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