DrNB Paediatric Cardiology In India: Check Out NBE Released Curriculum
The National Board of Examinations (NBE) has released the Curriculum for DrNB Paediatric Cardiology.
I. INTRODUCTION
Specialty training in Paediatric Cardiology consists of core and higher specialty training. Core training provides physicians with: the ability to investigate, treat and diagnose patients with acute and chronic medical symptoms; and with high quality review skills for managing inpatients and outpatients. Higher specialty training then builds on these core skills to develop the specific competencies required to practice independently as a consultant Paediatric Cardiologist.
The most important function of the specialist-training programme is to educate individuals who will become consultants capable of providing the highest standard of service to children with cardiac disorders and adolescents and adults with congenital heart disease.
The educational process set out in this curriculum aims to develop positive attitudes to lifelong learning and aims to equip the trainee to adapt to the changing expectations of society as well as to technological advances, with clear goals for achievement of a sound knowledge base, appropriate attitudes and achievement of competencies as well as appropriate methods of learning and assessment throughout the programme. Additionally, it is important for the trainee to become aware of the challenges faced at a national level in terms of disease burden and resources. Important adaptations are required to practice the specialty in our country given the resource constraints as well as challenges relating to our unique patient population.
II. PROGRAMME OBJECTIVES
The education programme in paediatric cardiology aims to produce physicians who:
1. Address all aspects of the healthcare needs of patients and their families
2. Communicate effectively with children, families, and colleagues
3. Are able to coordinate effectively the work of the paediatric cardiology team
4. Manage time and resources to the benefit of themselves, their patients and their colleagues.
5. Are able to operate as safe independent practitioners whilst recognizing the limitation of their own expertise and the obligation to seek assistance of colleagues where appropriate Have acquired and developed team working and leadership skills
6. Work effectively with other health care professionals
7. Are able to teach other physicians and health care professionals
8. Will be honest and objective when assessing the performance of those they have supervised and trained
9. Develop clinical practice which is based on an analysis of relevant clinical research and have an understanding of research methodology
10. Are aware of current thinking about ethical and legal issues
11. Can take advantage of information technology to enhance all aspects of patient care
12. Recognize specific challenges faced by children with heart disease at a national level and work to partner with government in achieving the national ideal of ensuring access to pediatric cardiac care to all affected children.
13. Maintain the highest standard in their professional field and show themselves able to respond constructively to assessments and appraisals of professional competence and performance.
14. Are able to identify and take responsibility for their own educational needs and the attainment of these needs. Are aware of procedures and able to take action when things go wrong, both in their own practice and in that of others
15. Work effectively and efficiently in health care organization
16. Are able to apply the knowledge of biological and behavioral sciences in clinical practice
17. Apply appropriate knowledge and skill in the diagnosis and management of children with cardiovascular disorders and adults with congenital heart disease
18. Are competent to perform the core investigations required for the evaluation of children with cardiovascular disorders and adults with congenital heart disease.
19. Can develop management plans for the whole patient and maintain knowledge of other areas of paediatrics and adult medicine which impinge on the specialty of paediatric cardiology.
By the end of specialist training the trainee should have developed competence in the following:
1. Good clinical care
2. History, examination, investigations, treatment, note keeping and correspondence
3. Managing chronic disease
4. Time management and decision making
5. Communication skills
6. Maintaining good medical practice
7. Maintaining Trust
8. Professional behaviour
9. Ethics and legal issues
10. Patient education and disease prevention
11. Working with colleagues
12. Teamwork and leadership skills
13. Teaching and educational supervision
14. Research
15. Clinical governance
16. Information use and management
17. Cross-specialty skills
18. Admissions and discharges
19. Discharge planning
20. Resuscitation
21. Nutrition
Clinical Learning Objectives By the end of the education programme the trainee is expected to manage the following clinical problems:
1. Cardiovascular collapse in infancy
2. Cardiac failure in infants and children
3. Cyanosis in the newborn period
4. Cyanosis beyond the newborn period
5. Evaluation of the child with a cardiac murmur
6. Evaluation of children and adolescents with chest pain, palpitations, presyncope or syncope Patients with acyanotic congenital heart disease
7. Left to right shunts
8. Duct dependent systemic circulation
9. Obstructive left heart lesions
10. Acyanotic obstructive right heart lesion
11. Patients with cyanotic congenital heart disease
12. Duct dependent pulmonary circulation
13. Transposition of the great arteries
14. Cyanotic congenital heart disease with high pulmonary flow
15. Complex cyanotic congenital heart disease Pulmonary hypertension
16. Fontan circulation
17. Inflammatory cardiovascular disease including Kawasaki Disease
18. Rheumatic Heart Disease
19. Cardiomyopathy and myocarditis
20. Prevention and management of infective endocarditis
21. Cardiovascular abnormalities in neonatal intensive care
22. Cardiovascular evaluation of children with genetic disorders and syndromes
22. Cardiac evaluation of the child with stridor
23. Detection and management of fetal cardiac abnormalities
24. Adolescent and adult congenital heart disease
25. Arrhythmias
26. Nutrition and growth in congenital heart disease
27. Assessment of children prior to cardiac surgery
28. Care of children following cardiac surgery
29. Assessment of children with cardiac disease prior to non-cardiac surgery
30. Management of critically ill children with cardiovascular compromise
III. TEACHING AND TRAINING ACTIVITIES
The fundamental components of the teaching programme should include:
1. Case presentations & discussion- once a week
2. Seminar – Once a week
3. Journal club- Once a week
4. Grand round presentation (by rotation departments and subspecialties)- once a week
5. Faculty lecture teaching- once a month
6. Clinical Audit-Once a Month
7. A poster and have one oral presentation at least once during their training period in a recognized conference.
The rounds should include bedside sessions, file rounds & documentation of case history and examination, progress notes, round discussions, investigations and management plan) interesting and difficult case unit discussions. The training program would focus on knowledge, skills and attitudes (behavior), all essential components of education. It is being divided into theoretical, clinical and practical in all aspects of the delivery of the rehabilitative care, including methodology of research and teaching.
1. Theoretical: The theoretical knowledge would be imparted to the candidates through discussions, journal clubs, symposia and seminars. The students are exposed to recent advances through discussions in journal clubs. These are considered necessary in view of an inadequate exposure to the subject in the undergraduate curriculum.
2. Symposia: Trainees would be required to present a minimum of 20 topics based on the curriculum in a period of three years to the combined class of teachers and students. A free discussion would be encouraged in these symposia. The topics of the symposia would be given to the trainees with the dates for presentation.
3. Clinical: The trainee would be attached to a faculty member to be able to pick up methods of history taking, examination, prescription writing and management in rehabilitation practice.
4. Bedside: The trainee would work up cases, learn management of cases by discussion with faculty of the department.
5. Journal Clubs: This would be a weekly academic exercise. A list of suggested Journals is given towards the end of this document. The candidate would summarize and discuss the scientific article critically. A faculty member will suggest the article and moderate the discussion, with participation by other faculty members and resident doctors. The contributions made by the article in furtherance of the scientific knowledge and limitations, if any, will be highlighted.
6. Research: The student would carry out the research project and write a thesis/ dissertation in accordance with NBE guidelines. He/ she would also be given exposure to partake in the research projects going on in the departments to learn their planning, methodology and execution so as to learn various aspects of research.
IV. SYLLABUS
1. Cardiology
Pediatric Cardiovascular Epidemiology:
• Disease burden and health system challenges associated with pediatric heart disease in India
• Relative importance of pediatric heart disease in the context of other pediatric health priorities
A detailed study of available literature published from the country on: Congenital Heart Disease
Rheumatic Heart Disease
Childhood obesity and lifestyle related heart disease
Cardiopulmonary Structure, Development, and Function
• Cardiovascular anatomy and ultrastructure
• Gross cardiovascular anatomy. Understand the principles of segmental anatomy
• Know the normal anatomy of the systemic veins and important variations
• Know the normal anatomy of the atria, atrial septum, appendages, and relationship to thoracic structures
• Know the anatomic features of the atrioventricular valves and atrioventricular orientation (concordance/discordance)
• Know the normal anatomical features of the right ventricle, left ventricle, and the inter-ventricular septum, and ventriculo-arterial orientation (concordance/discordance)
• Know the anatomic features of semilunar valves, including spatial relationships to each other and the ventricular outlets
• Know the anatomical features of the pulmonary arteries, pulmonary vasculature and orientation to thoracic structures (eg, bronchi)
• Know the normal structure and anatomic relationships of pulmonary veins
• Know the normal anatomic features of the coronary arteries
• Know the normal anatomy of the aorta and it's orientation to thoracic structures
• Know the normal anatomy of the systemic arteries and important variations
• Understand the relationship between the left recurrent laryngeal nerve and structures within the thorax
2. Ultrastructure
a) Know the ultrastructure of cardiac myocyte along with developmental aspects of the myofibrils, contractile proteins, transverse tubular system, sarcoplasmic reticulum, intercalated disc, nucleus and perinuclear region, mitochondria, and glycogen stores
b) Normal embryology and development of myocardial structure and function
• Know the important components (tissues) of the primitive cardiac tube and the origins of cardiac segments including origin of the primary and secondary heart fields
• Understand looping of the primitive cardiac tube under normal and abnormal conditions
• Know the normal development of the peripheral vasculature
• Describe normal embryologic sequence in the development of pulmonary veins, including the fate of the common pulmonary vein
• Know the normal development of the bulbuscordis and truncus arteriosus
• Know the embryologic basis for atrioventricular connections
• Know the development of the six aortic arches (eg, sequence, timing, regressions)
• Know the normal development of the various cardiovascular structures (eg, semilunar valves, aortic pulmonary septum, division of truncus)
• Understand the contribution of neural crest tissue to normal cono - truncal development
• Understand the molecular regulation of cardiac determination and differentiation
• Identify the molecular pathways that determine visceral situs
• Know the origins of the epicardium and its importance for coronary, valvar, and fibrous development of the heart
• Know the normal development of the conduction system
• Know the normal developmental sequence of the pulmonary vasculature
• Know the normal developmental sequence of the coronary vasculature
Cardiovascular physiology
1. Embryo and fetus
• Know the distribution of cardiac output to the various circulations during normal and abnormal conditions (eg, pulmonary, coronary, central nervous system, ventricular, peripheral vascular beds, placenta)
• Understand how blood flow patterns in cardiovascular structures, including fetal structures, may be influenced by congenital anomalies
• Understand regulation of circulation in the embryo and fetus
• Understand the fetal circulation and its clinical correlates with findings on fetal echocardiography
2. Postnatal circulation
• Understand the physiologic aspects of postnatal heart rate, preload effects, afterload effects, and contractility, and how these factors modulate cardiac output Know the postnatal changes in pulmonary and systemic circulations after birth and how they may be influenced by congenital defects (eg, left-to- right shunts, hypoxemia, obstructive lesions)
3. Cardiac mechanics
• Understand the interaction of contractile and regulatory protein in determining sarcomere function
• Understand the role of calcium ions in the contractile process and dynamics of calcium ion movement/storage
• Understand the process of excitation-contraction coupling
• Understand the concepts and variation of length-tension relationships
• Understand ventricular pressure-volume function loops
• Understand the concept of inter-ventricular interaction
• Understand the role of neural-humoral factors on control of the cardiovascular system
• Understand the role of the thyroid in modulating control of the cardiovascular system
• Understand the role of baroreceptors in control of the cardiovascular system
• Understand the role of chemoreceptors in control of the cardiovascular system
• Understand cellular responses and their interactions with drugs, blood gases, and pH
• Know the molecular events occurring during the cardiac cycle
• Understand the role of the pericardium on impairment of cardiac function
• Understand myocardial metabolism and the impact of hormonal influences, hypoxia, ischemia, and age
• Know how hemodynamic loads affect myocardial gene expression
• Recognize the acute effects and compensatory responses of ventricular dilatation and hypertrophy on cardiac function
• Understand the atrial contribution of ventricular function
• Know the age-related differences in function of sarcolemma and sarcoplasmic reticulum
• Know the effects of acidemia and hypoxemia on contractility
• Recognize factors involved in the myocardial oxygen supply- demand ratio
• Know how hemodynamic loads affect vascular gene expression
• Understand cardiac receptor function and its response to drugs, blood gases, and pH
• Understand the determinants of contractions of isolated cardiac myocytes and papillary muscle
4. Vascular physiology
• Understand the concept of auto regulation of regional blood flow, including age-related differences
• Know the role of inflammatory mediators and of endothelium in control of regional circulation
• Understand the mechanisms that regulate coronary circulation, including exercise and hypoxemia
• Understand the mechanisms that regulate cerebral circulation, including pH, PCO2, PO2, and perfusion
• Understand the influence of pH, PO2, and PCO2 on pulmonary circulation
• Understand the role of endothelium on pulmonary circulation
• Understand the mechanisms involved in vasodilation in pulmonary and systemic vascular beds
• Identify the factors influencing tone in the pulmonary vascular bed
• Understand how vascular smooth muscle is maintained in a dilated state
• Understand the Poiseuille equation and the effect of changing the caliber of the resistance vessels
• Know the effects of asphyxia on regional circulatory functions, particularly heart, brain, kidneys, and lung
• Know the effects of changes in renal blood flow on renal function and body fluids
• Understand the mechanisms that regulate skeletal muscle blood flow during exercise
• Conduction system, including electrophysiology
5. Developmental aspects
• Recognize the age-dependent nature of structure and function of the conduction system
6. Anatomic aspects
• Know anatomic basis and features of the conduction system
• Know the conduction system abnormalities associated with cardiac anomalies
7. Electrophysiologic aspects
• Understand the structure and function of ion channels in myocardial tissue
• Understand the components of the myocardial cell action potential
• Understand the ionic basis of cardiac automaticity
• Know the electrophysiologic characteristics of the atrial, atrioventricular, and ventricular conduction system
8. Respiratory physiology and ventilation
a) Structure
• Understand the age-related (including prematurity) effects on airway physiology, including airway resistance and ventilation pattern
• Recognize the effects of upper airway obstruction on cardiopulmonary physiology
• Recognize effects of large airway obstruction on cardiopulmonary physiology
• Recognize effects of cardiomegaly and pulmonary vascular anatomy on large airway function
• Know the pathologic changes that occur in the small airways in various cardiopulmonary conditions
• Recognize potential effects of cardiomegaly and pulmonary vasculature on small airway function
• Know the pathologic changes that occur in the alveoli in various cardiopulmonary conditions, including congestive heart failure and alterations in pulmonary blood flow
B. Ventilation
• Identify and know importance of variations in pulmonary pressurevolume relationships
• Understand the effects of FIO2 on nitrogen clearance, regional blood flow, and arterial blood gas tensions
• Know the importance of normal lung inflation and deflation on cardiovascular physiology
• Recognize the influence of cardiovascular disease on lung volume, tidal volume, and respiratory rate
C. Oxygen delivery
• Understand the determinants of gas transfer from the airway to arterialblood
• Know factors influencing the amount of dissolved oxygen in blood
• Understand the differences between adult and fetal hemoglobin
• Understand the effects of a change in arterial oxygen tension in the oxyhemoglobin dissociation curve, and mixed venous oxygen content
• Apply the principles of ventilation-perfusion balance and mismatch in the evaluation of a patient with cardiovascular disease
D. Acid-base balance
• Know how to recognize acid-base abnormalities, including respiratory acidosis and alkalosis and metabolic acidosis and alkalosis
• Identify the causes of acid-base abnormalities, including respiratory acidosis and alkalosis and metabolic acidosis and alkalosis
• Know methods for correction of acid-base abnormalities, including respiratory alkalosis and acidosis and metabolic acidosis and alkalosis
E. Blood gas exchange
• Understand the effects of ischemia on O2 and CO2 exchange between blood and tissue
• Understand the effects of pH, hypoxemia, and hypercarbia on gas exchange between blood and tissue
• Know the effects of hypoxemia on ventilatory function and tissue metabolism
F. Mechanism of breathing
• Understand the possible physiologic effects of ches wall abnormality
• Understand the effects of dynamic compression of airways
• Recognize the effect of respiratory effort on caloric consumption
G. Respiratory physiology at altitude
• Recognize the effects of acute and chronic exposure to high altitude on oxygen delivery
• Know the effects of altitude on cardiovascular function
H. Effects of mechanical ventilation on CV performance
• Understand the effects of positive end-expiratory pressure and inspiratory pressures on cardiac output and their influence on right and left ventricular function
• Understand appropriate use of mechanical ventilation
• Know the general principles of how the mode of ventilation affects
cardiac output
Pharmacology
a) Pharmacologic basis for therapy of cardiovascular disease
• Understand the principles of pharmacokinetics, including drug absorption, distribution, biotransformation, and excretion
• Understand the principles of pharmacodynamics, including the loci of drug actions, role of receptors, and dose-response relationships
• Understand drug-drug interactions, adverse reactions, and off-target effects
• Understand the principles of maternal-fetal pharmacodynamics and pharmacokinetics
• Understand the basic principles of developmental pharmacology
• Understand the role of pharmacogenomics in drug response
• Understand the principles involved in clinical trials and drug regulation and development
B. Antiarrhythmic drugs
i. Class I antiarrhythmic drugs:
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of Class I antiarrhythmic drugs
• Know the mechanism of action for Class I antiarrhythmic drugs
• Identify indications for Class I antiarrhythmic drugs
• Identify contraindications for Class I antiarrhythmic drugs
• Plan therapy including appropriate dose and monitoring for Class I antiarrhythmic drugs
• Recognize the drug adverse effects and toxicity of Class I antiarrhythmic drugs
• Recognize potential drug-drug interactions for Class I antiarrhythmic drugs
ii. Class II antiarrhythmic drugs:
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of Class II antiarrhythmic drugs
• Know the mechanism of action for Class II antiarrhythmic drugs
• Identify Indications for Class II antiarrhythmic drugs
• Identify contraindications for Class II antiarrhythmic drugs
• Plan therapy including appropriate dose and monitoring for Class II antiarrhythmic drugs
• Recognize the drug adverse effects and toxicity of Class II antiarrhythmic drugs
• Recognize potential drug-drug interactions for Class II antiarrhythmic drugs
iii. Class III drugs:
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of Class III antiarrhythmic drugs
• Know the mechanism of action for Class III antiarrhythmic drugs
• Identify indications for Class III antiarrhythmic drugs
• Identify contraindications for Class III antiarrhythmic drugs
• Plan therapy including appropriate dose and monitoring for Class III antiarrhythmic drugs
• Recognize the drug adverse effects and toxicity of Class III antiarrhythmics
• Recognize potential drug-drug interactions for Class III antiarrhythmic drugs
iv. Class IV antiarrhythmic drugs:
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of Class IV antiarrhythmic drugs
• Know the mechanism of action for Class IV antiarrhythmic drugs
• Identify indications for Class IV antiarrhythmic drugs
• Identify contraindications for Class IV antiarrhythmic drugs
• Plan therapy including appropriate dose and monitoring for Class IV antiarrhythmic drugs
• Recognize the drug adverse effects and toxicity of Class IV antiarrhythmics
• Recognize potential drug-drug interactions for Class IV antiarrhythmic drugs
v. Adenosine:
• Know the pharmacologic effects (pharmacokinetics and
pharmacodynamics) of adenosine
• Know the mechanism of action for adenosine
• Identify indications for adenosine
• Identify contraindications for adenosine
• Plan therapy including appropriate dose and monitoring for adenosine
• Recognize the drug adverse effects and toxicity of adenosine
• Recognize potential drug-drug interactions for adenosine Inotropic agents
i. Digitalis and ATPase inhibitors
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of digitalis and ATPase inhibitors
• Know the mechanism of action for digitalis and ATPase inhibitors Identify indications for digitalis and ATPase inhibitors
• Identify contraindications for digitalis and ATPase inhibitors
• Plan therapy including appropriate dose and monitoring for digitalis and ATPase inhibitors
• Recognize the drug adverse effects and toxicity of digitalis and ATPase inhibitors
• Recognize potential drug-drug interactions for digitalis and ATPase inhibitors
ii. Catecholamines
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of catecholamines
• Know the mechanism of action for catecholamines
• Identify indications for catecholamines
• Identify contraindications for catecholamines
• Plan therapy including appropriate dose and monitoring for catecholamines
• Recognize the drug adverse effects and toxicity of catecholamines
• Recognize potential drug-drug interactions for catecholamines
iii. Phosphodiesterase inhibitors
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of phosphodiesterase inhibitors
• Know the mechanism of action for phosphodiesterase inhibitors
• Identify indications for phosphodiesterase inhibitors
• Identify contraindications for phosphodiesterase inhibitors
• Plan therapy including appropriate dose and
monitoring for phosphodiesterase inhibitors
• Recognize the drug adverse effects and toxicity of phosphodiesterase inhibitors
• Recognize potential drug-drug interactions for phosphodiesterase inhibitors
iv. Calcium sensitizers
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of calcium sensitizers
• Know the mechanism of action for calcium sensitizers
• Identify indications for calcium sensitizers
• Identify contraindications for calcium sensitizers
• Plan therapy including appropriate dose and monitoring for calcium sensitizers
• Recognize the drug adverse effects and toxicity of calcium sensitizers
• Recognize potential drug-drug interactions for calcium sensitizers
Systemic vasoactive agents
i. Nitrates
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of nitrates
• Know the mechanism of action for nitrates
• Identify indications for nitrates
• Identify contraindications for nitrates
• Plan therapy including appropriate dose and monitoring for nitrates
• Recognize the drug adverse effects and toxicity of nitrates
• Recognize potential drug-drug interactions for nitrates
ii. Calcium channel antagonists
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of calcium channel antagonists
• Know the mechanism of action for calcium channel antagonists
• Identify indications for calcium channel antagonists
• Identify contraindications for calcium channel antagonists
• Plan therapy including appropriate dose and monitoring for calcium channel antagonists
• Recognize the drug adverse effects and toxicity of calcium channel antagonists
• Recognize potential drug-drug interactions for calcium channel antagonists
iii. Angiotensin-converting enzyme (ACE) inhibitors
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of ACE inhibitors
• Know the mechanism of action for ACE Inhibitors
• Identify indications for ACE inhibitors
• Identify contraindications for ACE inhibitors
• Plan therapy including appropriate dose and monitoring for ACE inhibitors
iv. Beta-adrenergic blocking drugs
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of ?-adrenergic blocking drugs
• Know the mechanism of action for ?-adrenergic blocking drugs
• Identify indications for ?-adrenergic blocking drugs
• Identify contraindications for ?-adrenergic blocking drugs
• Plan therapy including appropriate dose and monitoring for ?- adrenergic blocking drugs
• Recognize the drug adverse effects and toxicity of ?-adrenergic blocking drugs
• Recognize potential drug-drug interactions foradrenergic blocking drugs
v. Angiotensin-receptor blockers (ARBs)
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of ARBs
• Know the mechanism of action for ARBs
• Identify indications for ARBs
• Identify contraindications for ARBs
• Plan therapy including appropriate dose and monitoring for ARBs
• Recognize the drug adverse effects and toxicity of ARBs
• Recognize potential drug-drug interactions for ARBs
vi. Fenoldopam
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of fenoldopam
• Know the mechanism of action for fenoldopam
• Identify indications for fenoldopam
• Identify contraindications for fenoldopam
• Plan therapy including appropriate dose and monitoring for fenoldopam
• Recognize the drug adverse effects and toxicity of fenoldopam
• Recognize potential drug-drug interactions for fenoldopam
vii. Vasopressin
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of vasopressin
• Know the mechanism of action for vasopressin
• Identify indications for vasopressin
• Identify contraindications for vasopressin
• Plan therapy including appropriate dose and monitoring for vasopressin
• Recognize the drug adverse effects and toxicity of vasopressin
• Recognize potential drug-drug interactions for vasopressin Pulmonary vasoactive agents
i. Prostacyclin, epoprostenol, sildenafil, bosentan, etc.
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of pulmonary vasodilators
• Know the mechanism of action for pulmonary vasodilators
• Identify indications for pulmonary vasodilators
• Identify contraindications for pulmonary vasodilators
• Plan therapy including appropriate dose and monitoring for pulmonary vasodilators
• Recognize the drug adverse effects and toxicity of pulmonary vasodilators
• Recognize potential drug-drug interactions for pulmonary vasodilators
ii. Diuretics
Loop diuretics
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of loop diuretics
• Know the mechanism of action for loop diuretics
• Identify indications for loop diuretics
• Identify contraindications for loop diuretics
• Plan therapy including appropriate dose and monitoring for loop diuretics
• Recognize the drug adverse effects and toxicity of loop diuretics
• Recognize potential drug-drug interactions for loop diuretics Thiazides
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of thiazides
• Know the mechanism of action for thiazides
• Identify indications for thiazides
• Identify contraindications for thiazides
• Plan therapy including appropriate dose and monitoring for thiazides
• Recognize the drug adverse effects and toxicity of thiazides
• Recognize potential drug-drug interactions for thiazides
Carbonic anhydrase inhibitors
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of carbonic anhydrase inhibitors
• Know the mechanism of action for carbonic anhydrase inhibitors
• Identify indications for carbonic anhydrase inhibitors
• Identify contraindications for carbonic anhydrase inhibitors
• Plan therapy including appropriate dose and monitoring for carbonic anhydrase inhibitors
• Recognize the drug adverse effects and toxicity of carbonic anhydrase inhibitors
• Recognize potential drug-drug interactions for carbonic anhydrase inhibitors Potassium-sparing diuretics
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of potassium-sparing diuretics
• Know the mechanism of action for potassium-sparing diuretics
• Identify indications for potassium-sparing diuretics
• Identify contraindications for potassium-sparing diuretics
• Plan therapy including appropriate dose and
monitoring for potassium-sparing diuretics
• Recognize the drug adverse effects and toxicity of potassium- sparing diuretics
• Recognize potential drug-drug interactions for potassium-sparing diuretics
B-type natriuretic peptides
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of b-type natriuretic peptides
• Know the mechanism of action for b-type natriuretic peptides
• Identify indications for b-type natriuretic peptides
• Identify contraindications for b-type natriuretic peptides
• Plan therapy including appropriate dose and monitoring for b-type natriuretic peptides
• Recognize the drug adverse effects and toxicity of b-type natriuretic peptides
• Recognize potential drug-drug interactions for b-type natriuretic peptides
Anti-inflammatory agents
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of anti-inflammatory agents
• Know the mechanism of action of anti-inflammatory agents
• Identify indications for anti-inflammatory agents
• Identify contraindications for anti-inflammatory agents
• Plan therapy including appropriate dose and monitoring for anti- inflammatory agents
• Recognize the drug adverse effects and toxicity of anti-inflammatory agents
• Recognize potential drug-drug interactions for anti-inflammatory agents Antiplatelet/anticoagulant therapy
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of antithrombic/anticoagulant agents
• Know the mechanism of action for antithrombic/anticoagulant agents
• Identify indications for antithrombic/anticoagulant agents
• Identify contraindications for antithrombic/anticoagulant agents
• Plan therapy including appropriate dose and monitoring for antithrombic/anticoagulant agents
• Recognize the drug adverse effects and toxicity of antithrombic/anticoagulant agents
• Recognize potential drug-drug interactions for antithrombic/anticoagulant agents
Lipid-lowering drugs
i. Bile acid sequestrants
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of lipid-reducing agents
• Know the mechanism of action for lipid-reducing agents
• Identify indications for lipid-reducing agents
• Identify contraindications for lipid-reducing agents
• Plan therapy including appropriate dose and monitoring for lipidreducing agents
• Recognize the drug adverse effects and toxicity of lipid-reducing agents
• Recognize potential drug-drug interactions for lipid-reducing agents
ii. HMG CoA reductase inhibitors
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of HMG CoA reductase inhibitors
• Know the mechanism of action for HMG CoA reductase inhibitors
• Identify indications for HMG CoA reductase inhibitors
• Identify contraindications for HMG CoA reductase inhibitors
• Plan therapy including appropriate dose and monitoring for HMG CoA reductase inhibitors
• Recognize the drug adverse effects and toxicity of HMG CoA reductase inhibitors
• Recognize potential drug-drug interactions for HMG CoA reductase inhibitors
iii. Glycoprotein IIb/IIIa inhibitors
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of glycoprotein IIb/IIIa inhibitors
• Know the mechanism of action for glycoprotein IIb/IIIa inhibitors
• Identify indications for glycoprotein IIb/IIIa inhibitors
• Identify contraindications for glycoprotein IIb/IIIa inhibitors
• Plan therapy including appropriate dose and monitoring for glycoprotein IIb/IIIa inhibitors
• Recognize the drug adverse effects and toxicity of glycoprotein IIb/IIIa inhibitors
• Recognize potential drug-drug interactions for glycoprotein IIb/IIIa inhibitors
iv. Ductal arteriosus drugs
Prostaglandins
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of prostaglandin E (PGE)
• Know the mechanism of action for PGE
• Identify indications for PGE
• Identify contraindications for PGE
• Plan therapy including appropriate dose and monitoring for PGE
• Recognize the drug adverse effects and toxicity of PGE
• Recognize potential drug-drug interactions for PGE
Indomethacin and ibuprofen
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of indomethacin/ibuprofen
• Know the mechanism of action for indomethacin/ibuprofen
• Identify indications for indomethacin/ibuprofen
• Identify contraindications for indomethacin/ibuprofen
• Plan therapy including appropriate dose and monitoring for indomethacin /ibuprofen
• Recognize the drug adverse effects and toxicity of indomethacin /ibuprofen
• Recognize potential drug-drug interactions for indomethacin/ibuprofen
v. Specific sedative, hypnotic, and analgesic drugs
Barbiturates
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of barbiturates
• Know the mechanism of action of barbiturates
• Identify indications for barbiturates
• Identify contraindications for barbiturates
• Plan therapy including appropriate dose and monitoringfor barbiturates
• Recognize the drug adverse effects and toxicity of barbiturates
• Recognize potential drug-drug interactions for barbiturates
vi. Benzodiazepines and antagonists (eg, diazepam, midazolam, flumazenil)
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of benzodiazepines and antagonists
• Know the mechanism of action for benzodiazepinesand antagonists
• Identify indications for benzodiazepines and antagonists
• Identify contraindications for benzodiazepines and antagonists
• Plan therapy including appropriate dose andmonitoringfor benzodiazepines and antagonists
• Recognize the drug adverse effects and toxicity of benzodiazepines and antagonists
• Recognize potential drug-drug interactions for benzodiazepines and antagonists
vii. Non-barbiturates/non-benzodiazepines (eg, etomidate, ketamine)
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of non-barbiturate/non-benzodiazepine agents
• Know the mechanism of action for non-barbiturate/nonbenzodiazepine agents
• Identify indications for non-barbiturate/non-benzodiazepine agents
• Identify contraindications for non-barbiturate/non-benzodiazepine agents
• Plan therapy including appropriate dose and monitoring for nonbarbiturate/non-benzodiazepine agents
• Recognize the drug adverse effects and toxicity
ofnon- barbiturate/non-benzodiazepine agents
• Recognize potential drug-drug interactions for non-barbiturate/nonbenzodiazepine agents
viii. Opioids (eg, morphine, fentanyl, meperidine, sufentanil, methadone)
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of opioids
• Know the mechanism of action for opioids
• Identify indications for opioids
• Identify contraindications for opioids
• Plan therapy including appropriate dose and monitoring for opioids
• Recognize the drug adverse effects and toxicity of opioids
• Recognize potential drug-drug interactions for opioids
ix. Psychotropic drugs
• Know the pharmacologic effects (pharmacokinetics and
pharmacodynamics) of psychotropic drugs
• Know the mechanism of action for psychotropic drugs
• Identify indications for psychotropic drugs
• Identify contraindications for psychotropic drugs
• Plan therapy including appropriate dose and monitoring for psychotropic drugs
• Recognize the drug adverse effects and toxicity of psychotropic drugs
• Recognize potential drug-drug interactions for psychotropic drugs
x. Local anesthetics (eg, lidocaine, mepivacaine)
• Know the pharmacologic effects (pharmacokinetics andpharmacodynamics) of local anesthetics
• Know the mechanism of action for local anesthetics
• Identify indications for local anesthetics
• Identify contraindications for local anesthetics
• Plan therapy including appropriate dose and monitoring for local anesthetics
• Recognize the drug adverse effects and toxicity of local anesthetics
• Recognize potential drug-drug interactions for local anesthetics
xi. Anti-cholinergic drugs
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of anti-cholinergic drugs
• Know the mechanism of action for anti-cholinergic drugs
• Identify indications for anti-cholinergic drugs
• Identify contraindications for anti-cholinergic drugs
• Plan therapy including appropriate dose and monitoring for anticholinergic drugs
• Recognize the drug adverse effects and toxicity of anti-cholinergic drugs
• Recognize potential drug-drug interactions for anti-cholinergic drugs
xii. Neuromuscular blocking agents
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of neuromuscular blocking drugs
• Know the mechanism of action for neuromuscular blocking drugs
• Identify indications for neuromuscular blocking drugs
• Identify contraindications for neuromuscular blocking drugs
• Plan therapy including appropriate dose and monitoring for neuromuscular blocking drugs
• Recognize the drug adverse effects and toxicity of neuromuscular blocking drugs
• Recognize potential drug-drug interactions for neuromuscular blocking drugs
xiii. Inhalation anesthetics
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of inhalation anesthetics
• Know the mechanism of action for inhalation anesthetics
• Identify indications for inhalation anesthetics
• Identify contraindications for inhalation anesthetics
• Plan therapy including appropriate dose and monitoring for inhalation anesthetics
• Recognize the drug adverse effects and toxicity of inhalation anesthetics
• Recognize potential drug-drug interactions for inhalation anesthetics
xiv. Antireflux drugs
• Understand the cardiovascular effects of antireflux drugs, including contraindications and interactions with other drugs
• Know the mechanism of action for antireflux drugs
• Identify indications for antireflux drugs
• Identify contraindications for antireflux drugs
• Plan therapy including appropriate dose and monitoring for antireflux drugs
• Recognize the drug adverse effects and toxicity of antireflux drugs
• Recognize potential drug-drug interactions for antireflux drugs
xv. Enzyme replacement therapy for Pompe, Fabry, Hurler
• Know the pharmacologic effects (pharmacokinetics and pharmacodynamics) of enzyme replacement therapy
• Know the mechanism of action for enzyme replacement therapy
• Identify indications for enzyme replacement therapy
• Identify contraindications for enzyme replacement therapy
• Plan therapy including appropriate dose and monitoring for enzyme replacement therapy
• Recognize the drug adverse effects and toxicity of enzyme replacement therapy
• Recognize potential drug-drug interactions for enzyme replacement therapy
ï‚· xvi. Cardiovascular effects of drug abuse
• Recognize and manage the cardiovascular effects of drug abuse (eg, cocaine, diet pills, hallucinogens, inhalants, stimulants, anabolic steroids)
Cardiovascular Examination,Principles, and Application of Cardiac Diagnostics
C. Physical examination
i. Heart rate
• Know the age-related normal measurements of heart rate associated with disease states and medications
• Understand alterations in heart rate and types of rhythm associated with disease states and medications
ii. Vasculature including arterial and venous pulses, venous congestion, and blood pressure
• Know significance of differences in pulse amplitude between extremities
• Understand the physiology of paradoxical pulse
• Understand the significance of a widened pulse pressure
• Know the age-related changes in blood pressure values
• Know the different methods of determination of blood pressure and the potential associated artifacts
• Understand the physiologic events related to the jugular venous pulse and causes for variation
• Know the principles that underlie the assessment of perfusion (eg, temperature, capillary refilling, color)
• Recognize the clinical signs of systemic venous congestion and know the significance of peripheral edema in patients with cardiac disease
iii. Murmurs
• Understand the physical basis of murmurs, thrills, and ventricular heaves
• Know characteristics of normal and abnormal heart sounds with respect to physiologic events and timing in the cardiac cycle
• Recognize the characteristics of the various types of functional ("innocent") murmurs
• Understand the significance of localization and transmission of cardiac murmurs
• Know how to interpret extracardiac bruits
• Understand the significance of friction rubs
• Know the various characteristics of pathologic murmurs, clicks, and
cardiac sounds.
• Interpret clinical physical examination data influenced by cardiac and body position
ï‚· iv. Respiratory pattern
• Recognize the clinical signs of pulmonary congestion
• Know the clinical significance of abnormal respiratory patterns (eg, tachypnea, hyperpnea, stridor, grunting, retractions, wheezing)
v. Cyanosis and other skin manifestations of cardiac disease
• Know the cardiac and noncardiac causes of central cyanosis
• Understand the physiologic significance of central versus peripheral cyanosis
• Know the significance of jaundice in a cardiac patient
• Know the dermatologic abnormalities in a patient with cardiac disease and their pathogenesis
• Know the clinical manifestations and significance of embolic phenomena in patients with cardiac disease
• Recognize and understand the importance of variations in hepatic situs
D. Surface electrocardiography
i. Age-dependent features
• Know age-related changes in ECG wave forms and intervals Hypertrophy
• Recognize the ECG pattern of ventricular hypertrophy at various ages
• Recognize atrial enlargement on ECG
ii. Depolarization
• Recognize variations from normal pattern of atrial depolarization on ECG and make an interpretation
• Recognize variations from normal pattern of ventricular depolarization on ECG and make an interpretation
• Differentiate the ECG patterns associated with pre excitation, bundle branch block, and hemiblock
iii. Repolarization
• Recognize on ECG variations from normal pattern of ventricular repolarization and make an interpretation
iv. Clinical applications
• Recognize patterns of ischemia, injury, and infarction
v. Monitoring
• Know the indications for 24-hour ambulatory ECG recording, how to recognize artifacts, and how to interpret the results
• Know the indications for use of an event monitor or an implantable loop recorder and how to interpret the results
E. Exercise stress testing
• Know the guidelines for exercise in normal children
• Know the guidelines for exercise in children with cardiovascular disease
• Recognize the normal responses to exercise in terms of heart rate, blood pressure, cardiac output, oxygen uptake and consumption, and venous return
• Understand the ventilatory response to CO2 in terms of CO2 response curves and central and peripheral chemoreceptors
• Know the indications for and risks of exercise testing in children
• Understand the techniques, physiology, advantages, and disadvantages of the different types of exercise (cycle, treadmill, hand-grip exercise)
• Understand the physiologic principles related to electrocardiographic responses to exercise
• Understand the physiologic principles involved in the ventilatory response to exercise
• Understand the indications of nuclear medicine stress testing
F. Echocardiography/Doppler methods (includes fetal)
• Assess systolic and diastolic function utilizing echocardiography
• Know how to determine gradients and pressure measurement from Doppler-derived velocity measurements
• Know how Doppler-derived velocity measurements compare to directpressure gradient determinations
• Understand the principles of echocardiography
• Understand the physics of echocardiography
• Know the indications for, risks of, and limitations of transesophageal, stress, and fetal echocardiography
• Recognize normal cardiac anatomy on echocardiography
G. Catheterization and intervention
i. General principles
• Know the indications and contraindications for and risks of cardiac catheterization
• Know the most appropriate positional view to obtain optimal angiographic visualization of the targeted cardiac and vasculature structure of interest
• Interpret normal and abnormal pressure data during cardiac
catheterization
• Know the normal and potential abnormal courses of a cardiac catheter during cardiac catheterization and angiography
ii. Calculating cardiac output and shunts Invasive and noninvasive methods of calculating cardiac output
• Know how to calculate myocardial oxygen consumption from data measuring coronary blood flow and oxygen saturation
• Understand the concept, use, and limitations of the Fick method to determine blood flow (systemic and pulmonary)
• Calculate a right-to-left and a left-to-right shunt given relevant oxygen data
• Know how to arrive at a physiologic diagnosis given saturation data Understand the concept of effective pulmonary blood flow
• Recognize important sources of measurement error when quantifying ventricular function by invasive methods Interventional catheterization: balloon angioplasty/ valvuloplasty/ stent placement and angiography
• Know which lesions can be dilated by angioplasty
• Understand the factors associated with angioplasty (eg, indications, contraindications, risks, and limitations)
• Know how to perform angioplasty of native and postoperative pulmonary branch stenosis
• Manage the complications of angioplasty
• Interpret patterns of pulmonary and systemic vasculature on angiography
• Understand the factors associated with use of angiography (eg, risks, risk management, complications, and contraindications)
• Know the methods for and limitations of calculations of pulmonary and systemic vascular resistance and its application
• Know which valve lesions are candidates for balloon valvuloplasty
• Understand the factors associated with stent placement (eg, indications, contraindications, risks, and limitations)
• Understand the basic technical aspects of stent placement
• Understand medical management implications following stent placement in lesions
• Identify and manage the complications of stent placement
• Understand the factors associated with dilation of bioprosthetic valves/conduits (eg, indications, contraindications, risks, and limitations)
• Understand the factors associated with bioprosthetic valves/conduits (eg, indications, contraindications, risks, and limitations)
• Know how to perform angioplasty of bioprosthetic valves/conduits
i. Transeptal puncture and atrioseptostomy
• Know the indications, contraindications, risks, and limitations of atrioseptostomy
• Understand the basic technical aspects of balloon atrial septostomy
• Understand the factors associated with transeptal puncture (eg, indications, contraindications, risks, and limitations)
ii. Occlusion techniques
• Understand the factorsassociated with occlusion techniques(eg, indications, contraindications, risks, and limitations)
• Understand the basic technical aspects of occlusion techniques
• Recognize commonly approved occlusion devices for cardiac defects
• Plan appropriate management and follow-up evaluation relative to complications of occlusion devices
• Plan prophylactic management of thrombosis following the use of an occlusion device
• Percutaneous valve placement
a) Understand the principles of percutaneous valve placement
• Other interventional procedures
a) Understand the basic principles and techniques of latest interventional technologies
iii. Cardiac magnetic resonance imaging (MRI) and angiography (MRA) and computed tomography (CT) scan
• Understand the factors associated with cardiac CT scan and CT angiography (eg, indications, contraindications, and risks)
• Understand the factorsassociated with use of cardiac MRI (eg, indications, contraindications, risks, and limitations)
• Diagnose cardiovascular disease based on cardiac computed tomography
• Diagnose cardiac disease based on findings on cardiac MRI
• Know the factors associated with MRI/MRA assessment of cardiovascular function, including flow (eg, indications, techniques, limitations)
iv. Nuclear testing
• Know the indications, contraindications, risks, and limitations of radionuclide angiocardiography
• Recognize the clinical implications of normal and abnormal findings on lung perfusion scans and ventilation/perfusion scans
H. Other forms of cardiac testing
• Pulse oximetry a. Interpret the principles of pulse oximetry in the evaluation of a patient with cardiovascular disease
• X-ray studies of the chest
• Electrophysiologic testing
I. Electrocardiographic diagnosis
• Recognize electrocardiographic features of first-, second-, and thirddegree atrioventricular block
• Recognize electrocardiographic features of atrial and ventricular ectopy
J. Laboratory testing
i. Erythrocyte indices
• Recognize alterations in erythrocyte indices that are important in the evaluation of a patient with cardiovascular disease
ii. Arterial blood gases and pH
• Understand factors which influence oxygen-hemoglobin linkage and dissociation curves
• Understand how arterial blood gases and pH are used in the assessment of cardiovascular disease
iii. Cardiac injury profiles
• Know the uses of serum creatine kinase activity and troponin I and T concentration measurements in a patient with cardiovascular disease
• Heart failure profiles a. Understand the use and limitations of biomarkers in the evaluation of acute and chronic heart failure Office-Based Cardiac Problems
K. Syncope
• Know how to evaluate syncope and presyncope
• Diagnose and manage neurocardiogenic syncope
• Know the differential diagnosis of syncope
L. Lipidopathies and coronary risk management
• Know the various types of hyperlipidemias, including manifestations, their genetic basis, mode of transmission, diagnosis, and management
• Interpret serum lipid profile tests in children
• Plan appropriate management of a child with hypercholesterolemia
• Know the recommended daily dietary saturated fat intake for children of different ages
• Know the risk factors for hyperlipidemia and the timing of lipid testing based on risk factors
M. Hypertension
• Recognize and plan an appropriate evaluation in a patient with systemic hypertension
• Plan appropriate management of systemic hypertension
• Understand the natural history of systemic hypertension in children
N. Exercise restrictions in congenital heart disease
• Know the guidelines for exercise in normal children
• Know the guidelines for exercise in children with cardiovascular disease
O. Chest pain
• Plan the diagnosis and management of chest pain in children and adolescents
P. Cardiovascular problems in the athlete
• Know how to use echocardiography to recognize physiologic cardiac hypertrophy in an athlete, including differentiation from pathologic hypertrophy
• Understand and recognize cardiovascular and electrocardiographic changes (eg, heart rate, blood pressure, LV mass) in a well-trained athlete
• Identify the cause(s) of sudden cardiac death in an athlete
• Understand utilization and limitations of cardiovascular screening of the athlete and school-aged child
Q. Cyanosis
• Recognize manifestations of acute and chronic insufficient pulmonary blood flow
R. Palpitations
• Plan the evaluation and management of palpitations in children and adolescents
S. Murmurs
Left-to-Right Shunts
Atrial septal defects (non-AVSD types)
i. Anatomy
• Recognize the anatomic characteristics of different types of atrial septal defects
• Recognize cardiovascular lesions commonly associated with an atrial septal defect
ii. Physiology a. Understand the factors that affect shunting at the atrial level
iii. Natural history
• Understand the short- and long-term effects of an atrial septal defect on pulmonary vascular bed and cardiac function
• Understand the relationship between an atrial septal defect and arrhythmia
• Understand the relationship between an atrial septal defect and strokes
iv. Clinical findings
• Recognize the clinical findings consistent with an atrial septal defect
• Laboratory findings
• Recognize features associated with atrial septal defect using available laboratory tests and recognize important anatomic features that could affect surgical management
• Calculate pulmonary and systemic flows, blood flow ratios, and resistance by various modalities in a patient with atrial septal defect
• Recognize the cardiac MRI features associated with each type of atrial septal defect
v. Management, including complications
• Develop an appropriate management plan for a patient with an atrialseptal defect
• Determine the appropriate timing of surgical or catheter intervention in a patient with an atrial septal defect
• Identify and manage the early and long-term complications of surgical or catheter closure of an atrial septal defect
vi. Atrioventricular septal defects
1. Embryology, epidemiology, and genetics
• Recognize the genetic syndromes associated with atrioventricular septal defect
vii. Anatomy
• Recognize cardiovascular lesions commonly associated with atrioventricular septal defect including varying AVV morphology and insertion
viii. Physiology
• Identify the effects of an atrioventricular septal defect on the pulmonary vascular bed
• Understand the factors that determine shunting at atrial and ventricular levels in atrioventricular septal defect
2. Natural history a. Understand the natural history of atrioventricular septal defect
3. Clinical findings a. Recognize the clinical findings consistent with an atrioventricular septal defect
4. Laboratory findings
• Recognize features of atrioventricular septal defects using available laboratory tests and recognize important anatomic features that could affect surgical management
• Evaluate pulmonary pressures in a patient with atrioventricular septal defect
• Recognize the various atrioventricular valve morphologies and attachments in a patient with atrioventricular septal defect
5. Management, including complications
• Recognize implications of straddling and overriding of
atrioventricular valves on management decisions
• Plan appropriate medical management of a patient with an atrioventricular septal defect
• Plan the appropriate timing of surgery in a patient with an atrioventricular septal defect
• Recognize and manage early and long-term complications of surgical repair of an atrioventricular septal defect
• Recognize and manage the complications of an unoperated atrioventricular septal defect
Non-AVSD Ventricular septal defects
1. Embryology, epidemiology, and genetics
• Recognize specific genetic syndromes associated with ventricular septal defect
2. Anatomy
• Know the anatomic location of various types of ventricular septal defects
• Recognize cardiovascular lesions commonly associated with ventricular septal defect
3. Physiology
• Identify the effects of a ventricular septal defect on the pulmonary vascular bed
• Understand the effects of ventricular septal defect on cardiac function
• Understand the vascular and cardiac factors that determine shunting in a ventricular septal defect
4. Natural history a. Understand the natural history of ventricular septal defect
5. Clinical findings
• Differentiate between a closing VSD and development of subpulmonary obstruction
• Recognize and treat pulmonary arterial hypertension
• Recognize the clinical findings associated with a ventricular septal defect
• Recognize the clinical findings of commonly associated cardiovascular lesions with a ventricular septal defect (eg, aortic insufficiency, patent ductus arteriosus, double-chambered right ventricle)'
6. Laboratory findings
• Recognize the anatomic types of features of ventricular septal defect using available laboratory tests and recognize important anatomic features that could affect surgical management
• Distinguish between restrictive and nonrestrictive communications by Doppler echocardiography in a patient with a ventricular septal defect
7. Management, including complications
• Recognize and manage the early and long-term complications following surgical repair or catheter device closure of a ventricular septal defect
• Plan management of a patient with VSD and aortic regurgitation
• Plan appropriate medical management of a patient with ventricular septal defect
• Plan the appropriate timing of surgical or catheter intervention in the management of a patient with ventricular septal defect
• Recognize and manage the complications of unoperated ventricular septal defect
T. Patent ductus arteriosus
1. Embryology, epidemiology, and genetics
• Know the embryologic basis of patent ductus arteriosus
2. Anatomy
• Recognize the anatomic details of patent ductus arteriosus
Recognize lesions commonly associated with patentductus arteriosus
3. Physiology
• Identify the effects of patent ductus arteriosus on the pulmonary vascular bed
• Recognize the effects of gestational age at birth and postnatal age on the presentation of a patent ductus arteriosus
• Understand the effects of a patent ductus arteriosus on cardiac function
• Understand the determinantsof shunting in patent ductus arteriosus
4. Natural history a. Understand the natural history of patent ductus arteriosus
5. Clinical findings
• Recognize the clinical findings associated with patent ductus arteriosus
6. Laboratory findings
• Recognize features of patent ductus arteriosus of various sizes using available laboratory tests and recognize important anatomic features that could affect surgical management
• Assess volume overload and estimate pulmonary arterial pressures by echocardiography in a patient with patent ductus arteriosus
7. Management, including complications
• Plan management of patent ductus arteriosus in preterm and term infants, including appropriate use of prostaglandin inhibitors
• Plan the timing of surgical or catheter intervention in a patient with patent ductus arteriosus
• Recognize possible early and long-term complications of surgical or transcatheter repair of patent ductus arteriosus
• Recognize and manage the complications of untreated patent ductus arteriosus
• Understand the relationship between patent ductus arteriosus and necrotizing enterocolitis in preterm and full-term infants
U. Coronary arteriovenous fistula
1. Anatomy
• Understand the pathologic features of a coronary arteriovenous fistula
2. Physiology
• Understand the vascular physiology of a large coronary arteriovenous fistula
3. Natural history
• Understand the natural history of coronary arteriovenous fistula
4. Clinical findings
• Recognize the clinical findings of coronary arteriovenous fistula
5. Laboratory findings
• Recognize features associated with coronary arteriovenous fistula using available laboratory tests and recognize important anatomic features that could affect surgical management
6. Management, including complications
• Plan the appropriate technique and timing of surgical or catheter intervention in a patient with coronary arteriovenous fistula
• Identify and manage possible complications of
surgical or transcatheter repair of coronary arteriovenous fistula
• Recognize and manage the complications of an untreated arteriovenous fistula
V. Aortopulmonary window
1. Embryology, epidemiology, and genetics
• Know the embryologic basis of aortopulmonary window
2. Anatomy
• Recognize the anatomic details of an aortopulmonary window
• Recognize lesions commonly associated with an aortopulmonary window
3. Physiology
• Identify the effects of an aortopulmonary window on the pulmonary vascular bed
4. Natural history
• Understand the natural history of anunoperatedaortopulmonary window
5. Clinical findings
• Recognize the clinical presentation ofaortopulmonary window
6. Laboratory findings
• Recognize features consistent with a diagnosis of aortopulmonary window by available laboratory tests and recognize important features that could affect surgical management
7. Management, including complications
• Plan the appropriate timing of surgical or catheter intervention in a patient with aortopulmonary window
• Recognize and manage the long-term complications of
unoperatedaortopulmonary window
W. Right-to-Left Shunts
Tetralogy of Fallot
1. Embryology, epidemiology, and genetics
• Know the embryology, epidemiology, and genetics for tetralogy of Fallot
• Recognize genetic syndromes associated with tetralogy of Fallot
2. Anatomy
• Recognize the commonly associated lesions in a patient with tetralogy of Fallot
• Recognize the anatomic features in a patient with tetralogy of Fallot
3. Physiology
• Understand the circulatory abnormalities in a patient with tetralogy of Fallot, including the pathophysiology of a hypercyanotic episode
4. Natural history a. Know the natural history of tetralogy of Fallot
5. Clinical findings
• Recognize the clinical features of hypercyanotic episodes in patients with
tetralogy of Fallot
6. Laboratory findings
• Appropriately use and interpret diagnostic studies for evaluation and treatment planning in tetralogy of Fallot
• Recognize hemodynamic and angiographic findings of tetralogy of Fallot
7. Management, including complications
• Plan management of a hypercyanotic episode in a patient with tetralogy of Fallot
• Plan the treatment approach for palliation or correction of tetralogy of Fallot
• Recognize the complications of cyanosis in untreated tetralogy of Fallot
• Recognize and manage complications after treatment of tetralogy of Fallot
X. Double-outlet right ventricle
1. Embryology, epidemiology, and genetics
• Understand the etiology, epidemiology, and genetic syndromes associated with double-outlet right ventricle
2. Anatomy
• Recognize the anatomic features of double-outlet right ventricle and commonly associated lesions
3. Physiology
• Understand the circulatory physiology of double-outlet right ventricle and its relationship with anatomic features
4. Laboratory findings
• Appropriately use and interpret diagnostic studies for evaluation and treatment planning in double-outlet right ventricle
5. Management, including complications
• Recognize the effects of the transitional circulation on the clinical presentation of double-outlet right ventricle
• Plan the treatment of double-outlet right ventricle based on anatomic and physiological variables
• Recognize and manage the early and long-term complications after therapy in a patient with double-outlet right ventricle
Y. Pulmonary atresia with intact septum
1. Embryology, epidemiology, and genetics
• Know the embryology, epidemiology, and genetics of pulmonary atresia with intact septum
• Recognize the etiology, epidemiology, and genetic syndromes associated with pulmonary atresia with intact septum
2. Anatomy
• Recognize the anatomic features and their prognostic significance in pulmonary atresia with intact septum
• Recognize cardiovascular lesions commonlyassociatedwith pulmonary atresia with intact septum
3. Physiology
• Understand the physiologic consequences of the anatomic spectrum of pulmonary atresia with intact septum
4. Natural history
• Understand the range of natural history in pulmonary atresia with intact septum
5. Laboratory findings
• Appropriately use and interpret diagnostic studies for evaluation and treatment planning in pulmonary atresia with intact ventricular septum before and after intervention.
6. Management, including complications
• Plan the treatment of pulmonary atresia with intact septum
• Recognize and manage early and long-term complications of therapy in pulmonary atresia with intact septum
Z. Pulmonary atresia with ventricular septal defect
1. Embryology, epidemiology, and genetics
• Know the embryology, epidemiology, and genetics of pulmonary atresia with ventricular septal defect
• Recognize the etiology, epidemiology, and genetic syndromes associated with pulmonary atresia with ventricular septal defect
2. Anatomy
• Recognize the abnormalities of the pulmonary vascular bed in pulmonary atresia with ventricular septal defect
• Recognize lesions commonly associated with pulmonary atresia with ventricular septal defect
3. Physiology
• Understand the consequences of anatomic variants of pulmonary atresia with ventricular septal defect on treatment and prognosis
4. Natural history
• Understand the range of natural history in pulmonary atresia with ventricular septal defect
5. Laboratory findings
• Recognize features associated with pulmonary atresia with ventricular septal defect using available laboratory tests and recognize important anatomic features that could affect surgical management
6. Management, including complications
• Plan the treatment of pulmonary atresia with ventricular septal defect
• Recognize and manage early and long-term complications of therapy in pulmonary atresia with ventricular septal defect
• Recognize and manage a patient with unoperated pulmonary atresia and ventricular septal defect
AA. Absent pulmonary valve syndrome
1. Embryology, epidemiology, and genetics
• Recognize the etiology, epidemiology, and genetic syndromes associated with absent pulmonary valve syndrome
2. Anatomy
• Recognize the anatomic features and associated lesions in a patient with absent pulmonary valve syndrome
3. Physiology
• Understand the physiologic abnormalities in absent pulmonary valve syndrome
4. Natural history
• Understand the natural history of absentpulmonaryvalve syndrome
5. Clinical findings
• • Recognize the clinical features of absent pulmonary valve syndrome
6. Laboratory findings
• Appropriately use and interpret diagnostic studies for evaluation and treatment planning in pulmonary atresia with absent pulmonary valve syndrome before and after intervention.
7. Management, including complications
• Plan the surgical approach for palliation or correction of absent pulmonary valve syndrome
• • Recognize and manage the short- and long-term airway complications associated with absent pulmonary valve syndromeSingle Ventricular Lesions
BB. Hypoplastic left heart syndrome
1. Embryology, epidemiology, and genetics
• Recognize the etiology, epidemiology, and genetic syndromes associated with hypoplastic left heart syndrome
2. Anatomy
• Identify anatomic features of hypoplastic left heart syndrome
3. Physiology
• Understand the physiology of hypoplastic left heart syndrome
• Understand the circulatory and metabolic effects of hypoplastic left heart syndrome
• Understand the impact of hypoplastic left heart syndrome and its variants on fetal pulmonary and neurodevelopment.
4. Clinical findings
• Recognize the range of clinical presentation of hypoplastic left heart syndrome and its evolution after birth
• Recognize features of hypoplastic left heart syndrome using available laboratory tests and recognize important anatomic features that could affect surgical management
5. Management, including complications
• Plan appropriate management of obstructed atrial septum in a patient with hypoplastic left heart syndrome
• • Recognize the treatment options for hypoplastic left heart syndrome, their merits and drawbacks.
• Plan the management of a neonate with hypoplastic left heart syndrome who has undergone Norwood palliation
• Plan the management of an infant with hypoplastic left heart syndrome who has undergone hybrid palliation
CC. Tricuspid atresia
1. Etiology, epidemiology, and genetics
• Understand the embryologic basis of tricuspid atresia
2. Anatomy
• Identify anatomic features of tricuspid atresia and associated lesions
3. Physiology
• Understand the circulatory physiology of tricuspid atresia
4. Natural history
• Understand the natural history of tricuspid atresia
5. Clinical findings
• Recognize the clinical findings in a patient with tricuspid atresia
6. Laboratory findings
• Recognize features of tricuspid atresia using available laboratory tests and recognize important anatomic features that could affect surgical management
7. Management, including complications
• Plan appropriate medical management for a patient with tricuspid atresia
• Diagnose and manage the postoperative complications following surgical palliation of tricuspid atresia
DD. Other forms of single (univentricular) heart
1. Etiology, epidemiology, and genetics
• Understand the developmental basis for a univentricular heart
2. Anatomy
• Identify anatomic features of the various forms of univentricular heart
3. Physiology
• Understand the physiology of the univentricular heart
4. Natural history
• Understand the natural history of univentricular hearts and the impact on surgical decisions
5. Clinical findings
• Recognize the typical clinical findings of univentricular hearts
6. Laboratory findings
• Recognize features associated with univentricular heart using available laboratory tests and recognize important anatomic features that could affect surgical management
7. Management, including complications
• Plan medical management of a patient with univentricular heart
• Plan surgical management of a patient with a univentricular heart
• Manage complications of the natural history and medical therapy of a univentricular heart
• Manage complications of neonatal surgical palliations in univentricular hearts after treatment
EE. The Glenn and Fontan Circulation
1. Etiology, epidemiology, and genetics
• Recognize the indications and contraindications to Glenn and Fontan operations
2. Anatomy
• Identify anatomical variants of Glenn and Fontan circulation
3. Physiology
• Know the physiologic effects of Glenn and Fontan circulation on the heart and circulation
4. Clinical findings
• Recognize the typical clinical features of a Glenn and Fontan circulation
5. Laboratory findings
• Recognize features associated with Glenn and Fontan circulation using available laboratory tests and recognize important anatomic features that could affect management
6. Management, including complications
• Recognize and manage the early and long-term complications of a patient with Glenn and Fontan circulation, such as protein-losing enteropathy Structural, Valvar, and Obstructive Lesions
A. Tricuspid valve
• Tricuspid stenosis and regurgitation
• Ebstein anomaly of the tricuspid valve
• Obstructive lesions of the right ventricular outflow tract, pulmonary valve, and pulmonary branches
• Pulmonary valve stenosis
• Pulmonary regurgitation
• Pulmonary branch stenosis
• • Mitral stenosis, mitral regurgitation, and mitral valve prolapse
• Obstructive lesions of the left ventricular outflow tract, aortic valve, and aortic
• Bicuspid aortic valve a. Anatomy
• Aortic valve stenosis and regurgitation
• Supravalvar aortic stenosis
B. Etiology, epidemiology, and genetics
C. Anatomy
D. Physiology
E. Natural history
F. Clinical findings
G. Laboratory findings
H. Management, including complications
Congenital Abnormalities of the Great Arteries and Aorta
A. Truncus arteriosus
B. Transposition of the great arteries
C. Congenitally corrected transposition of the great arteries
• Etiology, epidemiology, and genetics
• Anatomy
• Physiology
• Natural history
• Clinical findings
• Laboratory findings
• Management, including complications
Aortic root and arch abnormalities
A. Management, including complications a. Recognize and manage root and arch abnormalities associated with connective tissue abnormalities
B. Vascular rings and slings
• Etiology, epidemiology, and genetics
• Anatomy
• Physiology
• Natural history
• Clinical findings
• Laboratory findings
• Management, including complications
Congenital malformations of the coronary circulation
A. Anomalous left coronary artery from the pulmonary artery
• Etiology, epidemiology, and genetics
• Anatomy
• Physiology
• Natural history
• Clinical findings
• Laboratory findings
• Management, including complications Systemic and Pulmonary Venous Abnormalities and Situs Abnormalities
A. Systemic venous abnormalities
B. Abnormalities of the pulmonary venous system
C. Cortriatriatum
D. Pulmonary venous stenosis/atresia
E. Situs abnormalities and heterotaxy syndromes
F. Ectopiacordis
• Etiology, epidemiology, and genetics
• Anatomy
• Physiology
• Natural history
• Clinical findings
• Laboratory findings
• Management, including complications
Disorders of the Myocardium, Pericardium, Endocardium, and Vasculature
A. Cardiomyopathies (including systolic dysfunction, diastolic dysfunction, and hypertrophic)
B. Cardiomyopathy in muscular dystrophies
C. Cardiomyopathies in metabolic diseases (includes storage diseases)
D. Transplant medicine
E. Pericardial diseases
F. Cardiac tumors
G. Pulmonary hypertension
• Etiology, epidemiology, and genetics
• Anatomy
• Physiology
• Natural history
• Clinical findings
• Laboratory findings
• Management, including complications
Heart Function and Disease in the Fetus and Newborn
A. Fetal diagnosis and management of congenital heart disease
B. Fetal arrhythmias
C. Effects of systemic disease on the fetal heart
D. Effects of maternal disease on the fetal heart
E. Transitional physiology and pulmonary hypertension of the newborn
F. Initial stabilization and management of the newborn with congenital heart disease Intensive Care Management of Patients with Congenital Heart Disease
A. Airway support, mechanical ventilation, and effects on congenital heart disease
B. Low cardiac output state
C. Cardiopulmonary resuscitation
D. Acute management of pulmonary hypertension
E. Multiorgan system management
F. Quality improvement
G. Perioperative issues
Arrhythmias
A. General principles
• Classification
 Formulate a differential diagnosis of rhythm disturbances causing a narrow QRS tachycardia, a wide QRS tachycardia, and bradycardia
• Symptoms
 Identify the signs and symptoms associated with rhythm abnormalities
 Evaluate a patient who has experienced a cardiac arrest
 Evaluate a family with a history of sudden cardiac death
• Basis or cause/physiology
 Understand the physiologic consequences of rhythm disturbances
 Understand the mechanisms involved in the genesis of cardiac arrhythmias (eg, re-entry, automaticity, conduction block)
B. Therapy
• General principles
 Understand the indications for acute and chronic medical
management of tachy- and bradyarrhythmias
 Know the mechanical methods (eg, vagal maneuvers; esophageal, external, intracardiac pacing; cardioversion) available for treatment of arrhythmias
 Identify the clinical features and genetic causes of diseases associated with arrhythmias (eg, LQTS, ARVD, Brugada syndrome, CPVT, cardiomyopathies, preexcitation)
• Autonomic interventions
 Know the techniques for use of vagal maneuvers (including indications, contraindications, risks, and limitations) (eg, Valsalva, ice to face, carotid sinus massage)
 Know the effect of vagal maneuvers in treating cardiac arrhythmias
• Temporary pacing
 Understand the factors associated with temporary pacing (eg, indications, contraindications, risks, and limitations)
 Understand the basic technical aspects of the different modalities available for temporary pacing
• Cardioversion/defibrillation
 Understand the factors associated with cardioversion/defibrillation (eg, indications, contraindications, risks, and limitations)
 Understand the basic technical aspects of cardioversion/defibrillation
• Implantable devices
 Recognize pacing mode and pacemaker malfunction by ECG
 Understand the factors associated with permanent pacing (eg, indications, contraindications, risks, and limitations)
 Understand the factors associated with an implantable cardioverterdefibrillator (eg, indications, contraindications, risks, and limitations
 Understand the basic technical aspects for insertion of a permanent pacemaker or an implantable cardioverter-defibrillator
 Understand the factors associated with bi-ventricular resynchronization pacing (eg, indications, contraindications, risks, and limitations)
C. Ectopy
• Clinical recognition
 Recognize clinical manifestations and significance of ectopy
• Basis or cause
 Recognize the association of ectopic atrial tachycardias with surgery for congenital heart disease
• Management
 Plan the evaluation and management of a patient with frequent atrial or ventricular ectopy
Supraventricular arrhythmias
A. Sinus tachycardia
• Clinical recognition
 Recognize the clinical features of sinus tachycardia
 Differentiate sinus tachycardia by surface electrocardiographic criteria
 Recognize intracardiacelectrophysiologic characteristics of sinus tachycardia
• Basis or cause
 Understand the mechanisms and natural history of sinustachycardia
 Recognize the association of sinus tachycardia with surgery for congenital heart disease (acute and long-term)
• Management
 Recognize and medically manage sinus tachycardia in patients of
varying ages (eg, fetus, infant, child, adolescent, young adult)
 Recognize and manage the consequences of long-term sinus tachycardia
B. Ectopic atrial tachycardia
• Clinical recognition
 Recognize the clinical features of ectopic atrial tachycardia
 Differentiate ectopic atrial tachycardia by surface electrocardiographic criteria
 Recognize intracardiacelectrophysiologic characteristics of ectopic atrial tachycardia
• Basis or cause
 Understand the mechanisms and natural history of ectopic atrial tachycardia
 Recognize the association of certain ectopic atrial tachycardias with surgery for congenital heart disease (acute and long-term)
• Management
 Recognize and medically manage ectopic atrial tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for ectopic atrial tachycardia
 Recognize and manage the consequences of ectopic atrial tachycardia
C. Multifocal atrial tachycardia
• Clinical recognition
 Recognize the clinical features of multifocal atrial tachycardia
 Differentiate multifocal atrial tachycardia by surface electrocardiographic criteria
 Recognize intracardiac electrophysiologic characteristics of multifocal atrial tachycardia
• Basis or cause
 Understand the mechanisms and natural history of multifocal atrial tachycardia
• Management
 Recognize and medically manage multifocal atrial tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for multifocal atrial tachycardia
 Recognize and manage the consequences of multifocal atrial tachycardia
D. Atrial flutter (intra-atrial reentry)
• Clinical recognition
 Recognize the clinical features of atrial flutter
 Differentiate atrial flutter by surface electrocardiographic criteria
 Recognize intracardiacelectrophysiologic characteristics of atrial flutter
• Basis or cause
 Understand the mechanisms and natural history of atrial flutter
 Recognize the association of atrial flutter with surgery for congenital
heart disease (acute and long-term)
• Management
 Recognize and medically manage atrial flutter in patients of varying
ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for atrial flutter
 Recognize and manage the consequences of atrial flutter
E. Atrial fibrillation
• Clinical recognition
• Recognize the clinical features of atrial fibrillation
• Differentiate atrial fibrillation by surface electrocardiographic criteria
• Recognize intracardiacelectrophysiologic characteristics of atrial fibrillation
• Basis or cause
 Understand the mechanisms and natural history of atrial fibrillation
 Recognize the association of atrial fibrillation with surgery for congenital heart disease (acute and long-term)
• Management
 Recognize and medically manage atrial fibrillation in patients of varying ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for atrial fibrillation
 Recognize and manage the consequences of atrial fibrillation
F. Atrioventricular node reentry
• Clinical recognition
 Recognize the clinical features of AV node reentry
 Differentiate AV node reentry by surface electrocardiographic criteria
 Recognize intracardiacelectrophysiologic characteristics of AV node reentry
• Basis or cause
 Understand the mechanisms and natural history of AV node reentry
• Management
 Recognize and medically manage AV node reentry in patients of varying ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for AV node reentry
 Recognize and manage the consequences of AV node reentry
G. Junctional ectopic tachycardia
• Clinical recognition
 Recognize the clinical features of junctional ectopic tachycardia
 Differentiate junctional ectopic tachycardia by surface
electrocardiographic criteria
 Recognize intracardiac electrophysiologic characteristics of junctional ectopic tachycardia
• Basis or cause
 Understand the mechanisms and natural history of junctional ectopic tachycardia
 Recognize the association of junctional ectopic tachycardia with surgery for congenital heart disease (acute and long-term)
• Management
 Recognize and medically manage junctional ectopic tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for the congenital type of junctional ectopic tachycardia
 Recognize and manage the consequences of junctional ectopic tachycardias
H. Orthodromic reentry via accessory pathway
• Clinical recognition
 Recognize the clinical features of orthodromic reentry via accessory pathway
 Differentiate orthodromic reentry via accessory pathway by surface electrocardiographic criteria
 Recognize intracardiacelectrophysiologic characteristics of orthodromic reentry via accessory pathway
• Basis or cause
 Understand the mechanisms and natural history of orthodromic reentry via accessory pathway
• Management
 Recognize and medically manage orthodromic reentry via accessory pathway in patients of varying ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for orthodromic reentry via accessory pathway
 Recognize and manage the consequences of orthodromic reentry via accessory pathway
I. Permanent form of junctional reciprocating tachycardia
• Clinical recognition
 Recognize the clinical features of the permanent form of junctional reciprocating tachycardia
 Differentiate the permanent form of junctionalreciprocating tachycardia by surface electrocardiographic criteria
 Recognize intracardiacelectrophysiologic characteristics of the permanent form of junctional reciprocating tachycardia
• Basis or cause
 Understand the mechanisms and natural history of the permanent form of junctional reciprocating tachycardia
• Management
 Recognize and medically manage the permanent form of junctional reciprocating tachycardia in patients of varying ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for the permanent form of junctional reciprocating tachycardia
 Recognize and manage the consequences of the permanent form of junctional reciprocating tachycardia
J. Antidromic reentry via accessory pathway
• Clinical recognition
 Recognize the clinical features of antidromic reentry via accessory pathway
 Differentiate antidromic reentry by surface electrocardiographic criteria
 Recognize intracardiac electrophysiologic characteristics of antidromic reentry
• Basis or cause
 Understand the mechanisms and natural history of antidromic reentry
• Management
 Recognize and medically manage antidromic reentry in patients of varying ages (eg, fetus, infant, child, adolescent, young adult)
 Understand the factors associated with electrophysiologic study (eg, indications, contraindications, risks, and limitations) and catheter- or surgical-based ablation therapy for antidromic reentry
 Recognize and manage the consequences of antidromic reentry
K. Accessory AV connection and pre-excitation syndrome
• Clinical recognition
 Recognize clinical features associated with accessory atrioventricular connection or pre-excitation syndromes
 Recognize associated cardiac defects in a patient with an accessory atrioventricular connection
• Electrocardiographic diagnosis
 Recognize the ECG features of an atrioventricular connection or preexcitation syndrome
• Electrophysiologic diagnosis
 Recognize characteristics of accessory atrioventricular connections or pre-excitation syndromes based on electrophysiologic studies
• Basis or cause
 Know the natural history of accessory atrioventricular connections or pre-excitation syndromes
• Management
 Plan the management of patients with accessory atrioventricular connections or pre-excitation syndromes Ventricular arrhythmias
A. Benign ventricular ectopy
• Clinical recognition
• Distinguish the clinical features of benign ventricular ectopy and distinguish from more serious ventricular arrhythmias
• Know the risk factors, clinical features, and natural history of benign ventricular ectopy associated with a structurally normal heart or congenital heart disease
• Know the differential diagnosis of benign ventricular ectopy on electrocardiogram
• Identify the specific electrocardiographic features of diseases associated with benign ventricular ectopy
• Basis or cause
• Understand the mechanisms and natural history of benign ventricular ectopy
• Management
 Plan the acute and chronic management of benign ventricular ectopy
B. Idiopathic outflow tract ventricular ectopy
• Clinical recognition
 Distinguish the clinical features of benign idiopathic outflow tract ventricular ectopy
 Know the risk factors, clinical features, and natural history of lifethreatening benign idiopathic outflow tract ventricular ectopy associated with a structurally normal heart or congenital heart disease
 Know the differential diagnosis of idiopathic outflow tract ventricular ectopy on electrocardiogram
• Basis or cause
 Understand the mechanisms and natural history of idiopathic outflow tract ventricular ectopy
• Management
 Plan the acute and chronic management of idiopathic outflow tract ventricular ectopy and ventricular fibrillation in patients with and without surgery for congenital heart disease
C. Verapamil-sensitive LV septal ventricular tachycardia
• Clinical recognition
 Distinguish the clinical features of benign verapamil-sensitive LV septal ventricular tachycardia
 Know the risk factors, clinical features, and natural history of lifethreatening verapamil-sensitive LV septal ventricular tachycardia associated with a structurally normal heart or congenital heart disease
 Know the differential diagnosis of verapamil-sensitive LV septal ventricular tachycardia on electrocardiogram
• Basis or cause
 Understand the mechanisms and natural history of verapamilsensitive LV septal ventricular tachycardia
• Management
 Plan the acute and chronic management of verapamil-sensitive LV septal ventricular tachycardia in patients with and without surgery for congenital heart disease
D. Scar-related macroreentrant ventricular tachycardia
• Clinical recognition
 Distinguish the clinical features of scar-related macroreentrant ventricular tachycardia
 Know the risk factors, clinical features, and natural history of lifethreatening scar-related macroreentrant ventricular tachycardia associated with a structurally normal heart or congenital heart disease
 Know the differential diagnosis of scar-related macroreentrant ventricular tachycardia on electrocardiogram
 Identify the specific electrocardiographic features of diseases associated with life-threatening scar-related macroreentrant ventricular tachycardia
• Basis or cause
 Understand the mechanisms and natural history of scar-related macroreentrant ventricular tachycardia
• Management
 Plan the acute and chronic management of scar-related macroreentrant ventricular tachycardia and ventricular fibrillation in patients with and without surgery for congenital heart disease
E. Ventricular tachycardia in cardiomyopathy
• Clinical recognition
 Know the risk factors, clinical features, and natural history of lifethreatening ventricular tachycardia in cardiomyopathy associated with a structurally normal heart or congenital heart disease
 Know the differential diagnosis of ventricular tachycardia in cardiomyopathy on electrocardiogram
 Identify the specific electrocardiographic features of diseases associated with life-threatening ventricular tachycardia in cardiomyopathy
• Basis or cause
 Understand the mechanisms and natural history of ventricular tachycardia in cardiomyopathy
• Management
 Plan the acute and chronic management of ventricular tachycardia in cardiomyopathy in patients with and without surgery for congenital heart disease
F. Catecholaminergic polymorphic ventricular tachycardia
• Clinical recognition
 Distinguish the clinical features of benign catecholaminergic polymorphic ventricular tachycardia
 Know the risk factors, clinical features, and natural history of lifethreatening catecholaminergic polymorphic ventricular tachycardia associated with a structurally normal heart or congenital heart disease
 Know the differential diagnosis of catecholaminergic polymorphicventricular tachycardia on electrocardiogram
 Identify the specific electrocardiographic features of diseases associated with life-threatening catecholaminergic polymorphic ventricular tachycardia
• Basis or cause
 Understand the mechanisms and natural history of catecholaminergic polymorphic ventricular tachycardia
• Management
 Plan the acute and chronic management of catecholaminergic polymorphic ventricular tachycardia in patients with and without surgery for congenital heart disease
G. Arrhythmogenic RV cardiomyopathy
• Clinical recognition
 Distinguish the clinical features of arrhythmogenic RV cardiomyopathy
 Know the risk factors, clinical features, and natural history of lifethreatening benign arrhythmogenic RV cardiomyopathy associated with a structurally normal heart or congenital heart disease
 Know the differential diagnosis of benign arrhythmogenic RV cardiomyopathy on electrocardiogram
 Identify the specific electrocardiographic features of diseases associated with life-threatening right ventricular cardiomyopathy
• Management
 Plan the acute and chronic management of arrhythmogenic RV cardiomyopathy in patients with and without surgery for congenital heart disease
H. Torsade de pointe ventricular tachycardia
• Clinical recognition
 Distinguish the clinical features of torsade de pointe ventricular tachycardia
 Know the risk factors, clinical features, and natural history of lifethreatening torsade de pointe ventricular tachycardia associated with a structurally normal heart or congenital heart disease
 Know the differential diagnosis of torsade de pointe ventricular tachycardia on electrocardiogram
 Identify the specific electrocardiographic features of diseases associated with life-threatening torsade de pointe ventricular tachycardia
• Basis or cause
 Understand the mechanisms and natural history of torsade de pointe ventricular tachycardia
• Management
 Plan the acute and chronic management of torsade de pointe ventricular tachycardia in patients with and without surgery for congenital heart disease
I. Long QT syndrome and channel abnormalities
• Clinical recognition
 Recognize and plan appropriate management of long QT interval syndromes and other channel abnormalities (eg, Brugada syndrome, CPMT, ARVD)
 Recognize the association between long QT interval and torsades de pointes
• Basis or cause
 Recognize the genotypic-phenotypic relationships and identify the genes associated with long QT syndrome and other channel abnormalities
 Recognize the therapeutic implications for the long QT syndrome genotype
 Know the mode of transmission, application, and interpretation of genetic tests of inherited channelopathies
• Management
 Plan the medical management of arrhythmias ofinherited channelopathies
 Understand the indications for implantation of an intracardiac device for inherited channelopathies
 Understand the potential role of cardiacsympathectomy in management of channelopathies
J. Atrioventricular block
• Clinical recognition
 Know causes of neonatal complete atrioventricular block (maternal SLE, complex heart disease)
 Recognize clinical manifestations of atrioventricular block
• Basis or cause
 Know congenital defects associated with atrioventricular block
 Recognize the association of cardiac surgery with atrioventricular block
 Recognize noncardiac diseases associated with atrioventricular block (eg, mitochondrial myopathy, myotonic dystrophy)
 Recognize acquired cardiac diseases associated with atrioventricular block (eg, Lyme disease)
 Know the natural history of atrioventricular block of various causes (eg, congenital, acquired, surgically induced)
• Management
 Plan appropriate management of atrioventricular block of various causes (eg, congenital, acquired, surgically induced)
K. Sinus node dysfunction
• Clinical recognition
 Recognize specific situations involving long QT syndrome and channel abnormalities
 Recognize ECG features of sinus node dysfunction
 Recognize the electrophysiologic abnormalities of sinus node dysfunction
 Identify symptoms associated with sinus node dysfunction
• Basis or cause
 Recognize the causes of sinus node dysfunction
• Management
 Know the indication for permanent pacer implantation in sinus node dysfunction
Acquired Forms of Cardiac Disease
A. Endocarditis
• Know the risk factors and cardiac and noncardiac lesions that have the highest risk of bacterial endocarditis
• Know the common microorganisms responsible for endocarditis
• Recognize the signs and clinical manifestations of infective endocarditis and the symptoms of bacterial endocarditis resulting in left-heart versus right-heart endocarditis
• Recognize the symptoms of bacterial endocarditis resulting in left- heart versus right-heart endocarditis
• Know the criteria for diagnosing endocarditis
• Identify the extracardiac manifestations and complications of endocarditis and understand their mechanism(s) of development
• Know the indications for surgical management in a patient with endocarditis
• Know the indications for and timing of prophylaxis for bacterial endocarditis
• Know the current status and duration of therapy of antimicrobial therapy of infective endocarditis
• Know the common reasons why endocarditis may yield negative results of a culture
• Plan the management of the complications of endocarditis
B. Myocarditis
• Know the infectious causes of myocarditis
• Know the role of cardiac catheterization and endomyocardial biopsy in diagnosis and management of myocarditis
• Plan appropriate treatment of myocarditis
• Plan appropriate treatment of the cardiac manifestations of Lyme disease
• • Formulate the differential diagnosis of an enlarged cardiac silhouette in a febrile child
• • Formulate the differential diagnosis of an enlarged, poorly contractile left ventricle
• Understand the natural history of myocarditis
• Know gross and histologic features of major cardiovascular inflammatory disease
• Recognize myocarditis cardiac manifestations of systemic cardiac disease (eg, rheumatoid arthritis, Kawasaki disease, sepsis)
• Recognize the clinical presentation and laboratory features of myocarditis
• Recognize the clinical presentation of viral myocarditis
C. Kawasaki disease
• Know pathologic features and clinical cardiovascular manifestations of Kawasaki disease
• Know the sequence and time of appearance of cardiac lesions associated with Kawasaki disease
• Understand the indications for and the role of diagnostic imaging in initial diagnosis and management of Kawasaki disease, including patients with atypical presentation
• Know the sequence and timing of noncardiac findings associated with Kawasaki disease
• Know current recommendations for drug treatment of acute and chronic Kawasaki disease and results of long-term sequelae
D. Rheumatic fever and rheumatic heart disease
• Epidemiology and disease burden
• Health system challenges
• Understand the etiologic features and specific anatomic features of rheumatic fever and rheumatic heart disease
• Understand diagnostic testing and classification of rheumatic fever
• Know the sequence of anatomic features and natural history of rheumatic fever
• Know the gross and microscopic pathology of rheumatic fever
• Know the effect of pathologic anatomy on physiology in a patient with rheumatic fever
• Recognize the major and minor manifestations of acute rheumatic fever and their significance (eg, carditis, chorea, arthritis etc)
• Know the natural history of valve involvement in rheumatic heart disease and the influence of prophylaxis
• Know how to prevent recurrence of rheumatic fever
• Know the currently recommended drug therapy for a patient with acute rheumatic fever with and without cardiac involvement
• Know the indications for intervention in a patient with rheumatic heart disease
E. Inflammatory heart disease caused by systemic disease
• Recognize the causes and understand treatment of inflammatory heart disease caused by systemic disease
F. Other infectious diseases affecting the heart
• Identify the common cardiac complications of AIDS and know the management of each
• Recognize the cardiac findings secondary to congenital rubella
• Know infectious causes of cardiovascular problems in a newborn infant
G. Cardiac trauma
• Recognize the significance of clinical history and physical examination in the evaluation of cardiovascular complications of cardiac trauma
• Recognize the causes and treatments of commotiocordis
• Know the role of noninvasive testing and laboratory findings in evaluation of cardiac trauma
• Plan appropriate management for a patient having cardiovascular trauma
H. Coronary disease and myocardial ischemia
• Recognize the risk factors for and the precursors to the development of risk factors for coronary artery disease
• Know recommendations for prevention of coronary artery disease, including diagnostic testing and exercise
I. Artificial valves, conduits, and hematologic issues
• Recognize major problems associated with artificial valves and plan appropriate management
• Regulate anticoagulation therapy (warfarin, heparin, low molecular weight heparin) in a patient with an artificial valve or conduit, including management plan at the time of an invasive procedure
• Manage antiplatelet / anticoagulation for noncardiac procedures and conditions
• Understand the effect of damaged endothelium on thrombosis
• Identify clinical and laboratory manifestations of embolic clotting disorders
• Formulate a differential diagnosis in a patient suspected of having an embolic clotting disorder
• Understand the physiology of embolic clotting disorders Genetic Disorders and Syndromes of the Cardiovascular System
A. Epidemiology and screening of congenital heart disease
• Know the recurrence risk for the common congenital cardiac anomalies based upon whether the mother or father is affected (parent-of-origin effect)
• Know the recurrence risk for the common congenital cardiac anomalies if a sibling is affected
• Understand appropriate use of genetic testing in unaffected children who have a family history of cardiovascular disease if a first-degree family member is affected
• Understand the appropriate use of genetic testing in children with congenital heart disease and extra-cardiac abnormalities such as intellectual and developmental disability
• Know the major associated cardiac and noncardiac conditions of trisomy 21 and manage their cardiovascular manifestations
• Know the major associated cardiac and noncardiac conditions of trisomy 18 and manage their cardiovascular manifestations
• Know the major associated cardiac and noncardiac conditions of trisomy 13 and manage their cardiovascular manifestations
• Recognize the clinical signs and symptoms of the cardiovascular manifestations of monosomy X (Turner syndrome) and manage their cardiovascular manifestations
• Recognize and diagnose Noonan syndrome and manage its cardiac manifestations
• Recognize and diagnose Holt Oram syndrome and its molecular pathogenesis
• Recognize and diagnose LEOPARD syndrome and manage its cardiac manifestations
• Recognize and diagnose Kartagener (dysmotile cilia) syndrome and manage its cardiac manifestations
• Recognize and diagnose CHARGE association and manage its cardiovascular manifestations
• Recognize and diagnose Barth syndrome and manage its cardiovascular manifestations
• Recognize and diagnose VATER association and manage its cardiovascular manifestations
• Recognize and diagnose Williams syndrome and manage its cardiac manifestations
• Recognize and diagnose the cardiac manifestations of Rubinstein-Taybi syndrome and manage its cardiac manifestations
• Recognize and diagnose Alagille syndrome and manage its cardiac manifestations
• Recognize and diagnose syndromes with chromosome 22q11 deletion and manage their cardiovascular manifestations
• Recognize and diagnose Ellis-van Creveld syndrome and manage its cardiac manifestations
B. Connective tissue diseases (including Marfan syndrome)
• Recognize cardiovascular involvement in a patient with collagen vascular disease and plan appropriate management
• Recognize and diagnose Marfan and related syndromes (eg, Loeys-Dietz syndrome, congenital contractural arachnodactyly) and manage their cardiovascular manifestations
• Recognize and diagnose the cardiovascular manifestations of the classical and vascular forms of Ehlers-Danlos syndrome and manage their cardiovascular manifestations
• Recognize and diagnose hereditary hemorrhagic telangiectasia (OslerRendu-Weber syndrome)
C. Hematologic diseases
• Recognize and manage the cardiovascular manifestations of sickle cell disease
• Recognize and diagnose thalassemia syndromes and manage their cardiovascular manifestations
D. Tuberous sclerosis and neurofibromatosis
• Recognize and diagnose tuberous sclerosis and manage its cardiovascular manifestations
• Recognize and diagnose neurofibromatosis and manage its cardiovascular manifestations
E. Familial atrial myxoma
• Recognize and diagnose familial atrial myxoma and manage its cardiovascular manifestations
F. Congenital Heart Disease in the Adolescent and Adult Transitional care
• Understand the importance of transitional education and timing
• Be able to inform patients regarding health care insurance issues related to their disease
• Be able to advise patients to regarding access to their medical records during transition
• Be able to advise patients regarding family planning issues
G. Pregnancy
• Know how to counsel an adolescent/adult with congenital heart disease regarding contraception and pregnancy
• Know the cardiovascular conditions that increase risk and those that are contraindications to pregnancy
• Know how to manage cardiac aspects of pregnancy
• Manage artificial valves during pregnancy
H. Cardiac risk of long-standing systemic disease
• Recognize and manage chronic cyanosis in a patient with pulmonary vascular obstructive disease
• Recognize the changes in arrhythmia risk as patients with CHD age, and understand the basic principles of risk stratification
I. Collateral disease associated with long-standing CHD
J. Recognize and be able to treat collateral disease associated with longstanding CHD
K. Psychosocial issues
• Understand appropriate employment settings for an adolescent/young adult with cardiovascular disease
• Identify risk-taking behaviors with magnified negative consequences in an adolescent/young adult with cardiovascular disease Preventive cardiology Core Knowledge in Scholarly Activities Principles of use of biostatistics in research
A. Types of variables
• Distinguish types of variables (eg, continuous, categorical, ordinal,nominal)
• Understand how the type of variable (eg, continuous, categorical, nominal) affects the choice of statistical test
B. Distribution of data
• Understand how distribution of data affects the choice of statistical test
• Differentiate normal from skewed distribution of data
• Understand the appropriate use of the mean, median, and mode
• Understand the appropriate use of standard deviation
• Understand the appropriate use of standard error
C. Hypothesis testing
• Distinguish the null hypothesis from an alternative hypothesis
• Interpret the results of hypothesis testing
D. Statistical tests
• Understand the appropriate use of the chi-square test versus a t- test
• Understand the appropriate use of analysis of variance (ANOVA)
• Understand the appropriate use of parametric (eg, t-test, ANOVA) versus non-parametric (eg, Mann-Whitney U, Wilcoxon) statistical tests
• Interpret the results of chi-square tests
• Interpret the results of t-tests
• Understand the appropriate use of a paired and non-paired t-test
• Determine the appropriate use of a 1- versus 2-tailed test of significance
• Interpret a p-value
• Interpret a p-value when multiple comparisons have been made
• Interpret a confidence interval
• Identify a type I error
• Identify a type II error
E. Measurement of association
• Differentiate relative risk reduction from absolute risk reduction
• Calculate and interpret a relative risk
• Calculate and interpret an odds ratio
• Interpret a hazard ratio
• Understand the uses and limitations of a correlation coefficient
F. Regression
• Identify when to apply regression analysis (eg, linear, logistic)
• Interpret a regression analysis (eg, linear, logistic)
• Identify when to apply survival analysis (eg, Kaplan-Meier)
• Interpret a survival analysis (eg, Kaplan-Meier)
G. Diagnostic tests
• Recognize the importance of an independent "gold standard" in
evaluating a diagnostic test
• Calculate and interpret sensitivity and specificity
• Calculate and interpret positive and negative predictive values
• Understand how disease prevalence affects the positive and negative
predictive value of a test
• Calculate and interpret likelihood ratios
• Interpret a receiver operator characteristic curve
• Interpret and apply a clinical prediction rule
• Systematic reviews and meta-analysis
• Understand the purpose of a systematic review
• Understand the advantages of adding a meta-analysis to a systematic review
• Interpret the results of a meta-analysis
• Identify the limitations of a systematic review
• Identify the limitations of a meta-analysis
Principles of epidemiology and clinical research design
A. Study types
• Distinguish between Phase I, II, III, and IV clinical trials
• Recognize a retrospective study
• Understand the strengths and limitations of retrospective studies
• Recognize a case series
• Understand the strengths and limitations of case series
• Recognize a cross-sectional study
• Understand the strengths and limitations of cross-sectional studies
• Recognize a case-control study
• Understand the strengths and limitations of case-control studies
• Recognize a longitudinal study
• Understand the strengths and limitations of longitudinal studies
• Recognize a cohort study
• Understand the strengths and limitations of cohort studies
• Recognize a randomized-controlled study
• Understand the strengths and limitations of randomized-controlled studies
• Recognize a before-after study
• Understand the strengths and limitations of before-after studies
• Recognize a crossover study
• Understand the strengths and limitations of crossover studies
• Recognize an open-label study
• Understand the strengths and limitations of open-label studies
• Recognize a post-hoc analysis
• Understand the strengths and limitations of post-hoc analyses
• Recognize a subgroup analysis
• Understand the strengths and limitations of subgroup analyses
B. Bias and confounding
• Understand how bias affects the validity of results
• Understand how confounding affects the validity of results
• Identify common strategies in study design to avoid or reduce bias
• Identify common strategies in study design to avoid or reduce confounding
• Understand how study results may differ between distinct subpopulations (effect modification)
C. Causation
• Understand the difference between association and causation
• Identify factors that strengthen causal inference in observational studies (eg, temporal sequence, dose response, repetition in a different population, consistency with other studies, biologic plausibility)
D. Incidence and prevalence
• Distinguish disease incidence from disease prevalence
E. Screening
• Understand factors that affect the rationale for screening for a condition or disease (eg, prevalence, test accuracy, risk-benefit, disease burden, presence of a presymptomatic state)
F. Decision analysis
• Understand the strengths and limitations of decision analyses
• Interpret a decision analysis
G. Cost-benefit, cost-effectiveness, and outcomes
• Differentiate cost-benefit from cost-effectiveness analysis
• Understand how quality-adjusted life years are used in cost analyses
• Understand the multiple perspectives (eg, of an individual, payor, society) that influence interpretation of cost-benefit and costeffectiveness analyses
H. Sensitivity analysis
• Understand the strengths and limitations of sensitivity analysis
• Interpret the results of sensitivity analysis
I. Measurement
• Understand the types of validity that relate to measurement (eg, face, construct, criterion, predictive, content)
• Distinguish validity from reliability
• Distinguish internal from external validity
• Distinguish accuracy from precision
• Understand and interpret measurements of interobserver reliability (eg, kappa)
• Understand and interpret Cronbach alpha
Applying research to clinical practice
A. Assessment of study design, performance, and analysis (internal validity)
• Recognize when appropriate control groups have been selected for a case-control study
• Recognize when appropriate control groups have been selected for a cohort study
• Recognize the use and limitations of surrogate endpoints
• Understand the use of intent-to-treat analysis
• Understand how sample size affects the power of a study
• Understand how sample size may limit the ability to detect adverse events
• Understand how to calculate an adequate sample size for a controlled trial (eg, clinically meaningful difference, variability in measurement, choice of alpha and beta)
B. Assessment of generalizability (external validity)
• Identify factors that contribute to or jeopardize generalizability
• Understand how non-representative samples can bias results
• Assess how the data source (eg, diaries, billing data, discharge diagnostic code) may affect study results
C. Application of information for patient care
• Estimate the post-test probability of a disease, given the pretest probability of the disease and the likelihood ratio for the test
• Calculate absolute risk reduction
• Calculate and interpret the number-needed-to-treat
• Distinguish statistical significance from clinical importance
D. Using the medical literature
• Given the need for specific clinical information, identify a clear, structured, searchable clinical question
• Identify the study design most likely to yield valid information about the accuracy of a diagnostic test
• Identify the study design most likely to yield valid information about the benefits and/or harms of an intervention
• Identify the study design most likely to yield valid information about the prognosis of a condition
Principles of teaching and learning
A. Educational theory
• Understand the basic principles of adult learning theory (eg, adult learners are self-directed, goal-oriented, practical; need to feel respected, build on life experiences; learn best when learning is based on an existing framework)
• Understand the attributes of an effective learning environment
• Understand the importance of "reflective practice" in teaching and learning
• Identify strategies that motivate learners
• Recognize the impact of the "hidden curriculum" on learning
B. Feedback and evaluation
• Identify components of effective feedback
• Distinguish between formative and summative feedback
• Distinguish between evaluation and feedback
• Understand the strengths and weaknesses of various methods to evaluate learners
C. Teaching methods
• Understand the strengths and weaknesses of various teaching methods (eg, lecture, small group discussion, bedside teaching, simulation)
• Understand that individuals may learn more effectively with certain teaching methods (eg, reading, hearing, doing) than with others
D. Educational planning
• Understand the role of needs assessment in educational planning
• Distinguish between goals and learning objectives
• Identify components of well-formulated learning objectives
• Recognize the strengths and weaknesses of various educational outcome measures (eg, participant satisfaction, acquisition of knowledge and skills, behavioral change, patient outcomes)
Ethics in research
A. Conflicts of interest and commitment
• Evaluate whether an investigator has a conflict of interest during the course of a study
• Understand ways to manage a conflict of interest
• Understand what constitutes a conflict of commitment
B. Professionalism and misconduct in research
• Identify forms of research misconduct (eg, plagiarism, fabrication, falsification)
• Differentiate honest error and differences of opinion from research misconduct
• Understand the criteria for authorship of clinical research publications
C. Principles of research with human subjects
• Understand and apply the three main principles of research ethics articulated in the Belmont Report (eg, respect for persons, beneficence, and justice)
• Understand the role of analysis of risks and benefits in the ethical conduct of research
• Understand the federal regulatory definitions regarding which activities are considered research
• Understand the federal regulatory definitions regarding when research includes the use of human subjects
• Understand the federal regulatory definition of minimal risk
• Understand the functions of an Institutional Review Board
• Understand when an exemption from review by the Institutional Review Board is permissible
• Understand the functions of a Data Safety Monitoring Board
• Understand the importance of clinical equipoise in research with human subjects
• Understand the impact of "therapeutic misconception" on clinical research with human subjects
• Understand the ethical considerations of study design (eg, placebo, harm of intervention, deception, flawed design)
D. Principles of consent and assent
• Understand what constitutes informed consent in research
• Understand how undue influence can affect obtaining consent for research
• Understand how coercion can affect obtaining consent for research
• Understand the special ethical considerations related to research utilizing children because of their inability to give informed consent
• Distinguish among consent, assent, and permission in research involving children
E. Vulnerable populations
• Recognize that the definition of "children" is related to the underlying clinical intervention in the jurisdiction in which the child is located rather than a fixed nationwide notion of age
• Recognize the types of protections that might be accorded to vulnerable populations (eg, incarcerated individuals, pregnant women, fetuses, children, mentally disabled individuals, educationally or economically disadvantage individuals)
• Understand the concept of minimal risk as it applies to research involving children
• Understand the circumstances under which research that involves children and that entails greater than minimal risk may be permissible Biostatistics, Research Methodology and Clinical Epidemiology
Ethics
Medico legal aspects relevant to the discipline
Health Policy issues as may be applicable to the discipline
V. COMPETENCIES
1. Be able to perform a reliable and appropriate examination
2. Be able to examine children in an appropriate manner
3. Behaviours Respect patients' dignity and confidentiality
4. Acknowledge cultural issues
5. Involve relatives appropriately
6. Appreciate the need for a chaperone
VI. LOG BOOK
A candidate shall maintain a log book of operations (assisted / performed) during the training period, certified by the concerned post graduate teacher / Head of the department/ senior consultant.
This log book shall be made available to the board of examiners for their perusal at the time of the final examination.
The log book should show evidence that the before mentioned subjects were covered (with dates and the name of teacher(s) The candidate will maintain the record of all academic activities undertaken by him/her in log book.
1. Personal profile of the candidate
2. Educational qualification/Professional data
3. Record of case histories
4. Procedures learnt
5. Record of case Demonstration/Presentations
6. Every candidate, at the time of practical examination, will be required to produce performance record (log book) containing details of the work done by him/her during the entire period of training as per requirements of the log book. It should be duly certified by the supervisor as work done by the candidate and countersigned by the administrative Head of the Institution.
7. In the absence of production of log book, the result will not be declared.
VII. RECOMMENDED TEXT BOOKS AND JOURNALS
BOOKS
• Moss & Adams' Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult
• Pediatric Cardiology - Springer
• Nadas' Pediatric Cardiology -
• Pediatric Cardiology and Cardiovascular Surgery:
• Elsevier: Park's The Pediatric Cardiology Handbook, 5th Edition: Park
• How to Read Pediatric ECGs - 9780323035705 | US Elsevier Healt
• Fundamentals of Pediatric Cardiology: David J Driscoll MD
• Pediatric Cardiovascular Medicine, 2nd Edition
• James H. Moller (Editor), Julien I. E. Hoffman (Editor)
• Concise Guide to Pediatric Arrhythmias by Christopher Wren
• Pediatric Cardiology Board Review, 2e By Benjamin W. Eidem, Bryan C. Cannon, Anthony C. Chang, Frank Cetta and Jonathan N. Johnson
• Practical Pediatric Cardiology
• Case-Based Management of Potential Pitfalls
• Editors: Magee, Alan G., Till, Jan, Seale, Anna N. (Eds.)
• Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care
• Editors: da Cruz, Eduardo, Ivy, Dunbar, Jaggers, James (Ed
• IAP Specialty Series on Pediatric Cardiology
• Pediatric Practice: Cardiology
• Marie Murphy Gleason, Jack Rychik, Robert Shaddy
• Pediatric Cardiology: Requisites (Requisites in Pediatrics) 1st Edition
• by Victoria L. Vetter
• Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult, 2nd Edition
• Wyman W. Lai, Luc L. Mertens, Meryl S. Cohen, Tal Geva
• Pediatric ECG Interpretation: An Illustrative Guide
• Barbara J. Deal, M.D., Christopher L. Johnsrude, M.D., Scott H. Buck, M.D.
• Congenital Diseases of the Heart: Clinical-Physiological Considerations, 3rd Edition
• Abraham Rudolph
• Illustrated FIELD GUIDE to Congenital Heart Disease and Repair
• Fundamentals of Pediatric Cardiology David J Driscoll MD
• By Allen D. Everett and D. Scott Lim, MD New
• • Insight in Pediatric Cardiology: From Basic to Therapeutics by Giuseppe Santoro, Giuseppe Pacileo, Maria Giovanna Russo
• The Science and Practice of Pediatric Cardiology Hardcover – Import, 1 Jan 1998 by Arthur Garson (Editor), etc. (Editor), Jonathan Pin
• Manual of Pediatric Cardiac Intensive Care – 2012 by Luthra (Author)
JOURNALS
• Pediatric Cardiology
• Progress in Pediatric Cardiology
• Annals of Pediatric Cardiology
• Cardiology in the Young | Cambridge Core
• Congenital Heart Disease and Pediatric Cardiology
• Progress in Pediatric Cardiology World Journal for Pediatric and Congenital Heart Surgery
