Cardiac investigations for breathless patients

Breathlessness

Most patients with breathlessness do not have an underlying cardiac cause. However, presence of an abnormal ECG, cardiomegaly, audible cardiac murmur or clinical/radiological evidence of cardiac failure increases the likelihood for a heart failure diagnosis. Please see “Heart Failure” section for eligibility and referral criteria.

Patients with breathlessness, tachycardia, or reduced exercise intolerance should have a 12 lead ECG initially.

All patients with suspected heart failure should have an ECG and NT pro BNP. If BNP is raised, then an echocardiogram can be requested directly. (see BGH guidance)

Patients with persistent tachycardia can be requested to have ambulatory monitoring.

If the echocardiogram or Holter monitor show abnormalities, patients can then be referred to General Cardiology.

Who to refer, who not to refer, how to refer

Who to refer:

Patients where a cardiac cause is suspected due to clinical features (abnormal ECG, cardiomegaly, audible cardiac murmur or clinical/radiological evidence of cardiac failure) or where the diagnosis remains unclear and there is a high clinical index of suspicion for underlying cardiac cause.

Who not to refer:

Patients with breathlessness whose clinical features do not suggest a cardiac cause.

How to refer:

See above for information regarding where to direct your referral and how to refer.

Resources and links

https://www.chss.org.uk/chest-information-and-support/living-with-your-chest-condition/breathlessness/

Local service details

Pinky.yadav@borders.scot.nhs.uk