Cardiology

The Cardiology team provide services at Ninewells Hospital and Perth Royal Infirmary and includes a team of Cardiology Consultants, Specialist Nurses, Cardiac Physiologists, Radiographers and an extensive support team.

The Catheter Laboratory is location within Ninewells Hospital and performs all interventional procedures including Coronary Angiography, Pacemaker and Device Implantation, Electrophysiology and Ablation.

The Physiology Departments in Ninewells Hospital and Perth Royal Infirmary deliver ambulatory cardiac monitoring with RTEST and Holter monitoring, Echocardiography including Trans-oesophageal echocardiograph, pacemaker and device checks.

• NHS Tayside Cardiology Referral Pathways Quick Reference Summary
• Follow linked pathways for RACPC, murmurs, palpitations, AF, new suspected heart failure - rest direct to cardiology: 
  • Chest pain that you suspect is angina
  • Poorly controlled existing angina. 
  • Palpitation that you suspect is due to cardiac rhythm disturbance
  • Symptomatic, uncontrolled, complex AF
  • Existing cardiac failure with uncontrolled symptoms. (For new cardiac failure see BNP pathway). 
  • Cardiac Murmurs
  • Syncope with suspected cardiac cause
  • Suspected Inherited Cardiac Condition

• Patients who have not been physically examined and had basic blood tests e.g FBC and Thyroid Function.
• Asymptomatic patients with atrial fibrillation over the age of 65.
• Patients for management of hypertension, assessment of cardiovascular risk or management of adverse lipid profile - Refer to Cardiovascular Risk Clinic at Ninewells.
• Palpitation with benign symptoms e.g. infrequent ectopy
• Chest pain that is not cardiac in nature
• Breathlessness with normal ECG and BNP that has not had a Respiratory cause excluded.

• Standard referral through SCI Gateway.
• Chest pain should be referred to the Rapid Access Chest Pain Clinic, all other presentations should be referred to the Cardiology Service
• Emergency advice can be obtained by calling the cardiology registrar.
• Patients with ongoing chest pain should be managed by dialling 999 and allowing the Scottish Ambulance Service to follow the well established protocol.

• All patients should have been examined to detect key cardiac signs e.g. a murmur prior to referral. All patients should have had basic blood test results available including FBC and Thyroid Function.
• Patients with shortness of breath should have a Chest-Xray.
• It is exceptionally helpful if an ECG can be performed and this will streamline the referral. If it is not possible to do an ECG in practice, these can be requested on ICE.
• Patients with ongoing chest pain should be managed by dialling 999 and allowing the Scottish Ambulance Service to follow the well established protocol.

• SCI Gateway is also best route for advice – reviewed several times daily.
• This allows review of associated results.
• It is exceptionally helpful to have done an ECG locally if possible and have this available either electronically on Clinical Portal or attached to the referral.
• Many referrals can be managed by advice through SCI Gateway rather than in-person review when we have all results available to review.
• A large number of referrals to Cardiology are managed by arranging the key cardiac investigations,
• If an emergency contact the on-call Cardiology registrar via Ninewells Switchboard.

Cardiovascular Section of NHS Tayside Formulary 

Approach to thromboprophylaxis for patients with non-valvular atrial fibrillation (AF)
Flow chart for sequence of therapy for Chronic Heart Failure
NHS Tayside Drug Treatment for Stable Angina Protocol