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Medical same day emergency care (MSDEC) referrals to Cardiology

This page is intended for use by clinicians at Queen Elizabeth Hospital Birmingham as a guideline for referring patients to Cardiology.

How to refer

If a patient needs further input from Cardiology, please refer via the following methods:

Cardiology emergency

If you suspect a cardiology emergency or need to speak directly with the Cardiology team, please contact: 

  • cardiac nurses via switchboard from Monday to Sunday, 08:00 - 20:00 
  • cardiology registrar via switchboard who will be available at all hours 

Monday to Sunday (all hours)

  • Refer all patients via PICS (Requests > Cardiology Review Referral UHB and the registrar or above to request)
  • Between Monday to Sunday from 08:00-20:00, referrals will be triaged by cardiology nurses and the patient will be reviewed accordingly
  • Cardiac nurses do not need to be routinely called to be informed of the referral
  • If the referral is not urgent and outside the above hours, but you feel the patient needs to stay in for an inpatient review, the referral will be triaged in the morning and the Cardiology team will review in MSDEC during normal working hours
  • Do not refer patients for an outpatient appointment via PICS, contact the Cardiology consultant's secretary to arrange an outpatient appointment

Suspected heart failure

Refer patients with suspected heart failure via PICS (Request > Heart failure referral).

How to request an echocardiogram in MSDEC

  • Submit a request via PICS (Request > Transthoracic Echocardiography (TTE) – Standard) 
  • Emergency echocardiogram: 
    • Contact Joe Bradley (available on Monday, Wednesday, Thursday and Friday between 08:00-17:30) on 07393 752 205
  • Emergency echocardiogram out of hours: 
    • Consider admitting the patient for an inpatient echocardiogram and specialist review 
  • Urgent requests (required within next two weeks): 
    • Submit a PICs request as above, select the urgency and in additional information provide the relevant information needed to ensure the echo is performed promptly as an SDEC returner, indicating the time frame you would like to echo to be completed. The requests will be triaged and booked by Joe Bradley into an available SDEC returner slot. (Five slots are available on Mondays, Wednesdays and Fridays for urgent echo SDEC returners) 
  • Non-urgent requests: 
    • can be performed within six weeks in the Outpatient department or sooner as an SDEC returner if enough slots are available. 
  • Only request an echocardiogram if advised by the registrar or consultant 
  • Ensure the following have been completed and included to request an echocardiogram: 
    • ECG, weight, height 
    • Bloods: FBC, U+Es, CRP, TFTs, calcium, magnesium, troponin (if relevant), NT-proBNP, d-dimer (if relevant) 
    • CXR 
    • Correct contact details including an address and contact details 
  • Please note: 
    • Patients with suspected heart failure (based on symptoms and signs) require an echo to confirm the diagnosis but if they already have an echo showing left ventricular dysfunction, they do not need another 
    • If an echocardiogram has already been performed, repeat only if there is a discrepancy between previous result and current clinical presentation, or if a new or worsening murmur is apparent 
  • If the request is out of hours, please consider admitting the patient for monitoring 

Echocardiogram timings

Emergency (less than 24 hours)

  • Acute decompensated Heart failure (NYHA III-IV)
  • Suspected large volume pericardial effusion/tamponade
  • AF with adverse features (needs adequate rate control first)
  • Suspected cardiomyopathy or moderate-severe valvular heart disease with adverse features
  • Pulmonary embolism with right heart strain
  • Aortic dissection
  • Tachy/bradyarrhythmia with adverse features* 

Urgent (less than two weeks)

  • Suspected Heart failure with BNP > 2000ng/L
  • AF with suspected stable heart failure
  • Suspected stable moderate-severe valvular heart disease
  • Suspected cardiomyopathy without adverse features
  • tachy/bradyarrhythmia detected on holter monitor without adverse features
  • Pregnant women without adverse features*

Non-urgent (less than six weeks)

  • Suspected heart failure with BNP 400-200ng/L
  • Pericardial disease
  • Newly diagnosed AF without adverse features
  • Suspected valvular heart disease without adverse features*
  • Abnormal ECG (i.e. hypertension related LVH or unexplained bundle branch block without adverse features)

*Adverse features include syncope, myocardial infarction, acute heart failure and cardiac arrest.

How to request a Holter monitor in MSDEC

  • Submit a request via PICS (Request > 24hr Holter)
  • Emergency Holter monitor or urgent requests (required within next two weeks):
    • 24hr Holter monitors are fitted by nursing and/or ECT staff on SDEC with relevant training. Ensure PICs request is completed and log in the diary that monitor has been given.   
    • Contact contact Joe Bradley (Monday to Friday, 08:00-17:30) on the above number
  • Patients requiring urgent 48 or 72 hour ambulatory monitoring:
    • Discuss with Joe Bradley to determine availability
  • Non-urgent requests:
    • Can be performed within six weeks in the outpatient department

Indications for 24-hour Holter monitoring

  • The following are indications for AECG as per the ACC/AHA(1) Guidelines for Ambulatory Electrocardiography: Executive Summary and Recommendations:  
    • Heart rate Variability (HRV)  
    • Assessment of symptoms that may be related to disturbances of heart rhythm, looking for arrhythmia for example patients suffering with syncope or pre-syncope or palpitations  
    • Assessment of risk in patients without symptoms of arrhythmias  
      • After myocardial infarction  
      • Congestive heart failure  
      • Hypertrophic cardiomyopathy  
    • Efficacy of antiarrhythmic therapy  
    • Ambulatory monitoring can be used to assess pacemaker and ICD function and for detection of Arrhythmias.  
    • Monitoring for myocardial ischemia  
    • Paediatric patients  
    • Patients who have had suspected TIA’s or Strokes, look to assess for Paroxysmal (PAF) Atrial Fibrillation or Atrial Fibrillation (AF) 
  • Only request a Holter monitor if advised by the registrar or consultant 
  • Ensure the following have been completed and included to request a Holter monitor: 
    • ECG, weight, height 
    • Bloods: FBC, U+Es, CRP, TFTs, Calcium, Magnesium, troponin (if relevant), NT-proBNP, d-dimer (if relevant) 
    • CXR 
    • Correct contact details including an address and contact details 

Last reviewed: 31 January 2025