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.
- 1.Coventry and Warwickshire University Hospitals (December 2009). Rapid Access Chest Pain Referral Pathway.
- 2 Clinical Knowledge Summaries 2009.Angina - Stable
- 3. Scottish Intercollegiate Guidelines Network (SIGN) 2001. Management of stable angina
- 4. Scottish Intercollegiate Guidelines Network (SIGN) 2007. Management of stable angina
Last reviewed 09/2019