Cardiology is the branch of medicine that deals with disorders of the heart and the cardiovascular system.
Our CASES reviewers can help give advice on the options available for patients with cardiovascular problems. This page provides resources for GPs that may help with management of a range of common issues
1. Palpitations: Ideally do blood tests including TFTs, calcium, FBC to exclude anaemia, 12 lead ECG and holter/24 hour tape via community providers before referral, and please attach the full report to the referral.
2. Cardiac sounding stable chest pain: Ideally do an ECG at earliest possible opportunity and start aspirin, statin and GTN at time of referral if sounds like a good story for angina. Please attach a good quality, readable scan of any 12 lead ECGs taken as these are not stored at STH. There is no rapid access chest pain service at STH (though the option still exists on ERS). Instead, if your patient has chest pain of recent (4 week or less) origin, please refer directly as an urgent referral, not through CASES.
3. Breathlessness: Ideally check ECG, CXR, spirometry and blood tests to exclude anaemia and do NTproBNP before referral.
4. Syncope: Ideally patients who sound like vasovagal syncope or POTS, encourage a teaspoon of table salt and 2.5litres of fluid per day at time of seeing.
5. Atrial fibrillation: Ideally use the guidance on the CCG meds management page (advice on anticoagulation, DOAC dosing guidance and renal function, and assess CHADS2VASC and ORBIT scores and anticoagulate at soonest opportunity.
6. Hyperlipidaemia: Ideally use the Sheffield lipid guidelines before considering referral to secondary care and refer to biochemistry lipid clinic run by Dr Delaney and colleagues.
7. Hypertension: Ideally treatment in primary care following NICE guidance unless multiple intolerances, very high BP, very young, secondary cause likely or resistance to treatment. The majority of referrals for hypertension in Sheffield are assessed by the Nephrology team rather than Cardiology, so please ask your secretary to refer directly there using eRS. If there are no recent U&E, urine ACR or ECG reports please arrange these to assess end organ damage.
8. Murmurs: Ideally if a new murmur then investigate with an open access echocardiogram. If referring someone with possible worsening of known valve disease it is helpful to get an up to date echo by same pathway.
9. Heart failure: Ideally if new symptoms of suspected heart failure, perform blood tests including NT pro BNP, ECG and chest x-ray. If BNP is >400 consider referring to the Heart Failure Assessment Clinic using the referral form on the clinical system or PRESS portal. Note if BNP >2000 the referral should be marked as urgent. For those diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) please follow the guidance from the meds management team/Prof Al-Mohammad .
10. Patients with an exacerbation of known coronary artery disease or previous revascularisation: ideally do blood tests to exclude non-cardiac causes of worsening e.g. anaemia and uptitrate or add antianginals at time of referral.