Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Indications for referral to a cardiologist in patients diagnosed with heart block include:
- Presence of second degree or third degree atrioventricular (AV) block on a 12-lead electrocardiogram (ECG) requires urgent referral to cardiology NICE CKS.
- High degree AV block detected on ECG in the context of palpitations or transient loss of consciousness (TLoC) warrants urgent cardiology assessment NICE CKS,NICE CG109.
- Patients with heart block who have symptoms such as syncope or near syncope, chest pain, or lightheadedness should be referred routinely or urgently depending on severity NICE CKS,NICE CG109.
- Family history of sudden cardiac death under the age of 40 years in a patient with heart block is an indication for urgent cardiology referral NICE CKS,NICE CG109.
- Evidence or suspicion of structural heart disease, heart failure, or hypertension in a patient with heart block should prompt routine referral to cardiology NICE CKS,NICE CG109.
- Any ECG abnormalities accompanying heart block, such as bundle branch block or other conduction abnormalities, support referral NICE CKS,NICE CG109.
- In the context of transient loss of consciousness, any conduction abnormality including any degree of heart block on ECG is a red flag requiring urgent cardiovascular assessment NICE CG109.
Referral urgency depends on clinical judgement but second or third degree AV block generally mandates urgent cardiology evaluation to assess for potential pacing or other interventions NICE CKS,NICE CG109.