Angina/Myocardial Ischaemia/Chest Pain

The Department will periodically contact patients waiting for an outpatient clinic appointment via SMS, with a link to an electronic form.  This is part of routine waitlist auditing to ensure patient details are up to date.  If you receive this SMS, please update your details.

Availability

North South North West Statewide

Pre-referral work-up

History

All referrals should comply with the Referral Standards and must include:

  • 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 cardiac disease or sudden cardiac death
  • Smoking status

Tests

    Pathology:

  • FBC
  • UEC
  • LFT
  • Lipids (chol, TG, HDL, LDL)
  • HbA1c (if diabetic)

    • Imaging:

  • Nil

    • Investigations:

    ECG

Interim/GP management

To refer a patient with this condition, please see the Cardiology clinic page for the full referral process and templates.

Other information which may be useful for triage:

  • Investigations relevant to significant comorbidities
  • Cardiovascular risk assessment score
  • Other investigations (if available) including CXR, cardiac imaging: stress test, stress echo or myocardial perfusion scan
  • History of alcohol intake and drug use (including recreational drugs)

Interim management advice can be found on the Tasmanian Health Pathways website.

For more information please see the Tasmanian Health Pathways website.

Emergency

suspected acute coronary syndrome
suspected pulmonary embolism or aortic dissection
suspected or confirmed endocarditis, myocarditis, or pericarditis
suspected ischemic chest pain within 24 hours with any of the following concerning features:

  • severe or ongoing chest pain
  • chest pain that is new at rest or with minimal activity
  • chest pain that is associated with severe dyspnoea
  • chest pain that is associated with syncope/pre-syncope
  • chest pain that is 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

Urgent / category 1

New cardiac chest pain of a possible cardiac origin but without any of the listed Emergency Referral concerning features (select to display above)
  Worsening pattern of angina in patients with established coronary heart disease but without any of the listed Emergency Referral concerning features (select to display above)
Low risk of cardiac chest pain with 3 or more cardiac risk factors (tick those that apply below)

Semi-urgent / category 2

* Chronic chest pain of a suspected cardiac origin not previously investigated but without any of the listed Emergency Referral concerning features (select to display above)
* Low risk of cardiac chest pain with 2 or less cardiac risk factors (tick those that apply below):

Routine / category 3

Unlikely to be cardiac chest pain but no found cause for pain
Cardiac Risk Factors
For all selections, please also tick applicable cardiac risk factors:
- aged > 65 years
- hypertension
- diabetes
- dyslipidaemia
- current or recent smoking
- first degree relatives with premature coronary artery disease (men aged < 55 years and women aged < 65 years).

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Additional Information

Please see:

Emergency:

Proceed to Emergency Department (ED).
LGH ED Reception  – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED* – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH ED* – Phone: (03) 6493 6351 Fax: (03) 6464 1926
RHH ED Reception – Phone: (03) 6166 6100  Fax: (03) 6173 0489

Advice for medical practitioners can be given by the Medical Officer In Charge (MOIC) - see HealthPathways Tasmania for contact information.
*MCH and NWRH MOICs request GPs call them prior to referring a patient to ensure the patient is being sent appropriately to a safe destination.

Urgent:

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review.

We will endeavour to see these patients within one week, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within four weeks

Routine:

Next available appointment usually within eight weeks