Cardiology

Mother and Daughter Love
Draft proposed by Dr Simon To, Dr Sabrina Tsao, Dr NC Fong
Reviewed by Dr Stephen Chan, Dr Annie Fok

Essential Skills

Domain 1 - Professional Values & Behaviour

Domain 2 - Communication

Domain 4 - Patient management

Domain 5 - Health Promotion & Illness Prevention

Additional desirable skills are listed in each proposal. These recommended skills are to be acquired as opportunity arises

Basic Training

Heart Failure

Pathophysiology of heart failure

Clinical manifestation and recognition

Pharmacology of diuretics and anti-failure medications

Heart murmur

Differentiating pathological murmurs

Formulate differential diagnoses based on murmur characteristics

Common forms of innocent murmur

Chest pain

Differentiating cardiac chest pain

Role and limitations of ECG, cardiac enzymes and treadmill testing

Palpitations, syncope and arrhythmias

Approach to palpitations

Approach to diagnosis and management of vasovagal syncope

Common causes of syncope and recognising red flags

ECG interpretation and recognition of significant arrhythmias (e.g. SVT, VT, VF, heart block) and channelopathies (e.g. long QT)

Acute management of SVT, VT, VF and symptomatic bradyarrhythmias

Diagnostic and therapeutic use of adenosine/ATP

DC cardioversion and defibrillation

Acyanotic congenital heart disease

Understand the haemodynamics, clinical, radiographic and ECG features, complications and natural history of congenital heart diseases with:

  • Left-to-right shunt

  • Valvular stenosis

  • Valvular regurgitation

 

Duct dependent lesions and cyanotic heart diseases

Approach and investigations in a cyanotic or collapsed newborn

Understand the haemodynamics and clinical features of congenital heart diseases with:

  • Right-to-left shunt, including tetralogy of Fallot

  • Common mixing, including transposition of great arteries

  • Duct dependent systemic circulation, including coarctation of aorta

  • Duct dependent pulmonary circulation, including critical PS/atresia

Pharmacology and monitoring of medications used to maintain ductal patency

Differentiating non-cardiac causes of a cyanotic newborn (e.g. PPHN, respiratory causes)

 

Coronary artery disease and Kawasaki disease

Understand the coronary complications in Kawasaki Disease

Recognise the clinical manifestations and investigation findings in Kawasaki Disease and initiate appropriate treatment

Identify risk factors for coronary artery disease

Counselling on lifestyle issues to improve coronary health

Pericardial Diseases and Myocarditis

Understand the clinical manifestations, initial investigations, initial management and indications for referral of

  • Pericarditis

  • Myocarditis

  • Pericardial effusion and cardiac tamponade

 

Acquired valvular diseases

Recognise the clinical features and indications for referral for:

  • Rheumatic fever

  • Infective endocarditis

 

Cardiovascular manifestation of systemic and genetic disorders

Recognise the cardiac involvement in common genetic disorders (e.g. Down, Turner, Noonan, Marfan, Williams and DiGeorge syndrome).

 

Cardiomyopathy

Recognise the presentation of hypertrophic and dilated cardiomyopathy

Higher Training

Heart Failure

Nutritional and feeding support

Pharmacological treatment of chronic heart failure, drug interactions, monitoring and follow up

Management of acute heart failure

Pharmacology of inotropes

Recognise the indications for referral for mechanical circulatory support (e.g. ECMO)

 

Heart murmur

Initiate investigations for heart murmurs and determining urgency of cardiology referral

Approach to murmur during acute or systemic illnesses

 

Congenital heart disease

Interpreting echocardiogram reports and associating them with clinical, radiographic and ECG features

Understand the indications for treatment and urgency of cardiology referral for congenital heart diseases

Stabilisation of the cyanotic or collapsed newborn and subsequent transport

Acute management of a hypercyanotic spell

Acute management of a pulmonary hypertensive crisis

Understanding the expansion of adult congenital heart disease and long term issues before they can be transitioned

 

Arrhythmias

Understanding ambulatory ECG and treadmill ECG reports

Approach to common ECG variants and abnormalities (e.g. ectopic beats, neonatal bradycardia, artefacts)

Pharmacology of common anti-arrhythmics (e.g. beta-blocker) and monitoring

Recognise indications for cardiology referral for arrhythmias, including those who may benefit from electrophysiology studies and ablation.

Recognise medication and exercise precautions in patients at risk of arrhythmias and sudden cardiac death (e.g. long QT syndrome)

 

Coronary artery disease and Kawasaki disease

Recognise acute complications of Kawasaki disease (e.g. KD shock syndrome, macrophage activation syndrome)

Recognition of refractory Kawasaki disease

 

Acquired valvular diseases

Management of infective endocarditis

Counseling regarding endocarditis prevention and dental hygiene

 

Cardiovascular manifestation of systemic and genetic diseases

Recognise the cardiac involvement and indications for cardiology referral in:

  • Syndromes with multiorgan involvement (e.g. VACTERL, Alagille, Duchenne muscular dystrophy)

  • Inborn errors of metabolism

  • Anorexia nervosa

  • Rheumatological diseases

 

Cardiomyopathy

Initial management in an acute DCM or HCM decompensation

Recognise patients who may be at risk of secondary cardiomyopathies (e.g. anthracycline toxicity in oncology patients, thalassaemia with iron overload)

 

Cardiovascular genetics

Recognise indications for genetic referral in syndromic cardiac diseases, cardiomyopathies and channelopathies

Interpret reports from genetic services and incorporate them in the overall management of the patient

Desirable skills 

1. Bedside functional echocardiogram to assess cardiac function, chamber sizes and pericardial effusions.