Cardiology curriculum standards (Paediatrics & Child Health)

Knowledge guide

LG 13: Scientific foundations of paediatric cardiology

Epidemiology, Pathophysiology, and Clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management, and outcomes.

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Anatomy:

coronary anatomy/territory
morphology/sequential segmental analysis
ultrastructure of the cardiac myocyte

Cardiovascular physiology:

altered physiological states:

circulatory support (e.g. VAD, ECMO)
exercise
pre- and postoperative changes
pregnancy
understanding of changes in structural and electrical heart disease, including biventricular and univentricular circulations

normal physiology:

BP homeostasis and circulatory control
cardiac cycle
cardiac mechanics and determinants of cardiac output
conduction pathway, including myocardial and pacemaker action potential
fetal circulation and transition to postnatal circulation
Frank-Starling mechanisms
normal haemodynamics/cardiac pressures
respiratory physiology, including ventilation, oxygen delivery, and its effects on cardiovascular performance

Embryology
Epidemiology of common cardiac conditions
Nutrition/fluid management:

fluid and caloric requirements, including alternative types of feed (e.g. Monogen)
normal growth

Pathophysiology of clinical findings, including murmurs, saturation differences, hepatomegaly, blood pressure and pulse volume discrepancies, JVP, peripheral oedema
Pharmacology:

drug-drug interactions/contra-indications of medications
effects of non-cardiac medications on the heart function and rhythm
formulations of medications
monitoring of drug levels
pharmacodynamics and acquired heart diseases
screening for adverse effects

Syndromes associated with cardiac lesions (e.g. DiGeorge, Down, and Marfan syndromes, Trisomy 18, VACTERL association)
Understanding genetic inheritance of cardiac conditions
Understanding of interventional and surgical procedures
Understanding of paediatric cardiac intensive care management

Cardiac examination, including consideration of age and development
History taking for cardiac presentations

Investigations

Performing and interpretation of below investigations:

ambulatory BP monitoring
conduction system – ambulatory ECG monitoring, exercise stress test, pacemaker check
cross-sectional imaging (e.g. CT, MRI)
CXR
ECG
genetic testing
other imaging (e.g. V/Q, PET)
pathology (e.g. coagulation profile, CK, full blood count, inflammatory markers, troponin)
transthoracic and transoesophageal echocardiogram, including 2D, 3D, contrast echocardiogram, strain

Procedures

balloon atrial septostomy
cardiac catheterisation (diagnostic and interventional)
DC cardioversion
drug challenges (e.g., adenosine)
electrophysiology studies and ablation
pericardiocentesis

Consideration of research/education opportunities
Critical analyses of literature relating to scientific foundations of paediatric cardiology
Keeping up to date with current literature and guidelines and advanced technology in paediatric cardiology