Presentations
- Atypical chest pain
- Bradycardia
- Palpitations
- Syncope
- Tachycardia
Conditions
- Arrhythmias:
- atrial fibrillation (AF)
- atrial flutter
- ventricular
- Bradycardias:
- atrioventricular node conduction block
- bundle-branch and fascicular block
- sinus node dysfunction
- vasovagal episodes
- Ectopic beats:
- Tachycardias:
- atrial fibrillation
- postural orthostatic tachycardia syndrome (POTS)
- supraventricular
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
- Family history (e.g. channelopathy or sudden death)
- Ventricular arrhythmia storm
Conditions
- Arrhythmogenic right ventricular cardiomyopathy (ARVC)
- Dyssynchrony
- Familial channelopathies (e.g. Brugada syndrome)
- Right ventricular outflow tract tachycardia (RVOT)
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
- Know the indications for and management properties of:
- cardiac resynchronisation devices
- dual chamber permanent pacemakers
- electrophysiological studies
- implantable cardioverter-defibrillators (ICDs)
- implantable monitoring devices
- radiofrequency ablation
- single chamber permanent pacemakers
- temporary pacemakers
- Normal electrophysiology of the heart and basis of arrhythmogenesis
- Rate versus rhythm control
Key medications
- Anti-arrhythmics for atrial and ventricular arrhythmias
- Pharmacological (and non-pharmacological) approaches to the treatment of atrial and ventricular ectopy
- Pharmacology of drugs currently used in the treatment of arrhythmias (i.e. anti-arrhythmics for atrial and ventricular arrhythmias)
- Role of anticoagulation in thromboembolic prophylaxis
Investigations
- ECG, including exercise electrocardiogram (ETT)
- Electrophysiology studies (EPS)
- Flecainide challenge test (FCT)
- Holter monitor
- Loop recorders
- Tilt table test
Procedures
- Know the different types of devices available for clinical use:
- » defibrillators
- » pacemakers
- Know the indications for ablation:
- atrial fibrillation and flutter
- symptomatic supraventricular tachycardia (SVT) due to atrioventricular nodal re-entrant tachycardia (AVNRT)
- unifocal atrial tachycardia
- ventricular tachycardia
- Wolff-Parkinson-White syndrome
- Know the indications for and be able to perform cardioversion
- Know the indications for atrial appendage closure (e.g. LAA)
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 geographic location, socioeconomic status, ethnicity, and cultural background, and the considerations when managing and following up these patients (e.g. travel from rural to metropolitan areas)
- Impact of comorbidities on diagnosis and management
- The timing of decisions and risks for the individual patient
Specific management considerations
- Consideration of lifestyle modifications (e.g. alcohol consumption, sleep apnoea management, weight)
- Deactivation of devices (e.g. in end of life)
- Driving guidelines relating to implanted devices
- Management of device-related complications (e.g. infection)
- Perioperative device management and MRI compatibility
- Sports cardiology (e.g., exercise-induced arrythmias)
