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