Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
You should consider referring a patient with bradycardia for further cardiological evaluation in several circumstances, particularly if there are associated symptoms or specific ECG findings.
- Urgent Referral (within 24 hours):
- Refer urgently if the patient has a history of syncope or near syncope alongside bradycardia NICE CKS.
- If the patient has experienced Transient Loss of Consciousness (TLoC) and their 12-lead electrocardiogram (ECG) shows an abnormality such as a conduction abnormality (e.g., any degree of heart block) or inappropriate persistent bradycardia NICE CG109. This referral should be reviewed and prioritised by a specialist within 24 hours NICE CG109.
- Urgent referral is also indicated if TLoC occurs during exertion NICE CG109.
- Consider urgent referral if there is a family history of sudden cardiac death in people aged younger than 40 years and/or an inherited cardiac condition NICE CKS,NICE CG109.
- For patients aged over 65 years who have experienced TLoC without prodromal symptoms, consider referring within 24 hours for cardiovascular assessment NICE CG109.
- Routine Referral:
- Refer routinely to cardiology if the 12-lead ECG shows second-degree or third-degree atrioventricular block NICE CKS.
- Consider routine referral if the patient has accompanying chest pain or lightheadedness NICE CKS.
- Refer if there is a history or physical symptoms of structural heart disease, heart failure, or hypertension NICE CKS.
- If a resting ECG abnormality, other than second-degree or third-degree atrioventricular block, is present NICE CKS.