Jan 24, 2019 0

Contributor: Imre Hunyor, Alex Elder

Editor: Grace Leo

Reviewer: Sophie Offen

Know if they have a history of heart disease.
Arrange an ECG before the cardiology review and have a go at interpreting it yourself before you make the phone call. You will always be asked what it shows, and even if you’re not 100% correct it’s good practice!
Know what clinical question you would like to be addressed – e.g. anti-coagulation, rate control, titration of CCF medications.
Consults are generally seen within 24 hours, but if you think your patient needs to be reviewed more urgently then relay the reason for this up front. For example, ‘I am worried about our patient who has acute onset cardiac sounding chest pain with a concerning ECG.’

Prior history of heart disease (AMI/CABG/PTCA/arrhythmias/heart failure).
Collection of letters from patient’s cardiologist is very helpful.
Current medications.
Previous cardiac investigations.
How severe the problem is – has the patient decompensated? E.g. palpitations/pre-syncope/chest pain with AF, hypoxic/orthopnoea/PND with CCF.

Examinations: Vital signs, clinical signs of heart failure.
Investigations: Recent ECG (ideally on day of consult!), CXR. Bloods – EUC, FBC, CK/troponins if consult is regarding chest pain.
Transthoracic echocardiogram if there is a new diagnosis of heart failure or a significant de-compensation. If the patient has known/stable heart failure, then an outpatient echocardiogram within the last 12 months will usually suffice.

For AF – identification of risk factors for stroke (e.g. using CHA2DS2VASc.)
Be specific with your clinical question: For example, if asking about management of new atrial fibrillation, a mediocre consult question may be: “Please advise on management of AF.” A better consult question would be: “Please advise on the management of new AF in a patient with CHADS2 score of 2 and recurrent falls. Should we anti-coagulate?” The second question shows that you have assessed the bleeding risk against the stroke risk and specifically want advice on anti-coagulation. This additional information will ensure that we answer the question you’re interested in.

Not doing their homework first. Outpatient correspondence and results of investigations are very useful if the patient has been seen a cardiologist previously.
Not having information at your fingertips. Have the patient file/medical chart and results at hand if requested over the phone. This will help the consulting registrar help you!