When should I consider referring a patient with pericardial effusion to secondary care for further evaluation or intervention?

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) ⁴.
• Consider urgent (within 2 weeks) specialist assessment that includes echocardiography for adults with a systolic murmur and exertional syncope ³.
• 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 ³.
• 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 ².
• 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 ⁵.
• 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) ⁴.
• Refer to a specialist if the patient has moderate or severe valve disease of any type ³.
• Refer to a specialist if the patient has bicuspid aortic valve disease of any severity, including mild valve disease ³.
• 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 ³.
• Diagnostic Context:
• Echocardiography is used to assess cardiac function and can identify pericardial effusion ¹.
• If heart failure symptoms deteriorate and the pulse is regular, consider arranging an ECG to assess for atrial tachycardia ².
• When an acute coronary syndrome is not suspected, consider other life-threatening causes of chest pain such as pulmonary embolism or aortic dissection ⁵.