Cardiac Investigations for Breathless Patients

Breathlessness

The majority of 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 opens a new window” section for eligibility and referral criteria.

Other symptoms including patients with persistent post-COVID symptoms

Note that information regarding respiratory symptoms post-COVID can be found on the COVID-19 Post Covid Breathlessness opens a new windowRefhelp page.

Patients with breathlessness, tachycardia, or reduced exercise intolerance can be referred for a 12 lead ECG initially. If this is abnormal an echocardiogram can be requested directly, (see referrals for echocardiography opens a new window).

Patients with persistent tachycardia can be requested to have ambulatory monitoring (see Direct Access Ambulatory ECG opens a new window).

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

C.W & C.S 14-02-23

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.