referral criteria from primary care - stable angina

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Referral to a cardiologist with patient with angina/suspected angina

  • early referral to cardiologists should be considered in the following patients:
    • new onset of chest pain suspected to be ischaemic of origin (1)
    • exacerbation of stable angina (1)
    • recurrence of old angina (1)
    • results of the exercise tolerance test is highly abnormal
    • history of myocardial infarction, coronary artery bypass graft, or percutaneous transluminal coronary angioplasty and development of angina (2)
    • evidence of previous MI or other abnormality in the initial ECG (3)
    • newly diagnosed atrial fibrillation
    • cardiac failure and angina (2)
    • an ejection systolic murmur suggesting aortic stenosis (3,4)
    • treatment failure despite maximum therapeutic doses of two drugs

  • additional reasons for cardiologist referral include:
    • doubt about the diagnosis of patients with uncertain or atypical symptoms
    • presence of several risk factors or a strong family history "
    • patients wish for an early referral
    • problems with employment, life insurance, or unacceptable interference with lifestyle
    • significant comorbid disease e.g. - diabetes (3)

Note that if suspected unstable angin/myocardial infarction then this requires immediate referral to secondary care.


Last reviewed 09/2019