Rehabilitation medicine curriculum standards (adult)
Knowledge guides
Knowledge guide 7: Cardiac and respiratory conditions
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will describe the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the indications for and how to interpret the results of these investigations, procedures, and clinical assessments tools.
Advanced Trainees will know how to explain the investigation, procedure, or clinical assessment tool to patients, families, and carers.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management.
Presentations
- Acute, chronic pain
- Change in function
- Dyspnoea
Conditions
- Acquired:
- cardiac failure
- ischaemic:
- acute myocardial infarction
- pulmonary embolism infective (COVID-19)
- viral cardiomyopathy
- Associated heart and lung surgery:
- CABG
- post-transplantation
- revascularisation procedures
- Common arrhythmias
- Congenital heart and lung
- Infective respiratory conditions and sequelae
- Obstructive respiratory conditions:
- asthma
- chronic obstructive pulmonary disease (COPD)
- emphysema
- Restrictive respiratory conditions:
- fibrosis, including environmental conditions
Environmental exposure
- Dust-borne diseases
- Occupational aspect – animals, farming, mining
- Smoking
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
No less common or more complex presentations and conditions listed
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
- Aetiology
- Anatomy and physiology of the heart and coronary arteries
- Anatomy and physiology of the lungs and respiratory system
- Community cost
- Epidemiology of cardiac and respiratory disease in Australia and Aotearoa New Zealand
- Exercise physiology of the heart and peripheral circulation
- Incidence and prevalence
- Mortality and morbidity
- Pathophysiology of ischaemic heart disease:
- acute myocardial infarction
Examinations
- Examination and history
- Lung function and cardiac function
Investigations
- Chest x-ray
- Coronary angiography
- CT pulmonary angiogram (CTPA)
- Echocardiogram (ECG)
- Lung function
- MRI
- Radionuclide imaging
- Spirometry
- Stress echo
- Ventilation-perfusion (VQ) scans
Cardiac – acute/subacute hospital care (phase I)
- Aetiology and degree of impairment of cardiac disease:
- current drug therapy
- major complications, e.g. ventricular failure, ventricular tachycardia and fibrillation
- presence of minor complications, e.g. bundle branch block, first degree heart block
- Dietary and nutrition:
- associated medical disorders, e.g. hypertension, diabetes
- body weight and fat
- lipid profile
- medication
- usual dietary patterns
- Early supervised reintroduction of progressive activity involvement in personal care tasks
- Exercise testing – commonly used protocols including recognition of significant abnormalities, e.g. angina, arrhythmia, S-T segment depression
- Individual and group education:
- benefits of exercise and lifestyle change
- specific disability
- the importance of risk factor management
- Patient's personality and response to cardiac disease and disability:
- anxiety and depression following acute cardiac illness
- current life stresses, including financial and marital issues
- high risk personality profiles
- response of family to patient’s illness and disability
- Safe activity and exercise levels following hospital care:
- energy costs of activity – metabolic equivalent of tasks (METs)
- New York Heart Association Functional Classification System
- Vocational assessment:
- clearly stated goals for early return to work
- evaluation of the physical and psychological demands of work
- patient’s present work fitness
Cardiac post discharge care (phase II)
- Benefits of exercise therapy regarding activity tolerances, coronary artery disease progression, mortality, risk factor modification, and psychological wellbeing, including:
- prescription of duration, frequency, and intensity of continuous aerobic activity and light resistance exercises by reference to target heart rate range
- regular medical monitoring of clinical status and exercise responses
- Progressive exercise conditioning
- Progressive resumption of personal and recreational activities:
- activity tolerances as predicted by exercise testing
- energy costs of usual daily activities
- monitoring of symptoms and responses to activities
- techniques of energy conservation and work simplification
- Significant psychosocial factors:
- at-risk personality profiles and behaviour patterns
- family or carer counselling
- stress management
- treatment of anxiety and depression
- Support continuing education:
- lifestyle modification
- physiological benefits of exercise training, including appropriate techniques of warm-up and warm-down, cooling, fluid intake, and stretching
- support continuing dietary monitoring and counselling
- Vocational rehabilitation when appropriate by:
- adverse prognostic indicators for vocational resettlement
- full assessment of work demands related to degree of cardiac disability
- return to work planning and employer liaison
- specific work conditioning
- work monitoring and upgrading
Cardiac: maintenance care in the community (phase III)
- Exercise and lifestyle activities
- Community facilities for maintenance
- Patient’s ability to adhere to recommendations
- Personality traits and cardiovascular disease
- Progression of cardiac disease and disability monitoring
- Psychological support
Components of respiratory rehabilitation
- Breathing and relaxation techniques
- Education, including on proper use of prescribed drugs
- Energy conservation techniques
- Exercise training and reconditioning
- Expiratory muscle training
- Inspiratory muscle training
- Maximising energy level
- Neuromuscular electrical stimulation
- Nutrition
- Oxygen therapy
- Psychosocial counselling
- Smoking cessation
Management of cardiac disease
- Cardioactive drugs, including:
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin-receptor blocker
- antiarrhythmics
- anticoagulants
- antiplatelets
- ß-blockers
- calcium channel blockers
- digoxin
- diuretics
- glyceryl trinitrate
- lipid lowering drugs
- Surgical management:
- coronary artery bypass surgery
- coronary revascularisation procedures
- transluminal coronary angioplasty
Management of respiratory disease
- Drug therapies:
- anti-IgE monoclonal antibody therapy
- inhaled corticosteroids (ICS)
- long-acting and short-acting bronchodilator
- oral corticosteroids (OCS)
- Surgical management:
- lung resection
- lung transplantation
- lung volume reduction
Rehabilitation elements of patient care
- Clinical assessments and scales such as rating of perceived exertion, e.g. Borg rating of perceived exertion, calculating VO2 max, and maximal exercise, and using these results to prescribe exercise in cardiac and respiratory conditions, and other relevant tests of endurance, e.g. six-minute walk test
- Education of patient and family regarding exercise, lifestyle change, medical management, and risk factor modification
- Exercise conditioning, education, functional restoration, psychosocial support, and vocational settlement
- Multidisciplinary approach
- Return to avocational activities
- Return to work, with emphasis in most cases on return to usual pre-morbid employment
- Risk factors, cardiac and respiratory status, and functional disability
- Self-management (chronic disease) Psychosocial dysfunction
Respiratory management and insufficiency
- Airways suction
- Chest physiotherapy
- Respiratory function
- Respiratory function in tetraplegia
- Sepsis
- Types of respiratory support system surgical management
- respiratory impairment; types and indications for respiratory support systems