When should I consider referring a patient with cardiomegaly to a cardiologist for further evaluation?

Consider referring a patient with cardiomegaly to a cardiologist for further evaluation when:

• There is suspicion or evidence of heart valve disease, especially if moderate or severe valve disease is present, or if bicuspid aortic valve disease of any severity is identified. Referral should follow echocardiography findings to a specialist for assessment and management ¹.
• The patient has symptoms suggestive of significant cardiac dysfunction such as breathlessness, angina, peripheral oedema, or exertional syncope, particularly if these are thought to be related to valvular heart disease or heart failure ¹,².
• There is evidence or suspicion of heart failure, especially if NT-proBNP levels are elevated above 400 ng/litre, with urgent referral (within 2 weeks) if levels exceed 2000 ng/litre, to confirm diagnosis and initiate specialist management ².
• Initial investigations including ECG, chest X-ray, and blood tests suggest cardiac dysfunction or alternative diagnoses need exclusion, and echocardiography is indicated to assess ventricular function and valve status ².
• The patient is pregnant or considering pregnancy and has moderate or severe valve disease, bicuspid aortic valve disease with associated aortopathy, or a prosthetic valve, warranting referral to a cardiologist with expertise in pregnancy and cardiac disease ¹.

In summary, referral to a cardiologist should be considered after initial investigations suggest significant valve disease, heart failure, or symptomatic cardiac dysfunction, or in special populations such as pregnant women with valve disease ¹,².