cardiology curriculum

Egyptian Fellowship Board

Cardiology Curriculum

Cardiology Egyptian Fellowship Board

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2

Preface

T he Egyptian Fellowship Board and the cardiology scientific council worked collaboratively

and closely to make this curriculum available for trainees’ guidance and support.

Postgraduate medical education world wide is now governed by sets of academic standards

that describe the qualities and abilities of graduates. In addition, there are standards for The train-

ing processes , trainers’ selection and methods of assessment. standards ensure transparency

and clarify expectations.

The Egyptian fellowship board has already defined and published its standards for the general

and professional competencies expected from graduates in different specialties upon successful

completion of training. These expectations are clearly reflected in the cardiology curriculum.

The curriculum describes what trainees will know and be able to do upon completion of

training. In additions, methods of teaching and learning needed to deliver the curriculum are out-

lined. The curriculum also describes in details, expectations from trainees during their rotations in

“The training rules and regulations section”. Methods of assessment and examination regulations

are also available in the last section of the curriculum.

All topics covered during practical and theoretical study are outlined in tables. This will help

trainees to guide their readings and their choice of learning activities. In addition, all required

clinical cases and procedures are listed together with expected performance at various stages of

training

To help our trainers, supervisors and maximize benefits, we provided a guide for required lec-

tures at various rotations and years. Mandatory courses are also mentioned and the Egyptian Fel-

lowship Board will work closely with the cardiology scientific council to ensure proper organiza-

tion and implementation of mandatory courses at appropriate training stages.

We hope that all our trainees, trainers and educational supervisors will follow the guides provided

in the curriculum and cooperate with The Egyptian Fellowship Board and the cardiology scientific

council to implement the curriculum in the best ways. XáÅtà T{Åxw f{xut

Secretary General Higher Committee of Medical Specialties


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4

Acknowledgement This curriculum has been created through collaboration between The Cardiology Scientific Coun-

cil and The Egyptian Fellowship Curriculum Committee. The following members of the Cardiology

Scientific Council have made substantial contribution to the curriculum development as subject

matter experts

The Fellowship Board and The Cardiology Council would like to acknowledge the efforts of the

following members of the council who provided constructive feedback regarding the curriculum

structure and contents

The Egyptian Fellowship Curriculum Committee has contributed to the curriculum through provi-

sion of consultation regarding the educational structure , copy editing, and formulation of in-

tended learning outcomes . The Member who participated in The work is

The Committees consulted international curricula in cardiology. The external refer-

ences for the development of this curriculum are:

1. The cardiology curriculum issued by Joint Royal Colleges of Physicians Train-ing Board 2007

2. The American Council for Graduate Medical Education (Cardiology program requirements )

3. Recommendations of the European board for the specialty cardiology for edu-cation and training

4. Postgraduate Medical Education and Training Board UK (Guidelines for cur-riculum development 2006)

• Professor Dr Khairy Abd El Dayem , Professor of Cardiology , Ain Shams University

and Head of The Cardiology Scientific Council

• Professor Dr Eman Abd El Raouf Mohammed ,Educational consultant to The Egyptian Fellow-

ship Board

• Prof Dr Esam El Garhey , Professor of Cardiology, El Azhar University

• Prof Dr Gamal Abou El Nasr, Professor of Cardiology, National Cardiology Institute

• Prof Dr Ahmed Magdy, Professor of Cardiology, National Cardiology Institute


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6


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7

CONTENTS …………………

Scientific council …………………………………………………………………………………………………...

Entry Requirements for The Egyptian Fellowship of cardiology……...

Training rules and regulations …………………………………………………………………………

Specific Requirements and Obligation………………………………………….…………

General rules and regulations…………………………………………………………………………..

Interruption of the training…………………………………………………………………………………

Curriculum rationale statement……………………………………...…………………………

Curriculum aims……………………………………………………………………………………………..

Intended learning outcomes …………………………………………………………………………….

Basic Science Learning Outcomes…………………………………………………………………...

Clinical Science Learning Outcomes……………………………………………………...……...

Clinical problems of cardiology…………………..…………………………………………….

List of required lectures…………………………..……………………………………………………

Teaching and learning methods…………………………………………………………….

Regulations and Methods of Assessment …………………………………………………...

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9

انىظيفت اإلسى هيئت انجهس

أستبر انقهب بطب عي شس يحذ خيري عبذ انذايى. د.أ رئيس انجهس

استبر انقهب بطب األزهر يحذ يختبر جعت/ د.أ بئب انرئيس

استشبري قهب بعهذ انقهب جبل ابىانصر/ د.أ يقرر اإليتحببث

طب عي شس بيم فرج . د.أ عضى

أستبر انطب بطب عي شس عر عىاد/ د.أ عضى

استشبري انقهب بعهذ انقهب رؤوف يهرا/ د.أ عضى

طب انقبهرة شريف انطىبج. د.أ عضى

طب األسكذريت وجذي عيبد. د.أ عضى

طب األزهر عسيس يذكىر. د.أ عضى

طب انقبهرة خبنذ سرور. د.أ عضى

طب األزهر أي أبى انجذ. د.أ عضى

طب قبة انسىيس يحذ فتح يقهذ. د.أ عضى

قهب األطفبل ببنقبهرة. أ فىزا شهتىث. د.أ عضى

استبر انقهب بطب األزهر عصبو انجبرح/ د.أ عضى

إستشبري قهب بعهذ انقهب أحذ يجذي/ د.أ عضى

استشبري قهب بعهذ انقهب هب عبذانرازق/ د.أ عضى

طب انقبهرة شريف يختبر. د.أ عضى

قهب أطفبل عي شس. أ ي حذي انسيذ. د.أ عضى

قهب األطفبل انقبهرة. أ هىيذا جالل انسيذ. د.أ عضى

انجهس انعه نتخصص انقهب و األوعيت انذيىيت


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11


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12

Any of The following is considered a satisfactory entry requirement for The Egyptian

Fellowship of cardiology

1. Diploma in General Medicine

2. Master in General Medicine

3. M.D. in General Medicine

4. M.R.C.P.

5. Fellowship of Egyptian Board of General Medicine

6. Diploma in Cardiology

7. Master in Cardiology

Those admitted to the Fellowship training program with qualification in general

medicine (number 1 to 5 above) must attend and pass a course in basic sciences

relevant to the study of cardiology and in basic cardiology. The course will take

place during the first year.

The Egyptian Fellowship Board requires a minimum of three years supervised train-

ing programme that must be conducted in an accredited hospital before sitting for

the final examination. It also requires the presentation of a short thesis on a subject

approved by the supervisors. A list of accredited hospitals will be announced yearly

by the Board.

The cardiology training programme follows at least two years residency (or equiva-

lent training) in general medicine and consists of three years residency in cardiology.

During all the training programme the candidate must be dedicated full time and

must be fully responsible for patient care.

ENTRY REQUIREMENTS FOR THE EGYPTIAN FELLOWSHIP OF CARDIOLOGY

TRAINING RULES AND REGULATIONS

The structure of the training program


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The trainee should spend the first year in general cardiology including inpatient

care, outpatient clinics, emergency department, and CCU.

The candidate should attend and study the curriculum of basic science related to

cardiology in the field of anatomy, physiology, pathology, biochemistry and

pharmacology and basic cardiology. he should attend at least 75% of lectures in

these subjects (2/week) for 8 months. He should pass successfully through first

part written exam in these subjects before being promoted to the third year of

training.

He should be actively involved and fully responsible for patient care including

sharing in making decisions about diagnosis and management under supervision

of the consultants.

He must attend 75% of weekly departmental meeting including clinical rounds,

morbidity and mortality conferences and journal club.

His performance will be monitored by his trainer and a report made of this per-

formance monthly

The trainee should spend six months in general cardiology including inpatient

care, outpatient clinics and emergency unit.

He should spend two months in coronary care unit, two months in non-invasive

laboratory (including stress testing, tilt table test and nuclear studies) and two

months in echocardiography laboratory (including training on stress echo, con-

trast echo, transesophgeal echo, etc…).

He should attend once weekly in the catheterization laboratory as assistant or

operator in diagnostic cases and as assistant in interventional cases.

He should supervise junior trainees in his unit.

He should do consultations requested from other department.

He should attend 70% of weekly departmental meeting.

He should be responsible under supervision for outpatient clinic once weekly.

He should Take shifts on duty in the medical emergency department as deter-

mined by hospital regulations

During this year the trainee should be fully responsible for patient care in

outpatient, inpatient and emergency department.

First Year

Second Year

Third Year


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14

He should spend 2 months in the electrophysiology unit (including training on

pacemaker program and pacemaker follow-up) and 2 months in the pediatrics

unit and 2 months in the post surgical CCU.

He should spend one day per week in the catheterization laboratory. He

should be able to perform diagnostic coronary and right and left heart cathe-

terization under supervision of the consultant.

He should independently report ECGs, echocardiograms, stress ECG, and nu-

clear studies and decide what should be done for patients in association with

consultant responsible.

He should be involved in the research program of the institution and prepare a

short thesis or audit on a subject approved by the supervisor of the fellowship

training program.

A. The trainee will be responsible for admitting the patient from outpatient depart-

ment or emergency room.

B. He will ascertain the completion of the following documents in each :

• Complete history and physical examination form.

• Investigation requests, (laboratory, radiology, pathology, etc.).

• Results of the investigations.

• Plan of management and daily progress notes.

• Order and medication sheets and Order the necessary non-invasive diag-

nostic procedures such as E.C.G., Echo. X- rays, VIS etc.

• Discuss the indications of invasive diagnostic procedures such as abdomi-

nal tapping, liver biopsy etc…, with the consultant.

• Discharge summaries.

• Sick leaves and medical reports.

• The trainee should inform the senior staff of any high risk patient admis-

sion.

The trainee should attend the following outpatient clinics :

• General cardiology clinic.

• Subspecialties clinic (EG, hypertension, arrhythmia and post PCI clinics).

SPECIFIC REQUIREMENTS AND OBLIGATION

The admitted patients

Outpatient Clinics


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15

The trainee shall be required to attend and participate in the mandatory academic

and clinical activities of the department. Attendance and participation should not be

less than 75% of the total number of activities within and training rotation / period

including.

Daily morning endorsement meeting.

Clinical round presentation, at least once weekly to cover various topics,

problems, research, etc.

Journal club meeting, at least once monthly.

Clinic-pathological meeting, at least once monthly.

Mortality audits.

Interdepartmental meeting.

The trainee shall be required to keep a log book where he/she shall record all activities

and skills performed and learned during the training program. The activities should be

dated and categorized to whether been performed by the trainee him/her self or as

an assistant or participant. Each activity registered in the log book should be counter

signed by the trainer and finally the professor and the supervisor shall sign the com-

pleted log book.

The trainee shall undertake al least one research project or audit during the training

program under the guidance and supervision of his/her trainer. Such project or mini

thesis should be duly written (not necessarily published) before the trainee is accepted

for admission to the final certifying examination.

The trainee should have completed satisfactorily the rotations described in the struc-

ture of the program

maintain the confidentiality and ethics of the profession. He shall maintain healthy

relations with patients, their relatives, the medical, nursing and administrative staff.

3. Mandatory Clinical and Academic Activities :

4. The Log Book :

5. The research project :

6. At the completion of the training program :

7. The trainee shall


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16

GENERAL RULES AND REGULATION

A. Holidays and on call duties :

According to Ministry of health and Population regulation.

B. Evaluation procedures :

1. Performance of the trainee shall be evaluated on regular and continuous basis

the evaluation process should involve all aspects of the training including

theoretical, clinical and investigative procedures skills as well as attendance and

participation.

2. The trainers who are required to write confidential reports on the performance

of each trainee should evaluate the trainee periodically. The trainee should not

be allowed to proceed in the training program and move to the next rotation

unless he/she attains a satisfactory level of performance acceptable to the

responsible Professor and the head of The cardiology scientific council.

3. There is annual assessment (theoretical and clinical) for the trainees before

each pass from one level to the next (year 1 to year 2 to year 3) etc.

4. The trainee shall not be allowed to proceed to year three before successfully

passing the Egyptian Board Exam in Basic Science and Basic Cardiology (first

part exam).

It is not permissible to interrupt such a structural training program except in major

unavoidable circumstances. Such circumstances should be convincing and

approved by the Secretary General of The higher committee of Medical Specialties.

The interruption once approved should not be for more than one year.

Interruption of the training program for more than one year shall result in dismissal

from the program and cancellation of the preceding training period.

The purpose of this curriculum is to describe the knowledge, skills and expertise that

must be gained by trainees in cardiology in order to practice independently and

safely. The curriculum also describes teaching, learning and assessment methods

that will be used to ensure that the trainees have attained the required

competencies. We derived the contents of the curriculum from previous Fellowship

curricula together with a review of curricula of other cardiology training programs

in the European Union, UK and USA. Expert advice has been sought from the

board of the cardiology fellowship and others working in the field. The wide

participation of experts ensures that the curriculum is up to the international

accepted standards of practice in The field of cardiology.

INTERRUPTION OF TRAINING

CURRICULUM RATIONALE STATEMENT


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17

The educational process in the fellowship of Cardiovascular Medicine aims to equip

trainees with the necessary knowledge and skills so that they will be able to :

1. Develop management plans for the ―whole patient‖ and maintain knowledge in

areas of medicine which impinge on the specialty of cardiovascular medicine.

2. Apply appropriate knowledge and skill in the diagnosis and management of

patient with cardiovascular disorders.

3. Establish a differential diagnosis for patient presenting with cardiovascular

problems by the appropriate use of the clinical history, examination and

investigations.

4. Perform the core investigations required in cardiovascular medicine.

5. Develop clinical practice which is based on analysis of relevant clinical trials and

have an understanding of other research methodologies.

6. Apply the knowledge of biological and behavioural sciences in clinical practice.

7. Identify and take responsibility for their own educational needs and the

attainment of these needs.

8. Address all aspects of the health care needs of patients and their families.

9. Develop leadership and team working skills, especially with other healthcare

professionals.

10. Maintain the highest standards appropriate in their professional field and able to

respond constructively to assessments and appraisals of professional competence

and performance.

11. Be aware of current thinking about ethical and legal issues.

12. Act as safe independent specialists whilst recognizing the limitation of their own

practice and the obligation to seek assistance from colleagues where appropriate.

13. Take appropriate action when things go wrong, both in their own practice and in

that of others.

14. Assess honestly and objectively the performance of those they have supervised

and trained.

15. Manage time and resources to the benefit of themselves, their patients and

colleagues.

16. Take advantages of information technology to enhance all aspects of patient care.

TRAINING AIMS


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18

INTENDED LEARNING OUTCOMES

1. Communicate effectively in daily clinical practice.

2. Apply His knowledge of legal and ethical practice in day to day work

3. Function successfully in a multidisciplinary team.

4. Understand The management and service delivery issues in the

Egyptian Governmental Health System.

5. Teach medical knowledge and skills to junior colleagues and other

healthcare professionals

6. Plan, conduct and analyze a research project.

7. Manage health information.

1. Take a relevant and complete history and perform full and focused

clinical examination.

2. Choose investigations needed for the patient & interpret the results.

3. Use information available to reach diagnosis or differential diagnosis.

4. Competently manage (i.e. assess, diagnose and treat common and

important cardiac diseases and presentations mentioned in The cur-

riculum case and presentation list.

5. Participate effectively in primary and secondary prevention of cardio-

vascular diseases like hypertension, hyperlipidemia and infective en-

docarditis

6. Assess and care for cardiac patients before and after cardiac and non

cardiac surgery.

7. Manage critically ill patient with hemodynamic disturbances.

8. Perform cardiopulmonary resuscitation

9. Select, interpret and appropriately perform under supervision and

independently The cardiovascular procedures mentioned in The cur-

riculum list.

10. Refer appropriately his patients for invasive cardiac procedures men-

tioned in The curriculum list.

A. Generic intended learning outcomes

B. Clinical intended learning outcomes


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19

Clinical conditions to be managed competently by trainees

Stable angina Acute

breathlessness Cardiomyopa-

thy Arrhythmias Hyperlipidemia

Acute coronary syndrome

Chronic breathlessness

Valvular heart disease

Pericardial diseases

Congenital heart

Myocardial infarction

Heart failure Presyncope

and syncope Hypertension Endocarditis

Diseases of the aorta

Cardiac tumors Heart diseases in pregnancy

procedures to be performed or interpreted competently by The trainees

ECG recording & interpretation

Chest X-ray Basic electro-physiology

Cardioversion Pericardiocen-

tesis

Exercise testing, recording and interpretation

Echo-cardiography

Basic nuclear cardiology

Pacing Basic invasive

& interventional cardiology

Procedures and cases where trainees must seek referral for experts

Neonates and infants with congenital heart diseases

Diagnostic and therapeutic invasive electrophysiology

Stress Echo

Advanced Elec-trophysiology

Cardiac resynchroniza-tion therapy

Percutaneous coronary

intervention

Implantation and programming of Intra cardiac defibrillators

intra-aortic Balloon counter pulsation

Trans esophageal

echocardiogra-phy

Tissue Doppler studies

Computerized tomography and multislice C.T and MRI


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20


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21

Basic Sciences and Basic Cardiology

Learning Outcomes

Methods of teaching and learning: Lectures, seminars and self study.

Methods of assessment: First part written examination

Year of achievement: First Year


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22


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23

Anatomy

By The end of training, trainees should have adequate knowledge and deep under-

standing of :

1. The position of all cardiac structures to guide them in performing venous and

arterial access and navigate catheter and electrode in the heart.

2. The relevant cardiac and vascular structures & their relationship to each other in

order to help them during interpretation & performance of invasive and non-

invasive imaging by all imaging techniques (e.g. echo, MSCT, CT, MRI, Angiogra-

phy, etc.)

3. The developmental basis of all congenital cardiac and vascular malformation.

1. Identify anatomic landmarks on postmortem specimens.

2. Identify cardiac chambers and vascular structures in angiograms.

3. Identify normal and abnormal cardiac and vascular structures in X-rays, CT, MRI

1. Embryology of heart and aortic arch.

2. Surface anatomy of the heart aorta and great vessels

3. Anatomy of the heart and detailed anatomy of cardiac chamber.

4. Anatomy of the brachiocephalic vessels with special stress on the access to CVP.

5. Anatomy of aorta and its abdominal branches.

6. Anatomy of pulmonary circulation.

7. Histology of the heart and blood vessels.

8. Anatomy of coronary vessels.

Knowledge

Skills

Topics


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24

By The end of The module, trainees should have adequate knowledge and

deep understanding of:

1. The physiologic basis of cardiac action.

2. The physiology & pathophysiology of systemic and pulmonary circula-

tion in order to understand various effects of disease.

3. The various metabolic processes in order to evaluate normal and ab-

normal metabolic disorders affecting the circulation.

1. Interpret results of physiologic tests such as blood gas analysis, blood

pictures and electrolyte analysis.

2. Interpret normal intracardiac pressure tracings.

3. Calculate cardiac axis in ECG.

4. Interpret respiratory function tests.

5. Construct diet for different cardiac conditions based on patient’s re-

quirement and food chemistry.

A) General Physiology:

1. Homeostasis.

2. Hemostasis, Coagulation & Fibrinolysis.

3. Acid – Base Balance.

4. Water & electrolyte Regulation.

5. Blood Elements (RBCs & Anemias, WBCs).

6. Hypertension & Hypotension.

7. Cardiac Performance (Pump Function & Heart Failure).

8. Capillary Circulation, body fluids Formation & Edema.

9. Hemorrhage & Shock.

10. Glucose Homeostasis & D.M.

11. Regulation of Respiration (& Types of Breathing).

Physiology & Biochemistry

Knowledge

Skills

Topics


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25

B) cardiovascular physiology:

1. Functional Characteristics of C. V.S & Flow.

2. Physiology of Cardiac Muscles:

Electric properties (R.M.P., A. P., Origin & spread of Cardiac Impulse).

Mechanical Properties (Contractile Behavior, excitation/contraction

coupling. Coupling, types of Contraction, Mechanism of Contraction,

Mechanism of Relaxation, contractility, Elastic Behavior).

3. E. C.G. & Arrhythmias.

4. Cardiac Cycle, pressure/volume loop, JVP, Arterial Pulse & Heart Sounds.

5. Cardiac Function Curves & V.R. Curves.

6. Venous Circulation & Insufficiency.

7. Circulation in arteries.

8. Microcirculation & Tissue Blood Flow.

9. Syncope.

10. Pulmonary Circulation

11. Respiratory changes in Heart Failure.

12. Circulatory Changes during Exercise & training.

13. Coronary & Cerebral Circulations.

14. Respiratory failure, hypoxia and cyanosis

15. O2 therapy.

16. Basic kidney physiology

c) Biochemistry

1. Introduction to metabolism

2. Carbohydrate metabolism

3. Lipid metabolism

4. Lipoproteins

5. Cholesterol metabolism

6. Hormones

7. Mineral metabolism

8. Vitamins and disease

9. Purine metabolism & Hyperuricemia

10. Diagnostic enzymology (+ troponin)

11. Free radicals and disease

12. Food chemistry and principle of dietetics


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26

By The end of training, trainees should have adequate knowledge and deep

understanding of the pathological basis of different forms of heart disease.

1. Identify important pathological findings in pathological specimens.

2. Identify histopathological changes in arteries and correlate it to gross pa-

thology and IVUS pictures.

1. Inflammation.

2. Degenerative diseases:

2. a. Disturbance of carbohydrate metabolism

2. b. Disturbance of protein metabolism

2. c. Lipid storage diseases.

2. d. Glycogen infiltration

2. e. Diabetes mellitus

2. f. Nutritional disturbances.

2. g. Malnutrition—Thiamin—Deficiency & vitamin C deficiency-

2. h. Disturbance of mineral metabolism (calcium & potassium).

3. Thrombosis.

4. Embolism.

5. Pulmonary embolism.

6. Ischemic heart diseases.

7. Myocardial infarction.

8. Pericarditis.

9. Myocarditis.

10. Endocarditis.

11. Cardiomyopathy.

12. Congenital heart diseases.

13. vascular diseases:

A. Arteriosclerosis (degenerative)

Atherosclerosis.

Medial calcific sclerosis

Arteriolosclerosis (Hypertension).

B. Vasculitis or vasculitides (inflammatory).

C. Aneurysms and dissecting aneurysm

14. Cardiac Tumors

Pathology

Knowledge

Skills

Topics


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27

By The end of training, trainees should have adequate knowledge and deep un-

derstanding of :

1. The classification, mode of action , indications, contraindications, interactions

and adverse effects of drugs used in The field of cardiology (with emphasis on

angiotensin—converting enzyme inhibitors angiotensin-receptor blockers aldos-

terone antagonists, antiarrhythmic drugs, beta-blockers, calcium antagonists,

diuretics, lipid-lowering drugs, antiplatelet agents, anticoagulants, inotropes,

digitalis, nitrates. Other vasodilation drugs, drugs with cardiac toxicity and other

drugs with novel mechanisms of action).

2. The drugs pharmacokinetics (absorption, bioavailability, distribution, biotrans-

formation, excretion).

3. Pharmacogenetics..

1. Take a relevant history of a patient’s medication regimen including purchase of

over the counter medicines.

2. Assess the risks and benefits of prescribing an individualized drug treatment

regimen for a given cardiovascular condition.

3. Monitor the desired effects of a patient’s drug therapy and also the side effects.

From this he should be able to make appropriate modifications to the treat-

ment regimen.

4. Recognize and manage possible drug interactions (including treatments of

concomitant diseases).

5. Identify and interpret the importance of herbal remedies taken by patients

6. Perform and interpret diagnostic tests to assess drug efficacy and safety

(laboratory test, EGC and hemodynamic monitoring, echocardiography).

7. Incorporate the principles of current evidence-based therapeutic guidelines

into clinical practice.

8. Communicate with patients and their family members to improve treatment

compliance and to ensure early recognition of possible adverse effects.

9. Consider the cost effectiveness & feasibility of the prescribed treatment regi-

men.

Pharmacology

Knowledge

Skills


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28

By The end of training, trainees should have adequate knowledge and deep

understanding of the basic principles underlying procedures and instruments

used in the cardiovascular field

1. Identify different instruments, catheters, etc. used in cardiac procedures.

2. Interpret normal and abnormal hemodynamic measurement and tracings.

3. Interpret results of oxymetry from different cardiac chambers.

Basic Cardiology

Knowledge

Skills

Topics

♦ Principles of hemodynamics.

♦ Pressure measurement : techniques, instruments and limitations.

♦ Flow measurement : including thermo and dye dilution : techniques, in-

struments and limitations.

♦ Quantitative angiography.

♦ Arrhythmogenesis : basic mechanisms.

♦ Principles of radiation physics, X-rays and CT scan.

♦ Radiation safety : radiological anatomy of the heart and major vessels.

♦ Principles of nuclear medicine.

♦ Principles of magnetic resonance and PET imaging.

♦ Principles of electrocardiography: the waves, leads, electric axis, etc...

♦ Principles of infection control, sterilization and re-sterilization.

♦ Principles of ultrasound, and Doppler : physics, probes, machines.

♦ Contrast materials in the catheterization and echo lab.

♦ Contrast nephropathy mechanisms, diagnosis and prevention.

♦ The cell membrane : channels and receptors.

♦ Medical ethics and medicolegal aspects of the practice of cardiology.


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29

1. Describe the incidence and prevalence of inherited cardiovascular disorder in the

local community.

2. State the basic knowledge of cardiac embryology and major gene families involved

in cardiogenesis.

3. Describe the principles of mendelian inheritance.

4. Describe the principles of polygenic cardiovascular diseases (such as hypertension,

diabetes and dyslipidemia).

5. Outline The general features of major monogenic cardiovascular diseases, hyper-

trophic cardiomyopathy, familial aortopathies such as Marfan syndrome, Ehlers

Danlos syndrome and Williams syndrome, familial dilated cardiomyopathies, familial

channelopathy, familial disorders of septation, familial basis of conotruncal anoma-

lies, trisomies, in particular trisomy 21, familial dyslipidemia, in particular disorders of

the low density lipoprotein receptor.

6. Explain the familial basis of inherited cardiac tumors

1. Take full history and perform appropriate clinical examination for patients with in-

herited or familial cardiovascular disease and construct a family pedigree when in-

dicated

2. Distinguish autosomal dominant , autosomal recessive, X-linked and mitochondrial

inheritance.

3. Counsel index cases and family members at risk on the probability of being affected

by a genetic cardiovascular disorder.

4. Recognize problems with pedigree interpretation such as incomplete penetrance,

variable expressivity and age-related patterns of expressivity.

5. Manage the uncertainties associated with genetic testing.

6. Direct patients and families when appropriate to major centers with a specialized

interest in their particular disorder and cooperate with genetic specialists

7. Use appropriate counseling skills to explain, educate and inform patients fully of the

nature of their disease and the diagnostic tests used to make a diagnosis.

8. Consult with patients and their family members in improving the recognition and

management of familial cardiovascular disease.

Genetics

Knowledge

Skills


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1. Define the physics and hazards of ionizing radiation to patients and staff.

2. Define the current statutory requirements concerning the medical use of

ionizing radiation.

3. Know how to operate the equipment involved in the use of ionizing

radiation.

4. Define the factors that affect radiation exposure to both patients and staff.

5. Outline the important aspects of cardioradiology.

1. Use radiation equipment appropriately and safely for the diagnosis,

assessment and treatment of patients with cardiac disease according to

recent.

2. Operate radiation equipment safely and effectively.

Appreciate the risks and benefits to patients and staff of using ionizing

radiation.

1. Define the incidence, prevalence and risk factors of cardiovascular dis-

eases in the local community.

2. Explain risk assessment in primary prevention, multifactorial interaction

and risk scoring charts.

3. Explain diet and nutrition in relation to cardiovascular risk management.

4. Describe treatment & prevention strategies for smoking, dyslipidemia, dia-

betes mellitus , hypertension , physical inactivity, left ventricular hypertro-

phy, obesity. metabolic syndrome, psychosocial factors.

5. Recognize that risk factors often cluster and require a comprehensive ap-

proach.

Radiation use and safety

Knowledge

Skills

Attitudes

Cardiovascular Disease Prevention, Risk Assessment and Management

Knowledge


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31

6. Explain risk assessment in secondary prevention including drug therapy.

7. Recognize the complications and consequences of specific risk factors.

1. Assess and treat patients with risk factors for cardiovascular disease.

2. Evaluate how different prevention methods work.

3. Contribute to the global efforts in reducing cardiovascular morbidity and mortality

by communicating the prevention message to the public.

4. Manage risk factors appropriately and communicate their importance to patients

and their families

5. Evaluate the risk of CVD for an individual patient.

6. Evaluate the benefit of risk factor intervention for the individual patient.

1. Appreciate the importance of risk factor management.

2. Appreciate variation in CVD risks across population, socioeconomic, gender and

racial group.

3. Through patient education, encourage a healthier lifestyle with specific emphasis

on risk factor.

4. Offer advice and support to family members with inherited CVD.

5. Cooperate with other specialists such as dieticians, dialectologists and specialist

nurses.

6. Participate actively in CVD prevention programmers.

7. Consider the cost effectiveness of the prescribed treatment regimen.

1. Describe current guidelines on resuscitation.

2. Discuss the principles of cardiopulmonary resuscitation.

3. Outline the cardiac and non-cardiac causes of cardiac arrest.

Skills

Attitudes

Resuscitation - Basic & Advanced Life Support

Knowledge


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32

1. Carry out effectively and supervise resuscitation of patients suffering from

cardiac arrest in The hospital and in The field.

2. Supervise pre hospital care of critically ill.

3. Show proficiency in advanced life support.

4. Show proficiency in advisory defibrillation.

1. Support relatives in critical situations .

2. Break bad news in a empathetic manner.

3. Appreciate legal and ethical considerations of resuscitation.

4. Be Familiar with the legal and ethical issues associated with ―do not resus-

citate‖ orders.

Skills

Attitudes & behaviors


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33

Clinical Cardiology Learning Outcomes

Methods of teaching and learning: Lectures, seminars, on The Job training and self study.

Methods of assessment: Trainer evaluation, logbook, final written exam at The end of training and Clinical and oral exam Year of achievement: Throughout the training program


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34

1. Outline the causes of acute and chronic breathlessness.

2. Discuss the management of cardiac and non-cardiac disease present-

ing with acute or chronic breathlessness.

1. Take a focused or complete history and perform appropriate examina-

tion for patients presenting with acute or chronic breathlessness.

2. Select and use investigations appropriately.

1. Appreciate the importance of consulting other specialists e.g. respira-

tory physicians and intensivists.

2. Appreciate the importance of lifestyle, exercise and weight loss.

1. Define syncope.

2. Describe the epidemiology, pathophysiology and the prevalence of dif-

ferent causes of syncope.

3. Classify causes of loss of consciousness e.g. neural mediated reflex syn-

cope, Adams - Stokes attack, orthostatic hypotension.

4. Identify the prognosis of different causes of syncope.

5. Describe diagnostic evaluation :

a. Strategy of evaluation.

b. Initial evaluation (history, physical examination. Baseline ECG).

c. Echocardiogram.

Acute and Chronic Breathlessness

Knowledge

Attitudes & Behaviors

Skills

Syncope

Knowledge


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35

d. Exercise stress testing.

e. Tilt testing.

f. Electrocardiography monitoring (long-term ECG, external and implantable

loop recorders).

g. Electrophysiological test.

6. Describe treatment, device based or pharmacological :

a. Neurally mediated (reflex) syncope.

b. Orthostatic hypotension.

c. Cardiac arrhythmias as primary cause.

d. Structural cardiac or cardiopulmonary disease.

1. Differentiate syncope from the other causes of Loss of consciousness.

2. Assess syncope cases through history and clinical examination

3. Treat patients with syncope.

4. Perform or interpret :

a. Electrocardiogram.

b. Echocardiogram.

c. Carotid sinus massage.

d. Tilt testing.

e Electrocardiographic monitoring (long-term ECG, external and implant-

able lop recorder).

f. Electrophysiological test.

g. Exercise stress test.

h. Cardiac catheterization and coronary angiography.

5. Perform a risk stratification.

6. Select appropriate treatment including education and reassurance, physical

maneuvers, Drug therapy or device implantation

Skills


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36

1. Appreciate the impact of syncope on the patient’s lifestyle.

2. Appreciate that syncope is a transient symptom and not a disease.

3. Appreciate how patients with syncope should be hospitalized.

4. Appreciate that the diagnosis of syncope is often presumptive.

5.Appreciate that the diagnostic value {sensitivity and specificity} of test for

syncope is imperfect.

6. Appreciate that observations during the event are of key importance.

7. Appreciate that the diagnostic yield of tests depends on the appropriateness

of their selection (per-test probability).

8. Recognize that most patients do not need specific treatment a part from

education and reassurance and that drug therapies are often ineffective.

9. Recognize the risk / benefit and the cost-efficacy of pacemaker, ICD and

catheter ablation therapy.

1. Describe the epidemiology, causes , pathophysiology, prognosis and

complications of HF.

2. Outline the international classifications of functional limitation (e.g. New York

Heart Association (NYHA) classes.

3. Outline the diagnostic procedures in the patient with known or suspected

HF including natriuretic peptides, echocardiography, ECG, ambulatory ECG,

stress testing, cardiac catheterization.

4. Describe the medical management of acute HF.

5. Describe the medical management of chronic HF (neurohumoral blockade).

6. Outline device management of HF : cardiac resynchronization therapy, ICD.

7. Explain the role of cardiac surgery including transplantation.

8. Identify the role of exercise training programs in HF patients.

9. Identify the complications expected in HF patients.

10.Describe the impact of heart failure (HF) on morbidity and mortality in the

local and general population.

Attitudes and behaviors

Heart Failure

Knowledge


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37

1. Take a relevant history and perform an appropriate clinical examination.

2. Select & use diagnostic techniques to differentiate the underlying causes of HF.

3. Deliver lifestyle advice and home - based treatment strategy to patients.

4. Risk - stratify HF patients & select appropriate drug and other therapies (implantable

cardiac defibrillator (ICD), cardiac resynchronization therapy (CRT), surgery).

5. Evaluate HF patients during follow-up and appropriately and continuously adjust

the treatment plan.

1. Emphasize the importance of lifestyle, exercise and weight loss and help patients to

understand need for long - term complex drug and the importance of rehabilitation.

2. Develop and sustain supportive relationships with patients with chronic HF and

Train them , relatives and specialist nurses in HF treatment.

3. Recognize the importance of multidisciplinary care including home-based nursing in

Heart Failure..

4. Recognize the limitations of CD, CRT and heart transplantation.

1. Define the causes of chest pain.

2. Describe the indications, limitations, risks and predictive value of noninvasive and

invasive investigations

1. Take a relevant history and perform a reliable and appropriate examination.


1. Appreciate the importance of the history in evaluating chest pain.

2. Appreciate the anxiety and concerns of patients and relatives with chest pain.

3. Appreciate the contribution of non-medical and non-cardiology disciplines in the

treatment of patients with chest pain.

4. Recognize the associated psychological factors of patients with chest pain.

Skills


Chest Pain

Knowledge

Skills



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38

1. Discuss the pathophysiology of acute coronary syndrome including myocardial

ischemia, atherosclerosis of the epicardial coronary arteries, events that precipi-

tate ACS and non -atheromatous CAD.

2. Describe the dominant clinical features of Acute Coronary syndromes.

3. Describe the diagnostic process in unstable angina and non - STEMI : analysis of

symptoms and clinical differential diagnosis, 12 - lead ECG, laboratory studies and

imaging modalities.

4. Describe the diagnostic procedures in acute myocardial infarction (AMI) : analysis

of symptoms and clinical differential diagnosis, 12 - lead ECG, laboratory studies

and imaging modalities.

5. Describe the potential complications of AMI : myocardial ischemia, arrhythmias

and mechanical complications.

6. Describe treatment options for AMI : prehospital and early hospital adjunctive

pharmacological therapy, percutaneous coronary intervention (PCI), coronary

bypass grafting (CABG) and adjunctive therapy early in hospital.

1. Take a relevant history and perform and appropriate clinical examination for

patients with suspected acute coronary event

2. Interpret biochemical markers of myocardial damage.

3. Interpret ECG & imaging techniques to detect & locate ischemia & / or infarction.

4. Monitor effectively patients with ACS.

5. Provide appropriate pharmacological treatment including analgesic, antiplatelet,

antithrombotic and anti-ischaemic therapy.

6. Make appropriate decisions regarding the indications and contraindications of

acute reperfusion treatment .

7. Demonstrate proficiency in selecting patients who need cardiac catheterization

in the context of ACS.

8. Demonstrate proficiency in treating patients with heart failure and cardiogenic

shock including invasive hemodynamic monitoring.

9. Perform advanced cardiopulmonary resuscitation techniques and initiate man-

agement of life threatening arrhythmias.

Acute coronary syndromes

Knowledge

Skills


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39

1. Recognize the importance of the organized teamwork required for the opti-

mal management of patients with ACS.

2. Recognize the importance of making rapid decisions regarding patients with

ACS, from the time of their arrival in the emergency department until defini-

tive therapy is established.

3. Appreciate the distress that unexpected and serious illness causes to both

the patient and relatives.

4. Recognize when to transfer the patient to another hospital for interventional

or surgical revascularization.

1. Describe the epidemiology of chronic Ischemic Heart Diseases and its risk

factors.

2. Explain the molecular and cellular biology of IHD, its pathology and develop-

ment and the effects of ischemia on the cardiac myocyte.

3. Describe events that precipitate a clinical angina attack.

4. Outline the prognosis of chronic IHD.

5. Describe the clinical assessment of known or suspected chronic IHD includ-

ing evaluation of chest pain, other symptoms and signs and diagnostic pro-

cedures.

6. Describe the management of chronic IHD including lifestyle measures and

pharmacological management:

a. Disease-modifying drugs

b. Symptom-controlling drugs.

7. Explain the role and relative merits of medical therapy and revascularization

(percutaneous coronary intervention of coronary artery bypass surgery) in

the patient with IHD.

8. Describe the role of health care delivery systems in the management of IHD.


`Chronic Ischaemic Heart Disease (IHD)

Knowledge


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40


2. Demonstrate the ability to risk-stratify patients and to select an appropriate

management strategy.

3. Select, use and interpret non-invasive, and invasive diagnostic tools for the

evaluation of ischemia, viability, left ventricular structure and function and

coronary anatomy.

4. Identify and treat risk factors for chronic IHD.

1. Recognize the important of risk factor management and secondary preven-

tion.

2. Consult with specialists such as interventional cardiologists, cardiac surgeons,

dieticians and diabetologists to devise an appropriate management plan for

individual patients.

1. Define the epidemiology, etiology and pathophysiology of essential

hypertension.

2. Describe the complications and consequences of essential hypertension.

3. Describe the diagnosis and assessment of essential hypertension :

4. Elaborate the management of essential hypertension.

5. Define secondary hypertension and recall its various causes:

renovascular hypertension.

bilateral renal parenchymal disease.

hypertension induced by hormonal contraceptives and conjugated

estrogens.

other forms of secondary hypertension

6. Outline the cell biology of left ventricular hypertrophy.

Skills


Knowledge

Hypertension


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2. Assess blood pressure using the correct methods for diagnosis and therapeutic

monitoring including ambulatory blood pressure.

3. Diagnose and treat different forms of arterial hypertension.

4. Advise patients on lifestyle management and treatment compliance.

5. Advise patients on measuring their own blood pressure.

6. Perform cost-efficient screening for secondary hypertension.

7. Select adequate treatment for lowering blood pressure to target values and pre-

vent end-organ damage.

8. Select appropriate parameters to describe the risk profile in an individual patient

with hypertension.

9. Identify secondary organ damage (in particular cardiac, neurological, renal and

atherosclerotic vascular disease) caused by hypertension.

10.Manage multi-drug treatment regimens according to a patient’s comorbidities

and possible side effects.

1. Recognize that the diagnosis and treatment of hypertension need a multidiscipli-

nary approach.

2. Motivate the patient to maintain long term compliance with antihypertensive ther-

apy.

3. Appreciate that hypertension itself is often under-diagnosed and under treated.

4. Recognize the clustering of risk factors that include hypertension in order to for-

mulate a holistic approach to patient management.

1. Explain the pathology and pathophysiology of valvular heart diseases.

2. Recall the natural history and progression.

3. Explain strengths & limitations of invasive & non-invasive diagnostic techniques.

4. Recall the main aspects of surgical and percutaneous interventions.

5. Describe the results & indications of medical, surgical & interventional treat-

ments.

6. Outline postoperative care.


Valvular Heart Disease

Knowledge

Skills


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42

1. Describe the changes which occur in ventricular function and pulmonary

vascular resistance following surgery or intervention.

2. Discuss the use of anticoagulants - diuretics and other vasoactive drugs.

3. Assess and manage patients with the following valvular pathologies :

aortic stenosis

aortic regurgitation

tricuspid stenosis

tricuspid regurgitation

mitral valve regurgitation

mitral valve stenosis

pulmonary valve disease.

4. Perform patient follow up after valve surgery or percutaneous intervention

including immediate postoperative care and long term management of pa-

tients with prosthetic valves.

5. Select appropriately invasive or non-invasive diagnostic techniques and Inter-

pret results of diagnostic procedures.

6. Decide whether to indicate surgery and appropriate timing.

7. Recognize and manage the complications which may occur in patients with

prosthetic valves.

1. Adopt a management strategy which reflects a ―multifactorial approach‖

including clinical evaluation, results of diagnostic procedures and the risk /

benefit ratio of intervention.

2. Cooperate with cardiovascular surgeons, interventional cardiologists and radi-

ologists.

3. Recognize the importance of patient education with respect to the natural

history of valvular heart disease, management of anticoagulation, prophylaxis

of bacterial endocarditis & choice of valve prosthesis when appropriate.

Skills



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43

1. Describe the epidemiology, the pathology, pathogenesis and microbiol-

ogy of endocarditis.

2. Discuss its clinical features, laboratory investigations including microbi-

ological results.

3. Describe the use of cardiac and extracardiac diagnostic procedures.

4. Explain the selection and management of antibiotic therapy.

5. Describe the role of valve surgery in patients with endocarditis.

6. Describe the management of complications.

7. Outline features of high-risk patients and situations.

8. List indications for antibiotic prophylaxis.

1. Assess, diagnose and treat patients with infective endocarditis (native

and prosthetic valves).

2. Select the appropriate laboratory investigations and diagnostic proce-

dures.

3. Bring together information from different disciplines to establish a diag-

nosis.

4. Select an appropriate antibiotic regimen.

5. Determine the need for and timing of surgery.

6. Manage complications.

7. Prescribe appropriate antibiotic agents for prophylaxis.

1. Develop a multidisciplinary approach with cardiac surgeons and bacteri-

ologists for diagnosis and management.

2. Recognize the importance of patient and physician education on pro-

phylaxis.

3. Make efforts to encourage patients to prevent endocarditis..

Infective Endocarditis

Knowledge

Skills



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44

1.

1. Describe the different mechanisms of arrhythmogenesis

2. Discuss the etiology, clinical picture and management of arrhythmias

3. Explain the electrocardiographic pattern of each type of arrythmia

4. List the indications for electrophysiologic testing and for ablation

5. Outline the indications for devise treatment e.g. cardioversion, pacing,

ICD, Cardiac resynchronization etc.

6. Discuss the limitations of each diagnostic and therapeutic modality

Use history, examination and cardiac imaging to diagnose arrhythmias

and to determine which patients require an ICD.

Classify arrhythmias by standard electrocardiogram.

Manage acute arrhythmias with drugs or with cardioversion.

Prescribe appropriate preventive pharmacological therapy.

Perform and interpret electrocardiographic monitoring and Interpret elec-

trophysiological studies.

Refer patients for catheter ablation and perform follow up after catheter

ablation.

Insert temporary pacing electrodes.

Implant permanent single chamber, dual - chamber pacemakers ( a docu-

mented indicative number is 50 cases

Appropriately select and refer patients for biventricular pacing.

Manage the follow up of patients with pacemakers including interroga-

tion and programming of the device.

Recognize the limitations and potential risks of ant arrhythmic drug ther-

apy and non pharmacological therapy

Appreciate the importance of co-existing structural heart disease, in rela-

tion to the outcome and management of arrhythmias.

Arrhythmias

Skills and attitudes

Knowledge


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45

1. Describe the epidemiology, prognosis and pathophysiology of AF.

2. Classify AF.

3. Describe the diagnosis, clinical features and impact on quality of life.

4. Identify associated conditions.

5. Outline diagnostic procedures: • minimal evaluation. • additional investigation.

6. Recall embolic complications.

7. Describe management :

• anticoagulant therapy.

• rhythm vs. rate control.

• conversion to sinus rhythm.

• prevention of recurrences.

6. Take a relevant history and perform an appropriate clinical examination for pa-

tients with suspected atrial fibrillation.

7. Perform and interpret :

• electrocardiogram.

• transesophageal echocardiogram.

• prolonged ECG monitoring (e.g. Holter monitoring).

• exercise testing.

6. Develop appropriate antithrombotic strategies for prevention of ischaemic

stroke and systemic embolism.

7. Select patients appropriately for cardio version and perform it competently

8. Perform rhythm control therapy : pharmacological.

9. Perform rate control therapy : pharmacological.

10. Select and refer patients for :

• electrophysiological studies.

• arterial catheter ablation.

• surgical ablation.

11. Recognize the importance of co-existing structural heart diseases for the out-

come and management of AF.

Atrial Fibrillation

Knowledge

Skills

• control of ventricular rate.

• pacemaker defibrillator therapy.

• catheter ablation surgery.

• pacemaker and defibrillator implantation.

• arteriovenous junction ablation and pacing.


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46

Sudden cardiac Death

1. Define SCD and know and understand the epidemiology, etiology, pathol-

ogy, pathophysiology and clinical presentation of the different condition

which may lead to SCD.

2. Define the principles of acute management of patients with SCD.

3. Define the principles of diagnostic work-up and risk stratification of survivors.

Resuscitation

♦ Explain the methods and guidelines of basic and advanced life support in-

cluding airway management, appropriate drug use, defibrillation and pacing.

Sudden cardiac death

1. Manage patient with threatened or aborted Sudden Cardiac Death (SCD)

including risk stratification, investigation and treatment.

2. Perform resuscitation (see below).

3. Interpret prodromal symptoms underlying causes and prognosis of an SCD

survivor.

4. Interpret and (in part) perform risk stratification methods (long-term ECG, left

ventricular function, echocardiography, catheterization, electrophysiological

studies, heart rate variability).

5. Follow-up SCD survivors & select appropriate long-term therapeutic options.

6. Identify, risk-stratify and manage individuals at elevated risk including family

members of SCD patients.

Resuscitation 1. Perform basic life support (BLS, cardiopulmonary resuscitation) and Ad-

vanced Cardiac Life Support (ACLS) including different skills.

2. Lead and coordinate the actions of an ACLS team.

3. Identify the cause of collapse .

4. Teach BLS.

Sudden Cardiac Death (SCD)

& Resuscitation

Knowledge

Skills


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47

Sudden cardiac death

1. Recognize the urgency of the management of cardiac arrest.

2. Recognize the importance of prodromal symptoms.

3. Appreciate patient and family anxieties.

4. Appreciate the importance of patient education & secondary prevention.

Resuscitation

1. Appreciate the importance of working in a team with layperson, paramedics and

other medical personnel during resuscitation (BLS and ACLS).

2. Appreciate the importance of regular audit of the basic and advanced life support

programs.

1. Define diabetes mellitus & describe its pathophysiology, non-cardiac & cardiac

complications

2. Describe the role of diabetes in coronary heart disease in the following areas :

• epidemiology.

• pathophysiology of cardiovascular complications.

• role of risk factor intervention.

• screening for CAD in diabetes.

• screening for diabetes in CAD.

3. Outline treatments including diet, exercise hypoglycemic drugs and insulin.

4. Explain current thinking regarding the concept of the metabolic syndrome.

1. Diagnose and treat cardiovascular complications in the diabetic patient with

awareness of the continuum ranging from impaired fasting glucose to insulin -

dependent diabetes and associated complications.

2. Prevent, diagnose & treat diabetes & its associated cardiovascular complications.

3. Actively participate in a multidisciplinary network of physicians and supporting

medical personnel in order to treat patients with diabetes adequately according to

disease state and complications.

♦ Be aware of the importance of recognizing that the continuum extends from pri-

mary prevention of diabetes to treatment of end- organ damage.

Attitudes and behavior

Diabetic Heart Disease

Knowledge

Skills



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48

Cardiomyopathy

1. Define & describe the epidemiology of dilated, hypertrophic, restrictive & infiltra-

tive cardiomyopathies & obliterative endomyocardial disease.

2. Describe the pathophysiology including genetics, clinical features & diagnostic

criteria of cardiomyopathies & obliterative endomyocardial disease.

3. Discuss the medical and invasive surgical, electrophysiological & interventional

management of cardiomyopathies & obliterative endomyocardial disease in-

cluding indications, contraindications & possible adverse effects.

Myocarditis

1. Define myocarditis and describe its etiology.

2. Describe the clinical features, pathology and diagnostic criteria of infective and

non-infective myocarditis.

3. Recall the treatment of patients with myocarditis and its complications.

4. Identify prognostic factors for myocarditis.

1. Take a relevant history and perform an appropriate clinical examination for pa-

tients with suspected myocardial diseases

2. Interpret diagnostic data (ECG, ambulatory ECG. Echocardiography, exercise

testing, chest X-ray, cardiac catheterization coronary angiography, magnetic

resonance & radionuclide imaging, endomyocardial biopsy, genetic assessment).

3. Select appropriate treatment and support modalities (medical interventional. Sur-

gical, ICD /CRT, assist devices, balloon pumping or other treatment).

4. Assess individual prognosis in relation to the need for transplantation.

5. Evaluate patients for endomyocardial biopsy recognizing diagnostic yield and

potential risk for this procedure.

1. Establish cooperative atmosphere with medical professionals in other specialties

(immunology, bacteriology, genetics, cardiac surgery, interventional cardiology,

imaging) for timely differential diagnosis of myocardial disease and further treat-

ment.

2. Counsel patient with cardiomyopathies & their relatives about associated risks.

Myocardial Disease

Knowledge

Skills



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49

1. Classify and define.

• acute pericarditis (infective, idiopathic or malignant)

• chronic pericarditis.

• constrictive pericarditis.

2. Describe for each the epidemiology, pathophysiology and etiology (including

infective, inflammatory and neoplastic disorder).

3. Describe relevant investigation: non-invasive and invasive.

4. Explain and outline the differential diagnosis of constrictive pericarditis from re-

strictive cardiomyopathy.

5. Describe the management of pericarditis.

6. Recall related complications like pericardial effusion, cardiac tamponade and

constriction.

1. Assess, treat and prevent pericardial diseases.

2. Interpret ECG abnormalities in acute pericarditis.

3. Select and use different non-invasive imaging modalities: echocardiography,

CMR, as well as invasive pressure measurements to diagnose pericardial disease.

4. Evaluate hemodynamic status.

5. Recognize the etiology of pericardial effusion.

6. Clinically differentiate pericarditis from myocardial ischemia.

7. Perform pericardiocentesis on appropriately selected patients.

1. Describe the epidemiology, etiology, prevention, pathophysiology of congenital

heart diseases.

2. Define their nomenclature and The relationship to fetal & transitional circulation.

3. Describe the diagnosis and assessment.

4. Outline principles of management.

Pericardial Disease

Knowledge

Skills

Congenital Heart Disease

Knowledge


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50

1. Assess, manage and appropriately refer patients with congenital heart

disease including patients who have undergone previous cardiac surgery.

2. Select imaging techniques and, where appropriate, use invasive proce-

dures for diagnosis and treatment.

3. Provide long-term follow up including patient monitoring and lifestyle ad-

vice.

1. Recognize the importance of referring patients for a specialist opinion.

2. Appreciate the importance of genetic counseling.

3. Appreciate the social and emotional difficulties encountered by adult

patients with congenital heart disease.

Skills


Topics

Atrial septal defects. Tetralogy of Fallot.

Atrioventricular septal defects. Double-outlet right ventricle.

Ventricular septal defects. Complete transposition of the

great arteries.

Anomalous pulmonary venous

connections.

Congenitally corrected transposi-

tion of the great arteries.

Pulmonary stenosis. Double-outlet left ventricle.

Aortic stenosis. Common arterial trunk.

Patent ductus arteriosus. Pulmonary atresia.

Coarctation of the aorta. Congenital malformations of

coronary arteries.

Tricuspid atresia. Congenital malformations of pul-

monary arteries.

Ebstein anomaly of the tricuspid

valve. Aortic arch anomalies.

Abnormalities of the left atrioven-

tricular junction. Arteriovenous malformations.


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51

1. Outline cardiac conditions which may effect the pregnant woman (congenital

heart disease, acquired valve disease, prosthetic valves, coronary artery disease

cardiomyopathies, arrhythmias, hypertension, Marfan’s syndrome, aortic dissec-

tion)

2. Define cardiac contra indication to pregnancy (or which justify early termina-

tion).

3. Recall indications for genetic counseling for inheritable diseases.

4. Identify women who have a high risk of pregnancy-related cardiac complica-

tions and who may need intervention before considering pregnancy.

5. Outline cardiac follow up of pregnant women.

6. Identify situations requiring medical therapy.

7. Identify situations in which cardiac intervention may be required.

8. Define the modalities of delivery.

9. Describe the management of anticoagulation therapy.

10.Describe follow up modalities during the post partum period.

11.Describe The effectiveness, risks and contraindications for the various contracep-

tive methods according to type of heart disease.

1. Perform cardiac evaluation & treatment of women contemplating pregnancy.

2. perform cardiac follow up of the pregnant patient with heart disease.

3. give advice on contraception to cardiac patients and when necessary seek

specialist advice.

4. interpret the results of diagnostic procedures to assess the cardiac risk of preg-

nancy.

5. Institute preventive cardiac intervention, if needed.

6. Perform clinical and non-invasive evaluation of cardiac tolerance in pregnancy.

7. Select which drug therapies can be used during pregnancy.

8. Evaluate the fetal and maternal risk of different cardiac interventions.

9. Assess the fetal prognosis.

10. manage cardiac condition after pregnancy.

11. Assess the cardiac risk of subsequent pregnancies.

12. Indicate appropriate contraceptive method.

Pregnancy and Heart Disease

Knowledge

Skills


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52

1. Recognize the importance of education for women with heart disease on

the potential risks of pregnancy.

2. Cooperative with obstetricians to detect pregnant women with unknown

heart disease and to identify those at high risk.

3. Recognize the importance of patient education on the symptoms of poor

cardiac tolerance.

4. Educate obstetricians on symptoms of undiagnosed heart disease, enabling

prompt identification of situations requiring rapid cardiac management.

5. Cooperate with obstetricians and anesthetists to plan delivery (date, meth-

ods, drug therapy, medical environment).

6. Inform obstetricians on the risk of worsening of cardiac status during the

early post-partum period.

7. Cooperate with gynecologists.

8. Recognize the importance of patient education on contraception.

1. Define PAH and its functional classification.

2. Describe the epidemiology of PAH : incidence, prevalence, etiology, genetics

and high - risk groups.

3. Describe the pathology and pathophysiology of PAH.

4. Describe the clinical features of PAH.

5. Outline the diagnostic criteria of PAH.

6. Identify prognostic markers.

7. Describe the management of PAH (medical, surgical and interventional in-

cluding balloon arterial septostomy indications, contraindications & possible

adverse effects)

1. Diagnose pulmonary arterial hypertension (PAH) and Distinguish between

the different causes of PAH.

2. Differentiate between primary and secondary PAH and other diseases with

similar symptoms.


Pulmonary Arterial Hypertension (PAH)

Knowledge

Skills


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53

3. Perform and interpret accurate medical assessment (using laboratory analyses

including arterial blood gases, pulmonary function test, ECG, echocardiography,

cardiopulmonary stress testing, ventilation perfusion lung scan, spiral and mul-

tislice CT, magnetic resonance imaging, cardiac catheterization and pulmonary

angiography, lung biopsy).

4. Prescribe appropriate medical or invasive (surgical, interventional) management.

5. Evaluate clinical and hemodynamic prognostic markers.

1. Establish cooperation with family physician and other health care professional for

early recognition and management of primary and secondary PAH.

2. Maintain long term involvement of patients and their family members in suppor-

tive activities for healthy lifestyle adherence and treatment compliance.

3. Appreciate the increased prevalence of PAH in other medical conditions, such as

scleroderma.

4. Refer to specialists in PAH when appropriate.

1. Classify and describe the epidemiology of :

• primary cardiac tumors.• metastatic cardiac tumors including lymphoma.

2. Describe the pathophysiology of :

• benign tumors, malignant tumors

• effect of tumor size, location; effect of tumor type.

3. Outline clinical features including :

• impairment of cardiac function.

• systemic manifestations.

• systemic and pulmonary emboli.

• signs of physical obstruction to blood flow (e.g., atrial myxoma).

• pericardial involvement constriction and tamponade.

4. Describe The management of :

• complete tumors excision.

• partial resection + chemotherapy / radiotherapy.

• heart transplantation.

• palliative management.


Cardiac Tumors

Knowledge


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54

1. Take a relevant history and perform appropriate clinical examination of patients

with suspected cardiac tumors.

2. Select and use appropriate imaging modalities.

3. Consider a differential diagnosis of primary or secondary neoplastic involve-

ment of the heart.

4. Recognize other cardiac masses including thrombus - mimicking neoplastic

involvement.

1. Collaborate effectively with cardiovascular surgeons and with other specialists

dealing with neoplastic disease.

2. Appreciate the importance of support & counseling for the patient and fam-

ily..

1. Define rehabilitation.

2. Define target population and risk stratification of individual patients.

3. Identify the components of a rehabilitation program including : patient educa-

tion, exercise testing and exercise training.

4. Recognize the principles of chronic disease self management.

5. Describe programs for specific populations in appropriate settings.

6. Define safety issues.

1. Provide rehabilitation care to patients with cardiovascular disease, specifically:

• post-myocardial infraction • post-cardiac surgery • heart failure. • angina.

2. Monitor attendance and adherence to the rehabilitation programs

3. Demonstrate involvement as an active member of a multidisciplinary rehabili-

tation team.

4. Anticipate and address patient concerns regarding work, exercise and sex.

5. Discuss sensitive issues, such as sex, in an understanding manner.

Skills


Rehabilitation and Exercise

Knowledge

Skills


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55

1. Recognize the role of other professionals including nurse specialists, physiothera-

pists, dieticians and general practitioners in cardiac rehabilitation.

2. Recognize specific population challenges: ageing, gender, socioeconomic status

and culture.

1. Discuss the epidemiology, etiology, pathology, genetics, pathophysiology and

clinical presentation of aortic diseases & trauma to the aorta and heart including:

♦ Acute aortic syndromes.

♦ Aortic dissection.

♦ Intramural hematoma.

♦ Traumatic aortic transaction.

♦ Chronic aortic dissection.

♦ Aneurysm of the thoracic aorta.

♦ Aortic atheromatous disease.

♦ Aortitis.

♦ Trauma of the heart (including myocardial contusion).

2. Discuss strengths and limitations of different imaging modalities.

3. Describe the appropriate medical, interventional or surgical management

strategy.

1. Assess patients with suspected diseases of the aorta and trauma to the aorta and

heart.

2. Choose, perform and interpret the appropriate imaging studies : transthoracic

and transesophageal echocardiography, magnetic resonance, computed tomogra-

phy, ultrasound (surface and intravascular) and angiography of the aorta and of

the heart to assess aortic disease and traumatic lesions.

3. Implement the appropriate medical, interventional or surgical treatment regime.

Diseases of the aorta and trauma to the aorta and heart


Knowledge

Skills


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56

1. Describe the epidemiology, pathology and methods of diagnosis of periph-

eral vascular diseases

2. Describe medical and invasive (interventional and surgical) management

and their relative merits in different situations.

3. Identify the prognosis.

4. Recall the association of peripheral vascular disease with vascular disease in

other areas, in particular carotid and renal arteries.

5. Recognize the causes of acute limb ischemia and the urgency of its manage-

ment..

1. Take a relevant history and perform an appropriate physical examination,

especially the examination of peripheral pulses.

2. Identify the risk factors and select appropriately the management, strategy,

keeping in mind that peripheral vascular disease is a manifestation of gener-

alized atherosclerosis.

3. Select, use and interpret diagnostic tools appropriately including :

Ultrasound

CT angiography

Ultrasound (duplex scanning and other Doppler modalities includ-

ing ankle brachia index).

MR angiography.

Angiography.

.

1. Appreciate the systemic nature of atherosclerosis and its implication

2. Recognize the importance of risk factor modification in prevention.

3. Encourage patients to adopt a healthier lifestyle with specific emphasis on

risk factors.

Peripheral Arterial Vascular Diseases

Knowledge

Skills



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57

1. Describe the epidemiology & risk factors for deep venous thrombosis in the clini-

cal setting of recovery from major surgery or trauma, prolonged immobility, oral

contraceptive pill use, pregnancy & air travel.

2. Describe the clinical presentation of deep venous thrombosis and pulmonary

embolism.

3. Explain increased pulmonary vascular resistance & ventilation perfusion mis-

match.

4. Outline the diagnosis of thromboembolic venous disease by :

• biochemical markers : D-dimmer and troponin.

• ECG.• echocardiography • ultrasound & Doppler of leg and pelvic veins.

• spiral CT-scan • ventilation-perfusion scan • MR angiography.

• pulmonary angiography.

5. Describe treatment like heparins, new anticoagulants, warfarin, thrombolysis,

embolectomy and fragmentation.

6. Describe preventive measures : compression stockings, heparins.

7. Describe management of chronic pulmonary hypertension including throm-

boendarterectomy.

1. Diagnose, treat and prevent acute & chronic deep venous thrombosis & pulmo-

nary embolism.


3. Interpret ECG, echocardiography, spiral CT and ventilation-perfusion scanning.

4. Select appropriate therapy for acute pulmonary embolism.

5. Decide on the duration of anticoagulation therapy for patients with throm-

boembolic venous disease.

1. Appreciate the difficulties in diagnosing pulmonary embolism on the basis of

symptoms and signs.

2. Collaborate with other imaging specialists including radiologists and nuclear

imaging specialists.

Thromboembolic Venous Disease

Knowledge

Skills



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58

♦ Outline The methods of risk assessment prior to non-cardiac surgery for patients

with cardiac disease and give advice and management plans accordingly.

.♦ Assess patients with cardiovascular disease prior to non-cardiac surgery. The as-

sessment include The risk of anesthesia and surgery for individual patients.

♦ Educate Colleagues, patients and relatives about the suitability for non-cardiac

surgery and the risks involved.

1. Define the potential problems & complications of cardiac surgery whilst on ICU.

2. Define how to approach post-operative rehabilitation.

1. Assess patient on ICU and give advice to intensives and surgeons.

2. Participate in the management of patients in the early post-operative period

and long term.


1. Appreciate the importance of good communication and collaboration be-

tween surgeon, anesthetist and intensivist.

2. Appreciate the anxiety of relatives whilst patients are on ICU.

3. Appreciate the importance of rehabilitation after cardiac surgery.

Knowledge

Skills


Assessment of patients with cardiovascular disease prior to non-cardiac surgery

Care of Patients Following Cardiac Surgery

Knowledge

Skills



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59

1. Describe the pathogenesis, presentation and natural history of critical illnesses.

2. Discuss the indications and complications of intra-aortic balloon pump counter-

pulsation.

3. Define when to consider patients for ventricular assist devices.

4. Outline The indications for and hemodynamic consequences of positive pres-

sure ventilation.

1. Assess and treat patients who are critically ill with hemodynamic disturbances.

2. Recognize and manage acute conditions including :

Pulmonary embolism and Acute pericarditis.

Myocarditis. And Cardiac tamponade.

Aortic dissection. And Cardiac rupture.

Cardiogenic shock.

Post infraction ventricular septal defect and mitral regurgitation.

3. Select and use investigations appropriately to assess hemodynamics including

Echocardiography, Pulmonary artery catheterization and wedge pressure.

4. Use appropriately inotropic drugs while recognizing their indications and limita-

tions.

5. Undertake pericardiocentesis.

6. perform central venous catheterization and CVP measurement

7. monitor vital patients’ parameters, interpret the results and take appropriate ac-

tions

1. Recognize The importance of cooperation with anesthetists / intensivists and

other specialties.

2. Be aware of legal and ethical issues surrounding care, nutrition and ventilation of

the unconscious patient.

3. Break bad news appropriately and communicate sensitively with relatives.

Management of critically ill patients with hemodynamic disturbances

Knowledge

Skills



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60

1. Discuss the indications for

Echocardiograms (including high resolution)

CXR. Ands ECG

Ambulatory ECG.

Stress testing.

2. Define the physiology of exercise.

1. Select appropriately, interpret correctly & perform competently the following

investigations for the diagnosis & assessment of patients with cardiac disease :

Echocardiograms.

Ambulatory ECG.

Exercise testing.

CXR.

2. Supervise & analyze exercise test.

1. Appreciate the limitations of non-invasive investigations.

2. Recognize the sensitivity, specificity and predictive accuracy of exercise tests.

1. List the indications and limitations of echocardiography.

2. Explain physical principles behind ultrasound image formation & Doppler im-

aging.

3. Describe cardiac anatomy, physiology, hemodynamics and their abnormalities

relevant to echocardiography.

4. Outline the function of other echo modalities including transesophageal,

stress and contrast echocardiography.

Echocardiography

Knowledge

Skills

Basic investigations in the field of cardiology


Knowledge


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61

1. Carry out transthoracic echocardiography for the diagnosis and assessment of

patients with cardiac disease.

2. Use appropriate echo probes (including single crystal transducer), machines

and software.

3. Be able to use : •2D imaging.

Pulsed wave Doppler.

Colour flow imaging for the assessment of cardiac disease.

4. Recognize indications, contraindications and limitations of stress echocardiogra-

phy, Contrast echocardiography and transesophageal echocardiography. In addi-

tion, he must be able to interpret the results .

1. Appreciate the limitations of echocardiography.

2. Demonstrate ability to work with and where appropriate educate echocardi-

ography technicians.

1. Explain the principles of electrophysiology & cardiac anatomy relevant to elec-

trophysiology.

2. Differentiate between diagnostic and therapeutic electrophysiology

3. List when patients should be referred for invasive investigations.

4. Outline the principle techniques and safety aspects.

1. Assess and treat patients with arrhythmias

2. Witness electrophysiological studies and take part in their interpretation

3. Identify the clinical indications for :

Electrophysiology studies.

Electrical mapping.

Catheter ablation.

Defibrillator implantation.

Programming a defibrillator in the assessment and treatment of

arrhythmias.

Skills


Electrophysiology

Knowledge

Skills


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62

1. Appreciate the anxiety often suffered by patients and their relatives.

2. Appreciate the limitations of drug therapy in the treatment of arrhythmias.

3. Appreciate the importance of radiation protection.

1. Outline the different radionuclides and radiopharmaceuticals used in nu-

clear cardiology.

2. Define the different types of stress testing.

3. Explain the importance of radiation protection.

4. List the indications for the various investigations in the field of nuclear cardi-

ology.

1. Attend image acquisition and reporting sessions

2. Interpret the results of nuclear medicine investigations.

1. Appreciate the limitations of nuclear cardiology.

2. Appreciate the hazards of handling radioactive isotopes for patient & clinical

staff.

1. List the indications for cardioversion.

2. Outline the requirements for anticoagulation.

1. Carry out both chemical and direct current cardioversion.

2. Undertake cardioversion safely.


Nuclear Cardiology

Knowledge

Skills


Cardioversion

Knowledge

Skills


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63

1. Describe the indications and limitations of the procedures.

2. List potential complications of each procedure and outline methods of its

management

1. Interpret intracardiac pressure tracing and evaluate cardiac functions and

valvular diseases using these techniques

2. Recognize the course of cardiac catheter in different congenital heart dis-

eases

3. Interpret intracardiac oxygen saturation and dye dilution results

4. Calculate cardiac output, systemic and pulmonary vascular resistance and

intracardiac shunt

5. Recognize normal and abnormal coronary arteries and evaluate the severity

of coronary artery diseases, then plan management accordingly

Cardiac catheterization and angiography

Knowledge

Skills


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64

1. Explain The electrophysiology and cardiac anatomy relevant to pacing.

2. Define the indications for temporary and permanent pacing.

3. Describe the properties of different pacing systems used.

1. Assess patients for pacing.

2. Pace patients independently and safely.

3. Insert independently temporary pacing electrodes when indicated

4. Monitor, interrogate and program pacemakers..

5. Recognize and manage complications of pacing systems.

1. Appreciate the anxiety often suffered by patients and their relatives.

2. Appreciate the limitations of pacing.

3. Appreciate the economic considerations when choosing pacemaker systems.

Pacing

Knowledge

Skills



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65

Undifferentiated chest pain

Stable angina

Acute coronary syndromes

Myocardial infarction

Acute breathlessness

Chronic breathlessness

Heart failure

Cardiomyopathy

Patient with valvular heart disease

Pre-syncope and syncope

Arrhythmias

Pericardial disease

Hypertension

Hyperlipidemia

Adult congenital heart disease

Endocarditis

Aortic diseases

Cardiac Tumors

Cardiac patients who are prepared for non cardiac surgery

Patients who need cardiac rehabilitation

Cardiac surgery cases

Pregnant women with heart diseases

Critically ill patients with hemodynamic disturbances

Sudden cardiac death and Resuscitation

Clinical problems that must be observed, managed

under supervision & managed independently by

cardiology trainees


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66

Basic Investigations:

The following cases and investigations should not be managed or performed by

candidates unless he is fully competent & under strict supervision of trainers and

educational supervisors. Candidates must know when to refer their patients for

advanced procedures.

Investigations and procedures expected to be performed and interpreted by the trainees at the end of training

ECG and ambulatory ECG

recording and interpretation Basic nuclear cardiology

Exercise testing recording and in-

terpretation Cardioversion

Chest x-ray Pacing

Echocardiography Basic invasive and interventional

cardiology

Basic electrophysiology Pericardiocentesis

Newborns and infants with Con-

genital Heart Disease.

Percutaneous Coronary Intervention

(PTCA/stent)

Advanced Electrophysiology Intra-aortic balloon counter pulsation

Diagnostic and therapeutic invasive

Electrophysiology Advanced Non-invasive imaging

Implantation and programming of

Intra Cardiac Defibrillators (ICD)

Stress echo, Transesophageal echo-

cardiography and tissue Doppler

studies

Cardiac resynchronization therapy Computerized tomography and Mul-

tislice CT

Advanced Invasive and interven-

tional cardiology Magnetic Resonance Imaging


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67

Procedure/

Investigation

Indicative

Numbers

Level of

Participation

Level of

Competence

ECG 500 Interpret and report III

Echo-

cardiography

100

300

20

Attend

Interpret

Perform

III

TEE 50

20

Observe

Assist II

Stress ECG 150

30

Attend & Interpret

Perform III

Holter ECG 20

20

Attend & Interpret

perform III

Nuclear

procedures

50

25

Observe& Interpret

Assist II

Pacemaker

programming

30

30

30

Attend & Interpret

Assist

Perform

III

Temporary

pacemakers

50

25

Assist

perform

III

Tilt table test

10

10

10

Attend & Interpret

Assist

Perform

III


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68

Definition of The levels of competence:

Level I: Experience of selecting the appropriate diagnostic modality & interpreting the

results or choosing an appropriate treatment for which the patient should

be referred. This level of competence does not include performing a tech-

nique.

Level II: Practical experience, but not as an independent operator (has assisted in or

performed a particular technique or procedure under the guidance of a

superior).

Level III: Is able to independently perform the technique or procedure unaided (for

the General Cardiologist, these include: ECG, 24-hour long-term ECG moni-

toring, pacemaker implantation, echocardiography and diagnostic cardiac,

catheterization).

Procedure/

Investigation

Indicative

Numbers

Level of

Participation

Level of

Competence

Permanent

pacemakers

25

25

Observe

Assist

III

Cardiac

catheterization

20

20

Observe

Assist III

Coronary

angiography

50

50

10

Observe

Assist

Perform

III

Coronary

angioplasty

50

20

Observe

Assist II

Valvuloplasty 20

10

Observe

Assist II

Invasive

electrophysiology

25

10

Observe& Interpret

Assist

II


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69

List of required lectures

Subject # Time

Anatomy

Embryology 3 1st Year

Surface anatomy 1 ―

Anatomy of heart 2 ―

Anatomy of great vessels 1 ―

Anatomy of special circulation 1 ―

Histology of heart and vessels 1 ―

Coronary anatomy 1 ―

Physiology & Biochemistry

General physiology 3 1st Year

Physiology of cardiac muscle 2 ―

Genesis of ECG 1 ―

The cardiac cycle and function 2 ―

The venous system 1 ―

Peripheral and microcirculation 1 ―

Pulmonary circulation 1 ―

Exercise physiology 1 ―

Respiratory physiology 2 ―

Renal physiology 2 ―

Coronary circulation 1 ―

Metabolism of carbohydrates 2 ―

Lipid metabolism and dyslipidemia 2 ―

Vitamin and mineral metabolism 1 ―

Food chemistry 1 ―

Free radicals 1 ―

Metabolic disorders and hyperuricemia 1 ―


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70

Subject # Time

Pathology

General pathology 4 1st Year

Ischemic heart disease 2 ―

Pericarditis and myocarditis 1 ―

Endocarditis 1 ―

Cardiomyopathies 1 ―

Congenital heart diseases 3 ―

Vascular diseases 1 ―

Aortic disease 1 ―

Cardiac tumors 1 ―

Pharmacology

General pharmacology 2 1st Year

Drug toxicity and interactions 1 ―

Pharmacology of individual drugs 12 ―

Basic Cardiology

Pathogenesis of heart failure 1 1st Year

Pathogenesis of hypertension 1 ―

Pathogenesis of arrhythmias 1 ―

Hemodynamics 1 ―

Pressure measurement 1 ―

Flow measurement 1 ―

Angiography 1 ―

Radiation physics and safety 1 ―

Isotopes and nuclear medicine 1 ―

Ultrasound and principles of echocardiography 2 ―

Contrast materials and contrast nephropathy 1 ―


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71

Subject # Time

Basic Cardiology (Contd)

Medical ethics and Medicolegal issues related to The field

of cardiology 2 1

st Year

The cell membrane, receptors and channels 1 ―

Genetics 3 ―

Epidemiology of cardiovascular disease 1 ―

Risk factors and their modification 2 ―

Risk assessment 1 ―

Basic and advanced CPR 1 ―

Clinical Cardiology

Syncope 1 2nd Year

Differential diagnosis of chest pain 1 ―

Acute coronary syndromes 2 ―

Complication of myocardial infarction 2 ―

Percutaneous coronary interventions 2 ―

Coronary bypass surgery 1 ―

Valvular heart disease 3 ―

Valvuloplasty and valve surgery 2 ―

Endocarditis 2 ―

Atrial fibrillation 1 ―

Sudden cardiac death 1 ―

Diabetes and the heart 1 ―

Interaction between heart and kidney 1 ―

Exercise testing 1 ―


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72

Subject # Time

Clinical Cardiology (Cntd)

Echocardiographic interpretation 3 2nd

Year

Nuclear imaging in cardiology 1 ―

CT scanning in cardiology 1 ―

Recognition and management of arrhythmias 4 3rd

Year

Electrophysiologic and ablation procedures 2 ―

Cardiomyopathies 2 ―

Pericardial diseases 1 ―

Congenital heart disease 5 ―

Pregnancy and the heart 1 ―

Cor pulmonale 2 ―

Pulmonary embolism and hypertension 1 ―

Diseases of aorta 1 ―

Peripheral vascular disease 1 ―

The cardiac patient as surgical risk 1 ―

Pacing 2 ―


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73

The following methods of teaching and learning will be used in the fellowship of

cardiology training program:

- Apprenticeship learning (experiential learning):

a) Observation

b) Assisting

c) Participation

d) Supervised Performance

e) Independent Performance

- Formal Teaching:

a) Lectures

b) Seminars

c) Clinical ward rounds

d) Crash courses

e) Workshops

- Self-study:

a) Library

b) Textbooks

c) Journals

d) Internet

- Meetings and Conferences

- Supervised Research

Teaching and learning methods


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74


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Regulations The general rules and regulations of assessment approved by the Egyptian

fellowship board and published at the training handbook and at the board

website applies for the cardiology specialty. In addition to the successful

completion of the training program, all candidates must successfully pass

three exams in order to get the fellowship certificate.

First part Exam:

The first part exam is a written exam. Trainees are allowed to sit for the first

part exam after at least six months of training. Each candidate has three

chances to pass the exam and one more additional chance may be

granted in some special circumstances approved by the secretary general

of the higher committee of medical specialties. It is to be noted that after

one year of training each time the candidate choose not to enter the exam

will be calculated as one of his three attempts.

Second part exam:

The second part exam is a written exam. Trainees are allowed to sit for the

second part exam after passing successfully the first part and after comple-

tion of the training period (three years). In addition, each candidate must

submit his logbook for final assessment. The logbook requirements must all

be completed and signed by the trainer and educational supervisor. Each

candidate has three chances to pass the exam and one more additional

chance may be granted in special approved circumstances.

Clinical Exam (third part):

The third part exam is a clinical and oral exam. Candidates who pass suc-

cessfully the second part are allowed to sit for the third part. Again, each

requisites for entering the first part exam-Pre Trainees should pass the following courses in order to be eligible for the first part exam

Local TOEFEL with a score of at least 500 Computer courses in word processing, power point and internet

requisites for entering the second part exam-Pre Trainees should submit the final logbook and an audit project or short thesis on a subject chosen by educational supervisor/trainer. The scientific council must accept this project as adequate. Otherwise, the trainee will not be permitted for the exam


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78

candidate has three chances to pass the clinical exam and an additional

fourth chance may be granted in special approved circumstances.

The structure of the examination

s knowledge and intellectual skills 'aims to test trainee The first part exam

in the applications of basic sciences that are related to the field of

cardiology. It also aims to test their knowledge in the basics of cardiology.

The scientific council has made it very clear in the curriculum, which parts

of the cardiology curriculum must be studied in the first year and these

parts will be the subject of assessment in the first part exam.

: The examination consists of two papers

Paper I (2 hours): Multiple choice questions with a single best an-

swer format. This paper will cover applied basic sciences mentioned

in the curriculum.

Paper II (2 hours): Multiple-choice questions with a single best an-

swer (problem solving questions). This paper tests trainees' knowl-

edge in the basics of cardiology that must be covered during the

first year of training.

knowledge and skills in ' aims to test trainees The second part exam

cardiology. In this exam, the entire curriculum will be covered.

All papers are in MCQ format . The examination consists of four papers

with one best answer is correct. They are covering the whole cardiology

curriculum. Facts, problem solving and management skills are going to

be assessed.

part III exam is a clinical and oral exam and is :the third part exam

composed of the following components:

: The tracing examination

The tracing exam is composed of (30-40)slides presented to all candidates

in the same time through data projector in a suitable room. The slides

presents the candidates with ECGs, catheter images, echo images,

plain radiography, CT scan, MRI and other cardiac tracings e.g.

angiograms, intracardiac pressure recording, electrophysiologic

recording, etc. The aim of the exam is to test candidates' interpretative


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79

abilities as related to cardiology diagnostic and therapeutic imaging.

The clinical exam:

The clinical exam remains the most important part of the examination as the

long case evaluate the potential performance of the candidate in clinical

practice while short cases assess clinical examination and interpretation

skills.

During . one long caseeach candidate is requested to see :Long cases exam

The exam, the candidate is observed in silence for the first part of the

examination by two examiners where he/she is taking the history from the

patient and performing physical examination and then the examiners asks

him to present his findings in the history and examination and discuss his

proposed management of the case. Marks are given according to a

predetermined weighting of the components of the exam.

Each candidate examines two patients and take history : Short cases exam

from one patient. The examiners evaluate his abilities to correctly elicit and

interpret physical signs and his abilities to take focused cardiac history. An

agreed marking system is used to ensure objectivity and fairness of the exam.

The oral exam is the exam that tests the candidates’ ability to manage : VIVA

patients and explores his/her competencies in making an accurate diagnosis.

It also assesses his attitudes and interpersonal communication skills. It is based

on a set of topics with opening and supplementary questions. The questions'

cards are prepared in advance together with the expected ideal answer and

allocated marks. This allows a good objective basis for marking.

The candidate usually rotate through two oral committees, each committee

is composed of two examiners and cover two cardiology domains. each

examiner have 10-15 minutes with The candidate (40-60 minutes for The oral

examination)

cardiology curriculum

Documents

cardiology council

professor of cardiology

specialty cardiology

curriculum development

curriculum structure

curriculum available

european board

egyptian fellow ship