Presentations
- Arrhythmia (palpitations, syncope)
- Cachexia
- Dizziness
- Dyspnoea
- Fatigue/Lethargy
- Oedema
- Orthopnoea
- Reduced exercise tolerance
- Tachycardia
Conditions
- Cardiomyopathy:
- acquired
- myocarditis
- peripartum
- stress-induced
- tachycardia-induced
- genetic
- arrhythmogenic (ACM)
- hypertrophic (HCM)
- mixed
- primary
- Heart failure syndromes/ phenotypes:
- diabetes/diabetic myopathy
- mid-range EF(HFmrEF)
- preserved ejection fraction (HFpEF)
- recovered EF (HFrecEF)
- reduced EF (HFrEF)
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
- Deep vein thrombosis (DVT)
- Gastrointestinal:
- hepatic congestion and dysfunction
- malabsorption
- Musculoskeletal:
- Peripheral embolism
- Pulmonary embolism (PE)
- Stroke
- Sudden death
Conditions
- Athlete's heart
- Drug-induced cardiomyopathy, chemotherapy, or immunotherapy
- Infiltrative cardiomyopathies (e.g., amyloid)
- Inherited cardiomyopathies:
- arrhythmogenic (e.g. arrhythmogenic right ventricular dysplasia/ cardiomyopathy [ARVD/C])
- infiltrative (some) (e.g. hereditary TTR cardiac amyloid, Fabry disease)
- left ventricular noncompaction cardiomyopathy (LVNC)
- Post-vaccine or infective pericarditis and myocarditis (e.g. COVID-19 myocarditis)
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
- Cardiomyopathy:
- describe genetic basis for cardiomyopathies, including hypertrophic cardiomyopathy
- pathogenesis, natural history, and prognosis of cardiomyopathy
- Define heart failure, appreciating different classification systems based on clinical, morphological, and functional characteristics of the patient
- Differentiate between pathologic versus physiologic remodelling of the heart
- Understand different subgroups of heart failure classified by ejection fraction
- Understand the epidemiology of heart failure, including incidence, prevalence, risk factors, natural history, and prognosis
General management
- Management of underlying causes and associated conditions, including:
- arrhythmias/conduction system
- cardiomyopathy
- diabetes mellitus
- hypertension
- ischaemic heart disease
- other associated conditions
- valvular
- Monitoring of heart failure (serological, imaging, symptom-based)
- Non-pharmacological therapies
- Cardiac rehabilitation
- Device-based therapies
- left ventricular assist device (LVAD)
- Transplant
- Volume and sodium management
- Pharmacologic therapies
- Acute heart failure:
- Beta-blockers
- Digoxin
- Diuretic therapy
- Ivabradine
- Mineralocorticoid antagonist
- Renin-angiotensin system inhibitors:
- angiotensin II receptor blockers (ARB)
- angiotensin converting enzyme inhibitors (ACE)
- angiotensin receptor-neprilysin inhibitors (ARNI)
- SGLT2 inhibitors
Investigations
- Blood tests, including plasma markers and markers of perfusion (renal/hepatic)
- Cardiac catheterisation
- Cardiac CT
- Cardiac MRI
- Chest x-ray
- Electrocardiogram (ECG)
- Echocardiogram, including stress, transoesophageal (TOE), transthoracic (TTE), especially evaluation of systolic and diastolic dysfunction
- Genetic testing
- Myocardial biopsy
- Positron emission tomography (FDG) (e.g. for sarcoidosis)
- Technetium pyrophosphate (TC-PYP) scan
Procedures
- Cardiac transplantation (know indications for)
- Devices:
- defibrillators (know different types and indications for)
- pacemakers (know different types and indications for)
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)
- The timing of decisions and risks for the individual patient
Specific management considerations
- Advanced care, including referral to palliative care for patients with advanced heart failure to support discussion of treatment goals
- Management of heart failure in the community, including refractory heart failure
- Shared decision making (particularly for complex treatments options such as ICD, mechanical circulatory support, and transplantation)
- Sleep apnoea management
- Understand the implications of having a cardiomyopathy on quality of life, prognosis, and planning (e.g. pregnancy, competitive sport)
