CHD referral and discharge pathways

1
CHD referral and discharge pathways
2
Chest Pain
Patient presents with
HX EXAM
?CARDIAC
DIAL 999 AE
STABLE
UNSTABLE
FBC, UEs, TFTs, CHOL
IF 1ST PRESENTATION REFER TO RACPC (IF WITHIN
CRITERIA)
IF KNOWN CARDIAC PT REFER TO CARDIOLOGIST (For
ongoing Management)
NON- CARDIAC
ASSESSMENT /- ETT/PERFUSION
DISCHARGE TO GENERAL PRACTITIONER
ANGIO
MANAGE PT MEDICALLY
REVASC
DISCHARGE TO GPwSI OR GP
CARDIAC REHAB
3
Short of breath
Patient presents with
HX EXAM
OTHER
?CARDIAC
ACUTE AND UNWELL
STABLE
DIAL 999 AE
FBC, UEs, TFT, CHOL
IF APPROPRIATE FAST TRACK TO CARDIOLOGIST
ALL REFERRALS TO GPwSI
CLINICAL ASSESSMENT CXR, ECG.
ECHOCARDIOGRAM
CARDIOLOGIST OUTPATIENT CLINIC
DISCUSSION WITH CARDIOLOGIST
4
Palpitations
Patient presents with
HX EXAM
HX SUGGESTS ECTOPICS NO RISK FACTORS (See Box
below)
ABNORMAL PULSE
IF NORMAL PULSE
DO AN ECG
FBC, UEs, TFT, CHOL
CONFIRMS AF/ FLUTTER
REFER TO NURSE-LED CLINIC ACCORDING TO CLINIC
PROTOCOL
FOLLOW NICE GUIDANCE FOR AF/FLUTTER
24 HOUR HOLTER OR EVENT RECORDER, CXR, ECG, /-
ECHOCARDIOGRAM
RISK FACTORS Known cardiac disease Associated
syncope / SOB presyncope / CP FHX of SCD
IF HIGH RISK REFER CARDIOLOGIST
FOR FURTHER INVESTIGATION(S) AND TREATMENT
IF LOW RISK DISCHARGE PT
5
Murmurs
Patient presents with
HX EXAM
lt16 YEARS OLD
16 YEARS OLD OR ABOVE
UNSTABLE SYMPTOMS
NO SYMPTOMS OR STABLE
REFER TO PAEDS
REFER TO AE
REFER TO GPwSI FOR ECHO OR GP OPEN ACCESS ECHO
NORMAL OR MILD ANOMALY
SIGNIFICANT VALVULAR ANOMALY
REFER TO AE CARDIOLOGIST
DISCHARGE PATIENT APPROPRIATELY
REFER TO CARDIOLOGIST
6
Hypertension
Patient presents with
HX EXAM
ASSESS PT ACCORDING TO NICE GUIDANCE
i.e URINALYSIS, UEs, ECG, LIPID PROFILE
CONFIRM DIAGNOSIS WITH MULTIPLE B/P READINGS
IF END ORGAN DAMAGE OR FEATURES
SUGGESTING PRIMARY CAUSE
IF NO CARDIAC SYMPTOMS REFER TO NEPHROLOGIST (DR
SHARMAN - KGH) (DR FAHAL QUEENS)
IF ASSOCIATED CARDIAC SYMPTOMS REFER
CARDIOLOGIST
PLEASE SEE NICE GUIDANCE ON CHOOSING DRUGS FOR
PATIENTS NEWLY DIAGNOSED WITH HYPERTENSION
AND BETA-BLOCKERS BELOW (Link and next
slides.) http//www.nice.org.uk/page.aspx?oCG034q
uickrefguide
7
NICE Guidance on Hypertension treatment
8
Beta - blockers