Imaging (Echocardiography) —
Training activity: 23

Details

Adapt protocol and report to cater for endocarditis

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• Before this activity, what are the echocardiographic features suggestive of infective endocarditis (e.g., vegetations, abscesses)?
• How does the imaging protocol need to be adapted to specifically look for these features?
• What views and Doppler techniques are most important in assessing for endocarditis and its complications?
• What key elements should be included in the echo report when focusing on suspected endocarditis?

In action

• How are you modifying the standard echo protocol to specifically assess for features of endocarditis (e.g., vegetations, abscesses, valve perforations, new regurgitant jets)? Which specific views and Doppler techniques are you prioritising? How are you planning to structure your report to clearly document any findings suggestive of endocarditis and their impact on valve function? Are you carefully examining the valve leaflets and supporting structures for the presence of mobile, echogenic masses? Are you using colour Doppler to assess for new or worsening valvular regurgitation? Are you looking for evidence of myocardial or perivalvular abscess formation? Are you familiar with the echocardiographic features of infective endocarditis? Are you consciously applying specific diagnostic criteria (e.g., Duke criteria) in your assessment?

• Are you successfully visualising the heart valves and surrounding structures in sufficient detail to rule out or identify features of endocarditis? Are you encountering any difficulties in obtaining clear images due to patient factors or technical limitations? Are you gaining a better understanding of the echocardiographic manifestations of endocarditis and its potential complications? Are you learning to differentiate between vegetations and other cardiac masses? Are you applying your knowledge of the pathogenesis and clinical presentation of endocarditis, as well as your echocardiographic skills in assessing valve structure and function?

• Would transoesophageal echocardiography provide better sensitivity for detecting vegetations or complications like abscesses, especially in patients with prosthetic valves or poor transthoracic windows? If you identify a potential vegetation or other findings suggestive of endocarditis, would you immediately seek confirmation from a senior colleague? Are the protocol adaptations and the interpretation of findings related to endocarditis within the scope of your current training?

On action

• Describe the specific considerations for imaging a patient with suspected or known endocarditis. Outline how you adapted the standard echo protocol, including specific views and Doppler assessments to look for vegetations and haemodynamic consequences. Note the key features you focused on in the report.
• Reflect on your understanding of the echocardiographic assessment of endocarditis. Did you gain a better understanding of the imaging features of endocarditis? Were there any challenges in adapting the protocol or interpreting the findings? How does this relate to acquiring and interpreting cardiac images for pathological conditions?
• Identify any specific aspects of endocarditis imaging where you need to enhance your knowledge of protocols and reporting. How will you approach adapting protocols in the future? What resources will you use to further your understanding?

Beyond action

• Have you encountered patients with suspected or confirmed endocarditis requiring specific adaptations to the echo protocol and reporting to identify vegetations or other complications? Have your subsequent experiences deepened your understanding of the echocardiographic features of endocarditis?
• How has your ability to tailor echo protocols to optimise the detection of vegetations and assess for complications of endocarditis, such as valve dysfunction and abscess formation, improved? Are you now more proficient in documenting the characteristic findings of endocarditis in your reports?
• How will your understanding of echocardiography in endocarditis inform your collaboration with infectious disease specialists and cardiothoracic surgeons in the management of these patients? How will this experience support your ability to contribute to the early diagnosis and risk stratification of endocarditis?

Relevant learning outcomes

#	Outcome
# 1	Outcome Acquire and interpret cardiac images for a range of normal and pathological conditions.
# 2	Outcome Explain imaging results to patients and other health care professionals.
# 3	Outcome Distinguish and justify actions based on clinical and ECG findings.
# 5	Outcome Appraise new guidelines and evidence to inform practice.
# 6	Outcome Demonstrate safe practice in line with local, national and international guidelines and standards.
# 7	Outcome Assess and evaluate a patient’s clinical presentation and make recommendations for cardiac imaging.
# 8	Outcome Evaluate cardiac care pathways.
# 9	Outcome Summarise complex information into a concise and logical reports for specialist and non-specialist audiences.