Download Goals and Objectives Cardiac Catheterization

UBC Postgraduate Program in Cardiology
Goals and Objectives, Cardiac Catheterization
July 1, 2013
Objectives of Specialty Training Requirements in the Cardiac Catheterization
Laboratory
Overall objective of training:
Cardiac catheterization continues to be an important component of the workup and
treatment of patients with cardiac problems. Trainees in cardiology are expected to
spend 4 months in the Cath lab in order to obtain a broad experience in indications,
performance and interpretation of cardiac catheterizations.
GENERAL OBJECTIVES:
At the end of 4 months of training, the cardiologist will be expected to have mastered
the roles as medical expert, communicator, collaborator, manager, health advocate,
scholar and professional. Specific to cardiac catheterization they will be able to
demonstrate a clear understanding of:
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Indications and contraindications of the procedures
Normal hemodynamics and pathophysiology and the ability to interpret
hemodynamic and angiographic data such as:
o Normal and abnormal intracardiac pressures and wave forms
o Flow and cardiac output assessment
o Resistance
o Calculation of valve areas and intracardiac shunts
o Normal and abnormal coronary anatomy and views
o Contrast agents
Radiation safety
Complications of procedures and how to manage them
Implications of findings at cardiac catheterization and angiography and how to
manage them in the context of clinical status and noninvasive investigations
The trainee will gain technical skills in
 Right heart catheterization
 Percutaneous femoral vein and artery puncture and line insertion
 Measurement of ventricular pressures and valve areas
 Sterile techniques
 Temporary pacemaker insertion
The trainee will gain experience in;
 Coronary angiography
UBC Postgraduate Program in Cardiology
Goals and Objectives, Cardiac Catheterization
July 1, 2013
SPECIFIC OBJECTIVES
Specific objectives are framed within the global requirements for cardiology training.
Medical Expert
Specific objectives for the cath lab rotation are framed within the global requirements for
cardiology training by major disease process. There is considerable overlap in different
areas of training – especially in the areas of coronary artery disease, valvular heart
disease and congestive heart failure as well as other niche areas. The guidelines below
highlight the specific role of cardiac catheterization in these areas.
Cardiologists must be able to safely and effectively diagnose, investigate and treat
patients with cardiac disorders. This must be done in the setting a variety of
comorbidities and other scenarios. All trainees will be able to perform a focused,
complete assessment of patients prior to catheterization.
Trainees will be expected to progress in their technical skills over the four months of
training. In the first two months they should demonstrate proficiency in:
 Femoral arterial and venous access
 Right heart catheterization
 Familiarity with catheterization equipment
In the third and fourth months trainees will demonstrate proficiency in:
 Simple coronary arteriography
 Left ventriculography
 Temporary pacer insertion
Disease entities:
Coronary artery disease
Indications for cardiac catheterization in patients with stable angina, unstable coronary
syndromes and acute myocardial infarction
Identification of traditional and novel risk factors for atherosclerosis including ethnic and
gender differences
Risks of cardiac catheterization – obtain appropriate informed consent for each specific
patient
Description of normal and abnormal coronary anatomy
Assessment of coronary blood flow and endothelial function
Integration of noninvasive investigations into treatment plans
Indications for adjunctive pharmacology – antiplatelets, anticoagulants
Indications, contraindications and benefits of medical therapy and revascularization
procedures
Management strategies for patients with cardiogenic shock
Management of patients with complications post catheterization
UBC Postgraduate Program in Cardiology
Goals and Objectives, Cardiac Catheterization
July 1, 2013
Valvular Heart Disease
Hemodynamic assessment of valvular heart disease
Pathophysiology of valvular lesions
Integration of noninvasive investigations into treatment plans
Indications for interventions
Congestive Heart Failure
Hemodynamic assessment of systolic and diastolic function
Understanding of different methods of assessing cardiac output and their limitations
Interpretation of left ventriculography
Hemodynamic workup of patients being considered for heart transplantation including
use of inotropes and vasodilators
Pulmonary Hypertension
Hemodynamic workup of pulmonary hypertension including indications for pulmonary
vasodilators
Other topics
Congenital heart disease
Pericardial disease
Peripheral vascular disease including renovascular and peripheral lesions.
Aortic aneurysm and dissection
Communicator:
Obtain complete and accurate assessments of patients undergoing cardiac
catheterization
Obtain appropriate informed consents
Develop rapport and ease with patients
Relate findings to patients and families
Collaborator
Consult with other physicians regarding therapeutic choices
Work within the allied health care team to optimize patient experience
Participate in teaching and patient care discussion rounds
Recognize roles of each member of the team
Manager
Manage time effectively
Facilitate treatment decisions regarding patient care
Anticipate patient and study requirements
Understand waiting lists and risk stratification on them
Health advocate
Identify and deal with complications
Prioritize clinical scenarios and patients effectively
UBC Postgraduate Program in Cardiology
Goals and Objectives, Cardiac Catheterization
July 1, 2013
Understand the influence of comorbidity, social status, and environment on patient
outcomes and respond appropriately
Utilize patient education tools as well as individual counseling
Scholar
Read references provided
Prepare and present at rounds
Recognize knowledge gaps and seek information
Teach other members of the health care team
Professional
Treat patients with caring, empathy and respect
Maintain integrity, legal and ethical codes