Presentation and Management of Cardiac Disorders

Details

Title

Presentation and Management of Cardiac Disorders

Type

Stage One

Module code

HPS113

Requirement

Compulsory

Module objective

By the end of this module the Clinical Scientist in HSST, with respect to the symptoms, presentation and management of patients with cardiac conditions, will be able to critically analyse, synthesise, evaluate and apply knowledge, and perform the specialist assessment, diagnosis and treatment of patients while consistently demonstrating 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 with respect to the presenting symptoms and diagnosis of cardiac disease, including:

Symptoms that may have a cardiac cause Chest pain, including:

• the causes of chest pain;
• differential diagnosis of a patient presenting with chest pain;
• the indications, limitations, risks and predictive value of non-invasive and invasive investigations;
• the associated psychological factors of patients with chest pain;
• non-cardiac causes of chest pain.

Breathlessness, including:

• causes of acute and chronic breathlessness;
• differential diagnosis of a patient presenting with breathlessness;
• management of patients with chronic shortness of breath;
• non-cardiac causes of breathlessness.

Pre-syncope and syncope, including:

• causes of syncope and pre-syncope;
• indications, limitations, risks and predictive value of non-invasive and invasive investigations;
• indications for tilt table testing and loop recorders;
• current recommendations concerning fitness to drive in patients with pre-syncope and syncope;
• importance of the history from relatives and witnesses;
• problems specific to the elderly and address their social and medical needs;
• impact of syncope on patients’ lifestyle;
• non-cardiac causes of pre-syncope and syncope.

Diagnosis

Stable angina, including:

• the pathogenesis of atheroma and the importance of risk factors;
• the natural history, pathophysiology and presentations of coronary artery disease;
• the pharmacology of drugs currently used in the treatment of stable angina;
• the indications, limitations, risks and predictive value of non-invasive and invasive investigations;
• which patients should be investigated further and referred for intervention;
• the interaction of symptoms with the patient’s lifestyle.

Acute coronary syndromes and myocardial infarction, including:

• the pathogenesis of acute coronary syndromes and the importance of risk factors;
• the natural history, pathophysiology and acute presentations of coronary artery disease;
• the pharmacology of drugs currently used in the treatment of acute coronary syndromes;
• the indications, limitations, risks and predictive value of non-invasive and invasive investigations;
• which patients should be investigated further and referred for intervention.

Heart failure:

• the aetiology, pathophysiology, diagnosis and management of heart failure;
• the natural history and clinical presentation of patients with heart failure;
• the pharmacology of drugs used to treat heart failure;
• when and whom to refer for device therapies for heart failure (cardiac resynchronisation therapy [CRT] and implantable cardioverter defibrillators [ICDs]);
• the indications for onward referral for consideration of surgical interventions (including valve surgery, cardiac transplantation and assist devices.

Cardiomyopathy:

• different types of cardiomyopathy;
• pathogenesis, natural history and prognosis of the cardiomyopathies;
• genetic basis for cardiomyopathies, especially hypertrophic cardiomyopathy;
• role of screening;
• role of medical therapy, implantable cardioverter defibrillators, catheter-based and surgical-based treatments of the cardiomyopathies;
• indications for transplantation;
• current and future application of genomics and clinical bioinformatics.

Valvular heart disease:

• the pathological processes that are responsible for valvular heart disease;
• the natural history of valve disorders;
• the indications, limitations, risks and predictive value of non-invasive and invasive investigations;
• the indications for surgical intervention;
• the different types of prosthetic valve available for clinical use;
• the anticoagulation regimens appropriate for patients with valve disease and valve prostheses;
• which patients need regular follow-up;
• endocarditis prophylaxis protocols.
• endocarditis prophylaxis protocols.

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 appropriate to a range of cardiac disorders and will:

History taking, clinical examination and investigation:

• gain informed consent;
• take a relevant, focused history, elicit relevant physical signs, formulate a differential diagnosis, plan appropriate further investigations and formulate an appropriate management plan;
• perform a reliable and appropriate examination;
• select and use investigations appropriately, which may include:
  • echocardiography
  • magnetic resonance imaging (MRI)
  • exercise testing
  • determination of oxygen consumption.

Management:

• diagnose cardiac disorders accurately;
• recognise and respond appropriately to presence of acute coronary syndromes and myocardial infarction;
• discuss the risks and benefits of an intervention to a patient/carer/parent in a way that they understand and answer any questions they may have;
• recognise the role of other healthcare professionals working in this area;
• discuss the concerns and anxiety of patients and relatives with cardiac disorders;
• advise patients regarding lifestyle and long-term risk factor management;
• educate patients, carers and relatives appropriately;
• discuss sexual issues, including erectile dysfunction and use of drugs, with the patient and their partner in a sensitive manner;
• critically reflect on the challenges of applying research to practice in relation to cardiac disorders and suggest improvements, building on a critique of available evidence;
• discuss the advantages and disadvantages of medical versus surgical management in a way that patients can understand;
• discuss the advantages and disadvantages of different valve prostheses with patients;discuss sexual issues, including erectile dysfunction and use of drugs, with the patient and their partner in a sensitive manner;
• appreciate the importance of educating patients about endocarditis prophylaxis and the natural history of valvular heart disease.

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 importance of the history in evaluating patients presenting with cardiac disorders;
• adopt a non-judgemental and non-stereotyping approach to patients;
• appreciate the anxiety and concerns of patients and relatives with cardiac disorders;
• appreciate the contribution non-medical and non-cardiological disciplines have to play in the treatment of patients with cardiac disorders;
• appreciate the associated psychological factors of patients with cardiac disorders;
• involve/refer to other specialists, e.g. respiratory physicians, ENT, neurologists, as required, appreciating the contribution of the multiprofessional team;
• appreciate the importance of lifestyle, exercise and weight loss on the management of cardiac disorders;
• recognise the role of cardiac nurse specialists and cardiac rehabilitation;
• appreciate the interaction of symptoms with the patient’s lifestyle, including occupation and leisure
• appreciate the importance of rehabilitation;
• develop supportive relationships with patients with chronic cardiac disorders, e.g. heart failure;appreciate the interaction of symptoms with the patient’s lifestyle, including occupation and leisure;
• work collaboratively as part of a multiprofessional team.