Rapid Access Chest Pain Clinic Referral



Rapid Access Angina Clinic Referral

This form is for Specialist assessment of patients with new-onset angina (within two weeks of referral)

Patients who do not fulfil referral criteria will be seen in Cardiology Outpatients within 5 weeks

Yes No

Referral Criteria

1. First presentation of typical cardiac sounding chest pain (e.g. exertional) 40 years

NB Patients with a suspected acute coronary syndrome should attend A&E

Exclusion criteria (patients will be offered an appointment with Cardiology outpatients)

1. Known Ischaemic heart disease

2. Undiagnosed murmur or known valvular disease

3. Patients with palpitations, arrhythmias, dizzy spells, or blackouts

4. Uncontrolled hypertension (SBP>180;DBP>110)

5. Clinical evidence of heart failure

6. Atypical chest pain / presentation in absence >2 risk factors

7. Chest pain > 2 months duration

Please fax to: 01444 456179

Incomplete forms will be rejected and will result in delays for your patient and access to RACPC

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Name: GP:

DOB: Address:

Hospital ID:

Address:

Tel: Tel:

History

Risk factors

Diabetes [pic] Hyperlipidaemia [pic] PVD [pic]

Smoking [pic] Family history IHD ................
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