Direct to an emergency department for:

  • Syncope or pre-syncope with any of the following:
    • exertional onset
    • chest pain
    • persistent hypotension (systolic blood pressure < 90 mmHg) or bradycardia (< 50 beats per minute) on electrocardiogram (ECG)
    • evidence of second, or third-degree block on electrocardiogram (ECG)
    • severe, persistent headache
    • focal neurological deficits
    • preceded by, or associated with, palpitations
    • known ischaemic heart disease or reduced left ventricular systolic function
    • associated with supraventricular tachycardia (SVT) or paroxysmal atrial fibrillation
    • ‘pre-excited’ QRS wave on electrocardiogram (ECG)
    • suspected malfunction of a pacemaker or implantable cardioverter defibrillator (ICD)
    • absence of prodrome
    • associated injury
    • occurs while supine or sitting.

Criteria for referral to public hospital specialist clinic services

  • New episode(s) of syncope or pre-syncope (after any emergency assessment)
  • Recurrent syncope with undetermined cause.

Information to be included in the referral

Information that must be provided

  • Description of syncopal or pre-syncopal events and associated features
  • Lying or sitting / standing blood pressure
  • Relevant medical history
  • Any family history of sudden cardiac death or cardiac disease
  • Recent electrocardiogram (ECG) tracings, relevant to syncopal or pre-syncopal events
  • Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs).

Provide if available

  • Any imaging results that show the presence of impaired left ventricular function
  • Holter monitor report
  • Echocardiogram report
  • Recent urea and electrolytes
  • Recent full blood examination
  • Recent thyroid stimulating hormone (TSH) level
  • If the person identifies as an Aboriginal and Torres Strait Islander.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Note: there are also neurology and ENT statewide referral criteria for Vertigo. See Vertigo (ENT) and Vertigo (neurology).

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

  • Patients with mild or brief orthostatic dizziness
  • Dizziness due to a medicine or hypoglycaemia
  • Dizziness due to chronic fatigue syndrome.