (>180/110) without Red flags (see emergency section)

 

 

Hypertension that is difficult to control

Medication intolerance

Changing pattern of hypertension

Suspected renal artery stenosis (consider referral to vascular if available)

Refractory hypertension patients on three or more medications with BP >140/90

No category 3 criteria

 

Lipid Disorders

Essential information (Referral will be declined without this)

  • General Referral Information
  • Details of all treatments offered and efficacy
  • Relevant previous medical history and co-morbidities (especially cardiovascular disease)
  • BP
  • ELFTs, HbA1c, TSH, CK results
  • Fasting lipid results (cholesterol/ triglyceride/ HDL-cholesterol/ LDL-cholesterol)

Additional referral information (useful for processing the referral)

  • Smoking and alcohol history
  • Height, weight & BMI
  • Family history of hyperlipidaemia
  • Previous lipid results (serial if available)
  • Any imaging confirming presence of cardiovascular disease
  • Coronary artery calcium score

Other useful information for management (not an exhaustive list)

  • Consider commencing statins depending on  other cardiac risk factors
  • Depending on cardiac risk factors consider commencing statins
  • The Heart Foundation’s Lipid Management Guidelines provide some additional guidance for patient management
  • The QRISK®2 calculator is helpful in assessing cardiovascular disease risk
  • Patients with moderate hyperlipidaemia (total cholesterol 5 – 10mmol/L and/or triglycerides < 4mmol/L) may be referred to a general physician rather than a cardiologist depending on local services.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Total cholesterol > 10 mmol/l and triglyceride < 10 mmol/l in patient having had cardiovascular event in the preceding 3 months

Total triglyceride > 50mmol/l in patient having had episode of pancreatitis in the previous 3 months 

 

The following conditions not responsive to maximal tolerated therapy or statin intolerance

  • Hypercholesterolaemia
  • Hypertriglyceridaemia
  • Dyslipidaemia

Statin intolerance

Hyperlipidaemia not able to be managed in general practice

Patients with suspected familial hypercholesterolaemia

High cardiovascular risk +/- raised calcium score on CT

 

Murmurs

Essential information (Referral will be declined without this)

  • General Referral Information
  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • Past medical history (including rheumatic fever) and comorbidities
  • Family history of sudden cardiac death or premature coronary artery disease
  • History of smoking and drug use (including alcohol)
  • FBC, ELFTs, TSH, fasting lipids results
  • ECG
  • Exercise tolerance 

Additional referral information (useful for processing the referral)

  • Echocardiogram report
  • CXR report
  • Include if appropriate gestational and development history

Other useful information for management (not an exhaustive list)

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

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Murmur with heart failure symptoms (NYHA Class II-III)

Severe valve stenosis or regurgitation on echocardiograph without Red flags (see emergency section)

Stenosis or regurgitation with left ventricular dysfunction and/or pulmonary hypertension without Red flags (see emergency section)

 

Murmur with heart failure symptoms (NYHA Class I-II)

Moderate valve stenosis or regurgitation  with normal ventricular function, and no pulmonary hypertension

Asymptomatic murmur

Mild valve stenosis or regurgitation on echocardiograph with normal ventricular function and no pulmonary hypertension

 

Palpitations

Essential information (Referral will be declined without this)

  • 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 and Magnesium  results
  • 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 
  • Caffeine intake, alcohol intake and drug use (including recreational drug use) 

Other useful information for management (not an exhaustive list)

  • ECG at the time of palpitation (even if normal) may have important diagnostic clues

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

Palpitations in the presence of underlying cardiac disease

Palpitations with abnormal ECG

Frequent and persistent palpitations

 

No category 2 criteria

Frequent or persistent palpitations with no haemodynamic features

 

Syncope / Pre-Syncope

Essential information (Referral will be declined without this)

  • General Referral Information
  • Details of all treatments offered and efficacy
  • Relevant medical history (consider timeline, precipitating factors, any warning pre-syncopal symptoms, complete LOC or partial, duration of LOC, nature of recovery, witnessed signs, seizures, pallor, incontinence, cyanosis, irregular or absent pulse during attack, associated injury).
  • Lying / standing or sitting / standing BP
  • Family history of sudden cardiac death or premature coronary artery disease
  • Presence of impaired LV function by any imaging modality (MRI, echo or MPS) if known
  • FBC, TSH, ELFTs, magnesium results
  • All available ECGs       

Additional referral information (useful for processing the referral)

  • Holter monitor report (only useful if frequent symptoms)
  • Echocardiogram report
  • CXR report      

Other useful information for management (not an exhaustive list)

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

New episode(s) of syncope / near syncope without Red flags (see emergency section)      

 

Recurrent syncope previously investigated with undetermined cause         

No category 3 criteria     

 

Other Cardiology Conditions

Essential information (Referral will be declined without this)

Additional referral information (useful for processing the referral)

  • Cardiac Investigations – results of any investigations if available (ECG, ECHO, stress test, chest x-ray)

Other useful information for management (not an exhaustive list)

  • Nil other information

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Category 1 – urgent

Clinically recommended timeframe for initial appointment is 30 days

Category 2 - Priority

Clinically recommended timeframe for initial appointment is 90 days

Category 3 - Routine

Clinically recommended timeframe for initial appointment is 365 days

 


Our Specialists

A/Prof. Karam Kostner

Director of Cardiology - general cardiology, imaging, primary prevention and lipid disorders

Dr Adrian Chong

Cardiologist - general cardiology, imaging

Dr Mugurel Nikolai

Cardiologist - general cardiology, adult congenital heart disease

Dr Przemek Palka

Cardiologist - general cardiology, imaging 

Dr Sandhir Bhawan Prasad

Cardiologist - general cardiology, imaging 

Kerry Anne Creevey

Heart Failure nurse

Paul Camp

Cardiac rehab Nurse

 

Bulk Billed Clinics

Mater Health Services offers patients the opportunity to attend bulk billed clinics. To provide your patient with the opportunity to attend a bulk billed specialist clinic, please provide a named referral to one of our specialists listed above.

Contact Us

If you would like to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200.  

Current Waiting Time for Appointments

We provide up to date data on how long patients are waiting for their clinic first appointment by specialty here.

Referral Guideline Development

These Mater Referral Guidelines have been developed locally by GPs and specialists to support safe and quality referral to publicly funded specialist outpatient services.

 

Content last reviewed: 14 Feb 2018

 

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