Hypertension (Cardiology)
Adult

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Angina / myocardial ischaemia / chest pain

Suspected acute coronary syndrome
Suspected pulmonary embolism or aortic dissection
Suspected or confirmed endocarditis, myocarditis or pericarditis or pericarditis
Suspected ischaemic chest pain within 24 hours that is associated with any of the following concerning features:
- Severe or ongoing chest pain
- Ischemic chest pain lasting ten minutes or more
- Recurrent chest pain that is new at rest or occurring with minimal activity
- Chest pain accompanied by severe dyspnoea
- Chest pain associated with any of the following clinical signs:
  - syncope / pre-syncope
    o respiratory rate > 30 breaths per minute
  - tachycardia >120
  - systolic BP < 90mmHg
  - heart failure / suspected pulmonary oedema
  - ST elevation or depression
  - complete heart block
    o new left bundle branch block

Atrial fibrillation / flutter

Atrial fibrillation / flutter with any of the following concerning features:
- Haemodynamic instability
- Shortness of breath
- Chest pain
- Syncope/pre-syncope/dizziness
- Evidence of pre-excited QRS (delta waves)
- Neurological deficit indicative of TIA/stroke
- Uncontrolled Tachycardia/heart rate despite medical therapy

Aortic Disease

Suspected chest pain within 24 hours that is associated with any of the following concerning features:
- Severe or ongoing chest pain
- Ischemic chest pain lasting ten minutes or more
- Recurrent chest pain that is new at rest or occurring with minimal activity
- Chest pain accompanied by severe dyspnoea
- Chest pain associated with any of the following clinical signs:
  - syncope / pre-syncope
  - respiratory rate > 30 breaths per minute
  - tachycardia >120 bpm
  - systolic BP < 90mmHg
  - heart failure / suspected pulmonary oedema
  - ST elevation or depression
  - complete heart block
  - new left bundle branch block

Heart Failure

Acute or chronic heart failure with any of the following concerning features:
- NYHA Class IV heart failure
- Ongoing chest pain
- Significant orthopnoea/PND
- Oxygen saturation < 90%
- Clinical and/or radiographic signs of acute pulmonary oedema
- Haemodynamic instability:
  - pre-syncope / syncope / severe dizziness
  - altered level of consciousness
  - heart rate > 120 beats per minute
  - systolic BP < 90mmHg with symptoms of hypoperfusion
  - systolic BP < 80mmHg irrespective of symptoms
Significant pulmonary or pedal oedema
Recent myocardial infarction (within 2 weeks)
Pregnant patient
Signs of myocarditis
Signs of acute decompensated heart failure

NB: Early discussion with the patient’s usual heart failure team would be advised for local care protocols

Hypertension

Hypertensive emergency (BP>220/140)
Severe hypertension with systolic BP >180mmHg with any of the following concerning features:
- Headache
- Confusion
- Blurred vision
- Retinal haemorrhage
- Reduced level of consciousness
- Seizures
- Proteinuria
- Papilloedema
- Signs of heart failure
- Chest pain

If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible.

Murmur

New murmur with any of the following concerning features:
Haemodynamic instability
Persistent or progressive shortness of breath (NYHA Class III – IV)
Chest pain
Syncope / pre-syncope / dizziness
Neurological deficit indicative of TIA/stroke
Abnormal ECG (e.g. LV hypertrophy, AF, LBBB, RBBB)
Fever or constitutional symptoms suggestive of infection (eg endocarditis, acute rheumatic fever)
Signs of heart failure

Palpitations

Palpitations with any of the following concerning features:
- chest pain
- shortness of breath
- loss of consciousness
- syncope / pre-syncope
- persisting tachyarrhythmia on ECG

Supraventricular tachycardia

Unresolved acute supraventricular tachycardia with any of the following concerning features
- Syncope
- Severe dizziness
- Ongoing chest pain
- Increasing shortness of breath
- Hypotension
- Signs of cardiac failure
- Ventricular rate >120 bpm

Syncope/pre-syncope

Syncope with any of the following concerning features:
- Exertional onset
- Chest pain
- Persistent hypotension (systolic BP <90mmHg)
- Severe persistent headache
- Focal neurological deficits
- Preceded by or associated with palpitations
- Known ischaemic heart disease or reduced LV systolic function
- Associated with SVT or paroxysmal atrial fibrillation
- Evidence of pre-excited QRS (delta waves) on ECG
- Suspected malfunction of pacemaker or ICD
- Absence of prodrome
- Associated injury
- Occurs while supine
- Seizures

Useful Management Information

Refer to HealthPathways for assessment and management information if available
The Heart Foundation Hypertension Guidelines provide some additional guidance for patient management.
Nomenclature has also been redefined by KDIGO and may be worth reassessing
KHA Fact Sheet – Blood pressure and chronic kidney disease
Hypertension may impact on a patient’s medical fitness to drive. The Queensland Government’s Transport and Motoring website and Austroads - Assessing Fitness to Drive website has advice about managing driving

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	All hypertension referrals would be triaged to General Medicine , unless the referral contains specific clinical indicators warranting sub-specialist review. Referrals may be allocated to Kidney Medicine, Cardiology, or Endocrinology where clearly justified by comorbidities, diagnostic complexity, or suspected secondary causes of hypertension. Hypertension with symptoms suggestive of angina Hypertension with symptoms suggestive of heart failure
Category 2 (appointment within 90 calendar days)	Uncontrolled hypertension in the context of a history of symptomatic ischaemic heart disease or previous coronary revascularisation Uncontrolled hypertension in the context of known cardiomyopathy (or heart failure)
Category 3 (appointment within 365 calendar days)	No category 3 criteria

Category 1 (appointment within 30 calendar days)

All hypertension referrals would be triaged to General Medicine , unless the referral contains specific clinical indicators warranting sub-specialist review. Referrals may be allocated to Kidney Medicine, Cardiology, or Endocrinology where clearly justified by comorbidities, diagnostic complexity, or suspected secondary causes of hypertension.

Hypertension with symptoms suggestive of angina
Hypertension with symptoms suggestive of heart failure

Category 2 (appointment within 90 calendar days)

Uncontrolled hypertension in the context of a history of symptomatic ischaemic heart disease or previous coronary revascularisation
Uncontrolled hypertension in the context of known cardiomyopathy (or heart failure)

Category 3 (appointment within 365 calendar days)

No category 3 criteria

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Medical History & Clinical Background:
- Detailed medical history emphasising any cardiac, renal, or endocrine concerns.
- History of blood pressure (BP) measurements (preferred both arms), including 24-hour or home measurements if available.
- Current medication list, including over the counter (OTC) medications, and detailing all treatments tried, including efficacy.
Cardiac Investigations:
- Electrocardiogram (ECG).
- Echocardiogram*
- Fasting lipid profile.
Imaging & Other Diagnostic Tests:
- Chest X-ray report.
Laboratory Investigations:
- Full Blood Count (FBC).
- Electrolytes, Liver Function Tests (LFTs).

*Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Additional Referral Information

History of smoking, alcohol intake and drug use (including recreational drugs)
Ethnicity highlighting Aboriginal and Torres Strait Islander population especially at risk
Records and results of investigations pertinent to co-morbidities or tests excluding other secondary causes (e.g., sleep studies).

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Cardiology qhRefer

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Rohan Jayansinghe

Medical Director Cardiology

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Hypertension (Cardiology)Adult