Presentations
- Arrhythmias
- Chest pain
- Dyspnoea/Shortness of breath
- Fatigue
- Heart failure
- Oedema
- Syncope
Valvular Conditions
- Aortic regurgitation
- Aortic stenosis:
- bicuspid
- congenital
- degenerative
- Infective endocarditis
- Mitral regurgitation:
- Mitral stenosis:
- degenerative calcific
- rheumatic heart disease
- Rheumatic heart disease
- Tricuspid regurgitation
Congenital Conditions
- Coarctation of the aorta
- Ebstein anomaly
- Patent ductus arteriosus (PDA)
- Septal defects:
- atrial (ASD)
- patent foramen ovale (PFO)
- ventricular (VSD)
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
Conditions
- Carcinoid syndrome
- Coronary fistulas
- Eisenmenger syndrome
- Fontan circulation
- Left ventricular aneurysm
- Non-bacterial thrombotic endocarditis (Liebman-Sacks)
- Pulmonary valve stenosis/regurgitation
- Single ventricle defects
- Structural valve degeneration, bioprosthetic valve failure and paravalvular regurgitation of surgical and transcatheter valves
- Tetralogy of Fallot
- Total/Partial anomalous pulmonary venous connection (TAPVC)
- Transposition of the great arteries (TGA)
- Truncus arteriosus
- Unicuspid and quadricuspid aortic valves
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
Causation and pathophysiology
- Connective tissue disorders
- Degenerative valvular disease
- Endocarditis
- Heart failure
- Mechanical complications of MI:
- acute severe mitral regurgitation
- ventricular rupture or aneurysm
- Myocardial infarction
- Rheumatic heart disease
Key medications
- Antibiotic prophylaxis (refer to CSANZ guidelines regarding native and prosthetic valve conditions)
- Role of anticoagulants and antiplatelets in the long-term management of surgical and transcatheter bioprosthesis / structural intervention
- Role of warfarin management for mechanical heart valves, including bridging anticoagulation for cardiac and non-cardiac procedures
Investigations
- Cardiac MRI
- Chest X-ray
- Coronary angiography
- ECG
- Exercise stress test/Stress echo/Dobutamine stress echo
- Right-heart catheterisation
- Structural heart multislice spiral computed tomography (MSCT)
- Transesophageal echocardiogram (TOE)
- Transthoracic echocardiogram (TTE)
Procedures
- Know the indications for and types of intervention in structural, valvular,
- and congenital heart disease (i.e. heart valve repair/replacement):
- open heart surgery
- sternotomy versus minimally invasive techniques
- valve: mechanical versus bioprosthetic versus repair
- percutaneous
- closure of atrial septal defects (e.g. ASD, PFO)
- left atrial appendage (LAA) occlusion
- mitral edge to edge repair
- mitral valvotomy (for rheumatic heart disease)
- paravalvular leak (PVL) closure
- transcatheter aortic valve implantation (TAVI), melody transcatheter pulmonary valve
- Know the types of prosthetic valves available for clinical use
General management considerations
- Communication of the impact of lifelong congenital heart disease to patients, their families or carers
- Consider patient demographics, including geographic location, socioeconomic status, ethnicity, and cultural background when managing and organising follow-ups for these patients (e.g. travel from rural to metropolitan areas)
- Goals of therapy
- Impact of comorbidities on diagnosis and management
- Individualise patient needs to determine the most appropriate approach to investigations and care
- The timing of decisions and risks for individual patients (e.g. optimal time for valve intervention).
Specific management considerations
- Appropriate referral for cardiac and vascular imaging modalities for surveillance (as per current guidelines)
- Recognise need for pre-pregnancy assessment and counselling, including appropriate referrals to tertiary centres for pregnant patients with valvular/ structural/ congenital heart disease
- Role of the heart team (i.e. discuss patients with valvular/ structural/ congenital heart disease at multidisciplinary meetings to determine/implement the correct treatment modality for individual patients)
- Understand the need for a multidisciplinary assessment of patients with infective endocarditis
