Imaging (Echocardiography) —
Training activity: 9

Details

Adapt protocol and report to cater for ischaemia/coronary artery disease

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, how can echocardiography be used to assess for ischaemia and the effects of coronary artery disease (e.g., regional wall motion abnormalities)?
• How does the imaging protocol need to be adapted to assess for these features, potentially including stress echocardiography?
• What specific views and techniques are important when evaluating for ischaemia/coronary artery disease?
• What key elements should be included in the echo report when focusing on ischaemia/coronary artery disease?

In action

• How are you adapting the standard echo protocol to assess for evidence of ischaemia or the effects of coronary artery disease (e.g., regional wall motion abnormalities)? Which specific views are crucial? How are you planning to document these findings in your report? Are you focusing on specific segments of the myocardium known to be supplied by particular coronary arteries? Are you deciding on the severity and extent of any observed wall motion abnormalities? Are you familiar with the segmental anatomy of the left ventricle and its correlation with coronary artery territories? Are you consciously looking for subtle wall motion abnormalities?

• Are you successfully visualising all relevant segments of the left ventricle? Are you confident in your ability to identify and describe any regional wall motion abnormalities? Are you gaining a better understanding of how ischaemia and infarction manifest on echocardiography? Are you learning to differentiate between different patterns of wall motion abnormalities? Are you applying your knowledge of coronary artery anatomy, the pathophysiology of ischaemia, and echocardiographic techniques for assessing regional wall motion?

• Would the use of contrast or stress echocardiography potentially provide additional information in this clinical context? If you are unsure about the significance of certain wall motion abnormalities or their correlation with specific coronary arteries, would you seek advice? Are the protocol adaptations and the interpretation of findings related to ischaemia within the scope of your current training?

On action

• Describe the specific considerations for imaging a patient with suspected or known ischaemia/coronary artery disease. Outline how you adapted the standard echo protocol, including any specific views or techniques used (e.g., stress echo awareness). Note the key features you focused on in the report.
• Reflect on your understanding of the echocardiographic assessment of ischaemia/coronary artery disease. Did you gain a better understanding of the role of echo in this context? 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 ischaemia/coronary artery disease 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 different presentations of ischaemia and coronary artery disease requiring tailored echo protocols (e.g., stress echo, assessment of regional wall motion abnormalities)? How have your subsequent experiences refined your approach to these cases?
• How has your ability to adjust echo protocols to assess for myocardial ischaemia and its consequences improved? Are you now more skilled in identifying and documenting subtle signs of ischaemic heart disease on echocardiography?
• How will your understanding of echocardiography in the context of ischaemia and coronary artery disease inform your participation in the assessment of patients with chest pain or suspected acute coronary syndromes? How will this experience support your interpretation of stress echocardiograms and your communication of these findings?

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.