Presentations
- Chest pain
- Cold peripheries
- Dyspnoea
- Fatigue
- Headache
- Numbness
- Pallor
- Palpitations
- Presyncope
- Syncope
- Weight loss
Conditions
- Aortopathy
- Atherosclerosis
- Pericardial disease
- Pulmonary hypertension:
- arterial (PAH)
- due to chronic thromboembolic disease
- due to left heart disease
- due to lung disease
- due to unknown causes
- exercise-induced
- Systemic hypertension:
- Thromboembolic disease:
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Presentations
- Abdominal pain
- Dizziness, light-headedness
- Headache
Conditions
- Aneurysm
- Aortic dissection
- Cardiac tumours
- Carotid artery stenosis
- Peripheral vascular disease
- Primary and secondary
- Stroke
- Vasculitis and aortitis
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients' needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Anatomy and physiology of the cardiovascular system
- Causes and predisposing factors for thromboembolic disease
- Coronary blood flow
- Impact of a metabolic syndrome upon vascular health
- Pathophysiology and epidemiology of pro-coagulant disorders
- WHO classifications for pulmonary hypertension
Key medications
- Anti-diabetic agents
- Anti-hypertensive classes, including alpha-blockers, beta-blockers, calcium channel blockers, diuretics, novel agents, and RAAS inhibitors
- Anticoagulants and antiplatelets
- Appropriate analgesia, including opiates
- Lipid-lowering medications, including fibric acid derivatives, PCSK9 inhibitors, statins, and novel agents
- Pulmonary vasodilators, including endothelin receptor antagonists (ETRAs), phosphodiesterase-5 inhibitors, prostacyclin analogues, and soluble guanylate cyclase stimulators
Investigations
- Cardiac MRI
- Chest x-ray
- Computed tomography coronary angiogram (CTCA)
- Coronary angiography
- CT pulmonary angiography (CTPA)
- Doppler ultrasound imaging and flow studies
- Duplex scans
- ECG
- Lung ventilation/perfusion (VQ) scans
- Peripheral angiography
- Right heart catheterisation and haemodynamic measurements
- Serology
- Transoesophageal echocardiography (TOE)
- Transthoracic echocardiography (TTE), including stress echocardiogram
Procedures
- Diagnostic angiography
- Know the indications for carotid endarterectomy
- Know the indications for heart and/or lung transplantation
- Know the indications for pericardial window formation
- Know the indications for peripheral angioplasty
- Know the indications for surgical management of aortopathies (acute and chronic)
- Pulmonary balloon angioplasty
- Pulmonary endarterectomy
- Right heart catheterisation
General management considerations
- Goals of therapy
- Impact of comorbidities on diagnosis and management
- Individual patient clinical indications to determine patients' needs and the most appropriate approach to investigations and care
- Patient demographics, including geographical location, socioeconomic status, ethnicity, and cultural background, and considerations when managing and following up these patients (e.g. travel from rural to metropolitan areas)
- The timing of decisions and risks for the individual patient
Specific management considerations
- End-of-life care for severe pulmonary hypertension
- Implications of pulmonary hypertension to pregnancy and family planning
- Importance of multidisciplinary approach
- Management of hypertensive crisis and screening for posterior reversible encephalopathy syndrome
