Cardiac Arrhythmias

Details

Title

Cardiac Arrhythmias

Type

Stage One

Module code

HPS102

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST, with respect to cardiac arrhythmias, will be able to critically analyse, synthesise, evaluate and apply knowledge, and perform the specialist assessment and treatment of patients with a range of cardiac arrhythmias. They will be able to perform a range of technical procedures and clinical skills to: (i) explain the principles that underpin human inheritance and the role of genetic factors in cardiac disease; (ii) interpret physiological data while being cognisant of potential genetic involvement and demonstrate appreciation of the increasing relevance and application of genomic technology to cardiology. They will also consistently demonstrate the attitudes and behaviours necessary for the role of a Consultant Clinical Scientist within a patient-focused service.

Knowledge and understanding

By the end of this module the Clinical Scientist in HSST will critically analyse, synthesise, evaluate and apply their expert knowledge of arrhythmias, including the:

Cardiac arrhythmias:

• genetics, genomics, pathogenesis, natural history and prognosis of arrhythmias;
• methods of presentation of arrhythmias, their aetiology, recognition and management;
• normal electrophysiology of the heart and the basis of arrhythmogenesis;
• pharmacology of drugs currently used in the treatment of arrhythmias, including thromboprophylaxis;
• indications for temporary and permanent pacemakers;
• indications for electrophysiological studies and the use of radiofrequency ablation;
• indications for ICDs and CRT;
• current recommendations concerning fitness to drive.

Atrial fibrillation:

• epidemiology, pathophysiology and prognosis classification;
• diagnosis, clinical features and impact on quality of life;
• associated conditions;
• diagnostic procedures;
• embolic complications;
• anticoagulation options and indications;
• management:
  • rhythm vs rate control
  • conversion to sinus rhythm
  • prevention of recurrences
  • control of ventricular rate
  • pacemaker-defibrillator therapy
  • catheter ablation or surgery
• the importance of coexisting structural heart diseases for the outcome and management of atrial fibrillation (AF);
• the limitations and risks of anti-arrhythmic drug therapy;
• the importance of anticoagulant therapy;
• the palliative nature and potential adverse effects of non-pharmacological therapies;
• newer methods for treating AF and how to refer patients for specialist treatment when appropriate.

Channelopathies and other inherited syndromes:

• the inherited cardiac disorders presenting to cardiology:
  • channelopathies and other inherited syndromes:
    • long and short QT syndromes
    • Brugada syndrome
    • hypertrophic cardiomyopathies
    • right ventricular arrhythmogenic cardiomyopathies
    • catecholaminergic polymorphic ventricular tachycardia
    • ryanodine syndrome
  • cardiac disorders with a genetic component and multisystem disorders in which there is potential for cardiac involvement:
    • neuromuscular cardiomyopathies (myotonic dystrophy)
    • Fabry diseasecardiac disorders with a genetic component and multisystem disorders in which there is potential for cardiac involvement:
  • congenital conduction disorders.
• genetic disorders associated with CHD:
• Down syndromecongenital conduction disorders.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance, adaptation and mastery of a range of clinical and communication skills and will:

• take a relevant history, including family history, and perform an appropriate examination;
• select and use investigations appropriately;
• select appropriate drugs;
• perform and/or interpret:
  • electrocardiogram (ECG)
  • echocardiogram
  • transesophageal echocardiogram
  • prolonged ECG monitoring exercise testing
• develop appropriate antithrombotic strategies as appropriate;
• select patients appropriately for cardioversion;
• perform rhythm or rate control therapy;
• select and refer patients for consideration of:
  • atrial catheter ablation or surgical ablation
  • pacemaker and defibrillator implantation
  • reflect on the challenges of applying research to practice in relation to the diagnosis and management of patients with arrythmias and suggest improvements, building on a critique of available evidence.

Channelopathies and other inherited syndromes:

• identify findings in physiological data associated with genetic disorders;
• construct and interpret a family tree to recognise basic patterns of inheritance;
• synthesise communications with respect to cardiac genetic disorders provided by clinical geneticists;
• discuss genetic conditions with other professionals and patients.

Attitudes and behaviours

By the end of this module the Clinical Scientist in HSST will be expected to critically evaluate their own response to both normal and complex situations, consistently demonstrating the professional attributes and insights required of a Clinical Scientist in HSST working within the limits of professional competence, referring as appropriate to senior staff and will:

• appreciate the anxiety patients suffer with arrhythmias and with some methods of management, e.g. ICD;
• respond appropriately to anxious patients with arrhythmias and their carers and relatives, including discussing the possible management methods, e.g. catheter ablation and pacing;
• work within professional limits with regard to genetic conditions and when to seek further advice;
• work within a multiprofessional team to account for the fact that genetic conditions are often multisystem, hence other healthcare professionals are likely to be involved in patient care;
• appreciate that genetic information impacts not only on the patient but also on their family;
• consider the ethical issues involved in genetic testing, such as confidentiality, testing of children and pre-symptomatic testing.