Module information

Module details

Title
Ultrasound Imaging in Cardiac Disease
Module code
SPS121
Credits
30
Requirement
Compulsory

Aim of this module

This module provides trainees with the knowledge that underpins the third year specialist module in Cardiology, undertaking the Ultrasound route, and gives trainees the tools to undertake learning in the workplace. This rotation will enable trainees to perform cardiac imaging in a range of patients with cardiac disease, interact with patients and demonstrate safe, patient-centred practice. Trainees will be expected to build practical skills in setting up the equipment used, produce reports, interpret results, explain procedures  to patients and gain consent, while developing and building their professional practice.

Work-based content

Competencies

# Learning outcome Competency Action
# 1 Learning outcome 1,2,3,4,5,6,7 Competency

Control infection risks in accordance with departmental protocols.

Action View
# 2 Learning outcome 1,2,3,4,5,6,7 Competency

Minimise risks and hazards in compliance with health and safety policies.

Action View
# 3 Learning outcome 1,2,3,4,5,6,7,8 Competency

Treat patients in a way that respects their dignity, rights, privacy and confidentiality at all times.

Action View
# 4 Learning outcome 1,2,3,4,5,6,7,8 Competency

Review a suitably completed request form. Greet the patient, check patient identity and ensure that the patient’s identity is confirmed as correct and fully identified on each type of recording system for each procedure.

Action View
# 5 Learning outcome 1,2,3,4,5,6,7 Competency

Select suitable technology for the procedure, choosing and adapting the appropriate diagnostic technique, patient position, machine settings and transducer for each patient.

Action View
# 6 Learning outcome 1,2,3,4,5,6,7 Competency

Set up appropriate equipment in preparation for each type of procedure, including resuscitation equipment where appropriate.

Calibrate where necessary.

Action View
# 7 Learning outcome 1,2,3,4,5,6,7 Competency

Explain the full procedure to the patient and address any questions they may have relating to the procedure.

Action View
# 8 Learning outcome 1,2,3,4,5,6,7 Competency

Gain informed consent.

Action View
# 9 Learning outcome 1,2,3,4,5,6,7 Competency

Obtain a clinical history as appropriate for each procedure.

Action View
# 10 Learning outcome 1,2,3,4,5,6,7 Competency

Take appropriate action to respond to the specific needs of the patient, as defined by department protocol.

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# 11 Learning outcome 1,8 Competency

Generate high-quality ultrasound images and take accurate measurements to assess cardiac function.

Action View
# 12 Learning outcome 2,8 Competency

Generate high-quality ultrasound images and take accurate measurements to assess the mitral valve using 2D planimetry, pressure half-time, gradient, severity of regurgitation, chamber size and signal density, proximal flow acceleration and vena contracta.

Action View
# 13 Learning outcome 3,8 Competency

Generate high-quality ultrasound images and take accurate measurements to assess the aortic valve, and recognise a significantly stenotic aortic valve deriving peak and mean gradients using continuous wave Doppler and measuring valve area using the continuity equation.

Action View
# 14 Learning outcome 4,8 Competency

Generate high-quality ultrasound images and take accurate measurements to assess the right ventricle, recognising right ventricular dilatation, and estimate pulmonary artery systolic pressure and right atrial pressure from the appearance of the inferior vena cava.

Action View
# 15 Learning outcome 5,8 Competency

Generate high-quality ultrasound images and take accurate measurements to assess patients with suspected infective endocarditis, a cardiac mass and pericardial disease, judging the route for pericardiocentesis.

Action View
# 16 Learning outcome 6,8 Competency

Generate high-quality ultrasound images and take accurate measurements to assess adult patients with a secundum atrial septal defect and calculate a shunt.

Action View
# 17 Learning outcome 7 Competency

Generate ultrasound images and recognise clinically relevant abnormality in critically unwell patients.

Action View
# 18 Learning outcome 1,2,3,4,5,6,7,8 Competency

Review the results from each test, taking into account artefacts, necessary adjustments of values and planned/unplanned events occurring during the test.

Action View
# 19 Learning outcome 1,2,3,4,5,6,7,8 Competency

Compare the values/traces obtained with the normal range/values related to the procedure.

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# 20 Learning outcome 1,2,3,4,5,6,7,8 Competency

Produce a clear written report of the procedure.

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# 21 Learning outcome 1,2,3,4,5,6,7,8 Competency

Actively seek accurate and validated information related to evidence-based best practice with respect to cardiac ultrasound imaging.

Action View
# 22 Learning outcome 9 Competency

Present the findings of a critical review of current published research literature for general cardiac ultrasound and related topics, incorporating evidence-based practice at your local departmental meeting.

Action View

Assessments

You must complete:

  • 4 Case-based discussion(s)
  • 4 of the following Direct Observation of Practical Skills (DOPS) and/or Observed Clinical Event (OCE)
Assessment Title Type
Quantify the degree of left ventricular dysfunction in a patient with regional wall motion abnormalities DOPS
Measure valve area using the continuity equation. DOPS
Quantify the degree of mitral regurgitation using a range of echo derived data DOPS
Assess severity of an intracardiac shunt using echo derived date DOPS
Produce a clear written report of an echo procedure. DOPS
Generate high quality ultrasound images and take accurate measurements to assess cardiac function in a patient with regional wall motion abnormalities OCE
Generate high quality ultrasound images and take accurate measurements to assess disease severity in a patient with aortic stenosis OCE
Generate high quality ultrasound images and take accurate measurements to assess disease severity in a patient with mitral regurgitation OCE
Generate high quality ultrasound images and take accurate measurements to assess adult patients with a secundum atrial septal defect OCE
Demonstrate use of a stand alone CW probe pencil probe to measure aortic valve flow from the right sternal edge and suprasternal notch

Learning outcomes

# Learning outcome
1

Perform transthoracic echocardiographic examination to assess the size and function of the left ventricle.

2

Perform transthoracic echocardiographic examinations on patients with suspected mitral valve disease.

3

Perform transthoracic echocardiographic examinations on patients with suspected aortic valve disease.

4

Perform transthoracic echocardiographic examination to assess the size and function of the right ventricle.

5

Perform transthoracic echocardiographic examinations on patients with suspected infective endocarditis, pericardial effusion and cardiac masses.

6

Perform transthoracic echocardiographic examinations on adult patients with congenital heart disease.

7

Perform an appropriate transthoracic echocardiographic study in a critically unwell patient and identify any significant clinical findings.

8

Make appropriate measurements and interpret the ultrasound data, and produce high-quality reports.

9

Critically appraise current literature/research studies for general cardiac ultrasound and related topics, incorporating evidence-based practice.

Clinical experiences

Important information

Clinical experiences help you to develop insight into your practice and greater understanding of your specialty. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. While Clinical Experiences are not assessed, reflections and observations from your experiences can be used to support evidence for competencies to demonstrate your awareness and appreciation of your specialty and it’s impact on patient care. You may find it helpful to capture thoughts from your experiences in your reflective log.

Activities

  • Identify a patient with cardiac disease requiring ultrasound procedures and, with permission, follow the progress of the patient from the initial consultation, through procedures and follow-up appointment, and reflect on your learning from this process.
  • Scan and report on five patients, incorporating a normal study, moderate or severe aortic stenosis, moderate or severe mitral stenosis or regurgitation, myocardial infarction and one other pathology, i.e. pericardial effusion/constriction or cardiomyopathy, and critically reflect on the practice and the role of medical ultrasound in the management of the patient with a cardiac condition.
  • Observe the application of interventional cardiac ultrasound techniques and describe examples of evolving practice related to cardiac ultrasound imaging procedures.
  • Observe the use of transesophageal echocardiography (TOE) in the assessment of valvular pathology and critically evaluate the role of TOE in the assessment of patients with valvular heart disease.
  • Observe a series of patients reviewed as new and follow-up patients in an outpatient clinic and critically appraise the process of referral, diagnosis and treatment, including the range of healthcare professionals who contribute to the care of each patient and how the interprofessional team work together.

It is also recommended that trainees undertake the following clinical experiential learning:

  • Take part in a multidisciplinary meeting and reflect on the way the multidisciplinary team contributes to the care of patients with cardiac disease where ultrasound diagnosis and follow-up is important.
  • Observe the surgical treatment of patients with valvular heart disease and discuss how this experience will shape your professional practice.
  • Observe the echocardiographic assessment of paediatric heart disease and reflect on the differences between scanning children and adults.
  • Identify valvular lesions by auscultation of the anterior chest wall.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

  1. Describe the coronary anatomy and its correlation with 2D views of the left ventricle.
  2. Describe and evaluate methods used to measure and evaluate left ventricular function and recognise normal and abnormal ventricular function.
  3. Describe normal Doppler mitral valve filling patterns and normal ranges.
  4. Recognise the appearance of complications after myocardial infarction.
  5. Discuss the echocardiographic features and assessment methods associated with cardiomyopathies, valvular disease and ventricular dysfunction and the relationship to surgical treatments.
  6. Discuss the pathology, causes and echocardiographic features associated with right ventricular dysfunction and pulmonary hypertension; endocarditis and the Duke criteria for diagnosing endocarditis; pericardial disease, cardiac masses, suspected acute pulmonary embolus and blunt/penetrating cardiac trauma.
  7. Discuss the types of valve replacement, criteria of normality and signs of failure.
  8. Describe the echocardiographic findings typically occurring in association with a hypotensive/shocked patient and post cardiac arrest.
  9. Explain the use of echocardiography in the ventilated patient and post-surgery patient.
  10. Evaluate and justify the criteria for the use of transoesophaegeal echocardiography.

Indicative content

  • Anatomy and physiology of the cardiovascular system with particular reference to coronary anatomy
  • Measurement and evaluation of left ventricular function using echocardiography
  • Normal Doppler mitral valve filling patterns

Pathophysiology

  • Review of cardiovascular anatomy and physiology
  • Aetiology and echocardiographic features of cardiovascular pathophysiological conditions
  • Recognition and evaluation of cardiovascular disorders using cardiac ultrasound and Doppler imaging

Conditions

  • Mitral stenosis and regurgitation
  • Aortic stenosis and regurgitation
  • Diseases of the aorta
  • Tricuspid stenosis and regurgitation
  • Pulmonary valve disease
  • Pulmonary hypertension
  • Infective endocarditis
  • Intracardiac masses
  • Cardiomyopathies
  • Pericardial diseases
  • Coronary artery disease and LV function
  • Myocardial infarction and its sequelae
  • LV dyssynchrony
  • Overview of congenital heart disease

Emergency and ICU echocardiography

  • Environmental issues
  • Clinical findings
  • Constraints

Role of exercise echocardiography in assessing patients for surgery/balloon valvoplasty

Role of transesophageal echocardiography (TOE )in assessing valvular pathology to determine type of intervention

Role of echocardiography in the evaluation of effective function and dysfunction of prosthetic heart valves