Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
When considering referring a patient with pericardial effusion to secondary care for further evaluation or intervention, focus on the patient's symptoms, cardiac function, and any underlying conditions.
- Urgent Referral Considerations:
- Refer urgently (within 2 weeks) for specialist assessment and transthoracic echocardiography if the patient has suspected heart failure with an N-terminal pro-B-type natriuretic peptide (NT-proBNP) level above 2,000 ng/litre (236 pmol/litre) NICE NG106.
- Consider urgent (within 2 weeks) specialist assessment that includes echocardiography for adults with a systolic murmur and exertional syncope NICE NG208.
- Consider urgent (within 2 weeks) specialist assessment that includes echocardiography for adults with a murmur and severe symptoms such as angina or breathlessness on minimal exertion or at rest, if thought to be related to valvular heart disease NICE NG208.
- Refer to a cardiologist if the patient has syncope or presyncope (unless clearly due to postural hypotension), particularly if they have a reduced ejection fraction, as this may indicate ventricular tachycardia NICE CKS.
- If a recent (confirmed or suspected) acute coronary syndrome (ACS) is present and the patient develops further chest pain, refer to hospital as an emergency NICE CG95.
- Non-Urgent Referral Considerations:
- Refer for specialist assessment and transthoracic echocardiography within 6 weeks if the patient has suspected heart failure with an NT-proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) NICE NG106.
- Refer to a specialist if the patient has moderate or severe valve disease of any type NICE NG208.
- Refer to a specialist if the patient has bicuspid aortic valve disease of any severity, including mild valve disease NICE NG208.
- Refer pregnant women or women who are considering a pregnancy to a cardiologist with expertise in the care of pregnant women if they have moderate or severe valve disease, bicuspid aortic valve disease of any severity with associated aortopathy, or a prosthetic valve, regardless of symptoms NICE NG208.
- Diagnostic Context:
- Echocardiography is used to assess cardiac function and can identify pericardial effusion NICE CKS.
- If heart failure symptoms deteriorate and the pulse is regular, consider arranging an ECG to assess for atrial tachycardia NICE CKS.
- When an acute coronary syndrome is not suspected, consider other life-threatening causes of chest pain such as pulmonary embolism or aortic dissection NICE CG95.