Murmur

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

Direct Referral to Cardiology Clinic

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

  • Physical findings including colour assessment or oxygen saturation
  • Report presence or absence of the following:
    • - History of exercise intolerance
    • - Cyanotic episodes or blue spells
    • - Weak or absent femoral pulses
    • - Clubbing

Highly desirable information - may change triage category

  • Known other congenital abnormalities
  • Family history of congenital cardiac disease
  • Aboriginal or Torres Strait Islander or Maori status (acute rheumatic fever / rheumatic heart disease risk)

Tests

Pathology:

  • FBC
  • UEC
  • TFT

Imaging:

  • Nil

Investigations:

  • Any relevant e.g. echocardiogram report

Interim/GP management

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

Desirable information - will assist at consultation

  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Significant psychosocial risk factors (especially parent’s mental health, family violence, housing and financial stress, department of child safety involvement).
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology.
  • Any relevant laboratory results or medical imaging reports, urinalysis result.

Interim management advice for Heart Murmurs in Adults can be found on HealthPathways.

For more information please see the Tasmanian Health Pathways website.

Emergency

New murmur with any of the following concerning features:

  • haemodynamic instability
  • persistent or progressive shortness of breath with marked limitation of physical activity or worse.
  • chest pain
  • syncope / pre-syncope / dizziness
  • neurological deficit indicative of TIA/stroke
  • abnormal ECG (e.g. LV hypertrophy, AF, LBBB, RBBB)
  • fever or constitutional symptoms suggestive of infection (eg endocarditis, acute rheumatic fever)
  • signs of heart failure

Urgent / category 1

Murmur with heart failure symptoms without emergency referral concerning features

Severe valve stenosis or regurgitation as described on echo report without emergency referral concerning features

Stenosis or regurgitation with left ventricular dysfunction and/or pulmonary hypertension without emergency referral concerning features

Previous valve surgery with new heart failure symptoms without emergency referral concerning features

New or worsening heart failure symptoms in patient with a history of rheumatic fever or rheumatic heart disease without emergency referral concerning features

Semi-urgent / category 2

* Moderate valve stenosis or regurgitation as described on echo report with normal ventricular function, and no pulmonary hypertension

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

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