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