StlConnectCare.Cardio

Diagnosis	PCP Evaluation/Management Options	PCP Guidelines for Referral to Specialist
Acute Myocardial Infarction	Follow hospitalized patients to establish short and long-term treatment plans with the consultant and to facilitate patient and family understanding and cooperation. Follow and monitor treatment plan as initiated by cardiologist after intervention.	Consider consult for all patients with an Acute MI. Consult for angina after MI or Non-Q wave. Consult immediately for consideration of thrombolysis, catheterization, or angioplasty. Consult in inpatient care may require invasive monitoring for homodynamic complications or the care of major arrhythmias. Consult immediately if patient shows signs of restenosis after intervention
Acute Pericarditis	Evaluate with history, physical examination, EKG and echocardiogram.	Consult for pericardial effusion and other complications of acute or chronic pericardial disease.
Arrhythmias	Evaluate the need for monitoring.	Consult for patients with successful resuscitation, VT, symptomatic bradycardia, recurrent paroxysmal atrial fibrillation, atrial flutter, WPW syndrome, AV nodal reentrant tachycardia and SVT refractory to medical treatment. Continual consultation for patients with permanent pacemakers, implanted defibrillators, or tachyarrhythmia devices or history of EP ablation. Continual consultation for patients on certain anti- arrhythmic agents, as suggested by the cardiologist.
Chest Pain/Angina	Evaluate with history, physical exam, EKG, CXR. Evaluate and treat coronary risk factors. Identify and treat non cardiac diagnosis. Consider stress testing for suspected cardiac diagnosis. Treat angina in accordance with AHA guidelines.	Consider consultation for a typical chest pain and 2 or more risk factors. Consider consultation for confusing clinical picture or new onset chest pain suggestive with increasing frequency, duration, or decreased threshold of occurrence. Immediate consultation for acute chest pain with rest, prolonged pain, increasing pain, or class III-IV angina suggestive of unstable angina or MI. Consult for angina despite maximal medical treatment or non-invasive tests suggesting a poor prognosis.
Congenital and Valvular Disease	Evaluate with history and physical exam. If other than functional systolic ejection murmur, secure EKG and CXR. If consult not ordered and depending on level of comfort, consider discussion by telephone with specialist regarding use of echocardiogram. Provide education about and prophylaxis against acute rheumatic fever or bacterial endocarditis when appropriate. Provide appropriate antibiotic protocols.	Consult for all murmurs suggestive of significant valvular heart disease, confusing physical findings, abnormal EKG or CXR. Consult when diagnosed to determine a plan of treatment and follow-up.
Congestive Heart Failure	Evaluate with history, physical exam and echocardiogram. Treat with maintenance regimen for those who are stable.	Consider consult for patients with diastolic dysfunction, valvular disease, pericardial disease, or nonischemic cardiomyopathy. Consult for acute congestive heart failure associated with MI, arrhythmia, ischemia, hypertension, or if the cause of acute congestive heart failure is not known. Refer for refractory congestive heart failure and/or consideration for transplantation.
Hypertension	Evaluate and rule out secondary causes. Treat to achieve satisfactory control.	Consider consult if hypertension is refractory to treatment.
Syncope	Evaluate with history, physical examination, EKG, CXR (and echocardiogram if clinically indicated). Consider event or loop recorder for patients in whom a paroxysmal arrhythmia is thought to be related to syncope.	Consider consult if patient has underlying heart disease or if transient cause has not been identified and episodes are recurrent.