Paediatric Cardiology: Post CSCST Training in

Post CSCST TRAINING IN
PAEDIATRIC CARDIOLOGY
© Royal College of Physicians of Ireland, 2017 1

T his cu rr i cul um o f t r ain ing in 2 0 17 und e r the sp e ci a lt y of G en er a l P aed i atr i cs
w as dev elo pe d in 20 17 and und er go es an annu al r ev i ew b y th e S ubj e ct M atte r
E xp ert C ol in M c M ah on , D r An n O ’ S ha ugh ne ss y, He ad of E du c ati on, I n nov at ion
& R es e ar ch and b y t h e T ra in ing C om mitt e e . T he cu r ri cu lum i s a pprov ed b y th e
Fa cult y of P a edi at ri c s o f Ro ya l Co ll eg e o f P h ys ic ia ns of I r el an d .
Version Date Published Last Edited By Version Comments

0.0 01/07/2017 Ann Coughlan New curriculum

2017 Post CSCST Curriculum Table of Contents
Table of Contents
Introduction ............................................................................................................................................ 5
Recruitment and Selection.................................................................................................................. 5
Duration and Organisation of Training ............................................................................................... 5
Training Programme ........................................................................................................................... 5
Trainee Numbers ................................................................................................................................ 5
ePortfolio ............................................................................................................................................ 6
Programme Management ................................................................................................................... 6
Specialty Section ..................................................................................................................................... 7
Growth and Nutrition ......................................................................................................................... 8
Lifestyle ............................................................................................................................................... 9
Evaluation of a Child with a Cardiac Murmur ................................................................................... 10
Evaluation of the child with Chest Pain, Palpitations or Syncope .................................................... 11
Arrhythmias ...................................................................................................................................... 13
Cardiovascular Collapse in Infancy.................................................................................................... 15
Cardiac Failure in Infants and Children ............................................................................................. 16
Acyanotic Congenital Heart Disease throughout Childhood ............................................................ 17
Cyanotic Heart Disease in the Newborn Period................................................................................ 18
Cyanotic Heart Disease beyond the Newborn Period ...................................................................... 19
Practical Procedures and Investigations ........................................................................................... 21
Chest X-Ray ....................................................................................................................................... 22
Transthoracic Echocardiography ...................................................................................................... 23
Ambulatory ECG and External Cardiac Loop Recorder ..................................................................... 25
Ambulatory Blood Pressure .............................................................................................................. 26
Exercise Tests .................................................................................................................................... 27
ECG with Adenosine Challenge ......................................................................................................... 28
Tilt Table Testing ............................................................................................................................... 29
Cardiac Pacing ................................................................................................................................... 30
Cardiovascular evaluation of the child with features of a syndrome or genetic condition.............. 31
Cardiac Evaluation of a Child with Stridor ........................................................................................ 33
Cardiac Evaluation of a Child with Systemic Hypertension .............................................................. 34
Cardiomyopathy and Myocarditis..................................................................................................... 35
Inflammatory Cardiovascular Disease .............................................................................................. 36
Prevention and Management of Infective Endocarditis ................................................................... 37
Management of Critically Ill Children with Cardiovascular Compromise ......................................... 38

2017 Post CSCST Curriculum Table of Contents
Cardiovascular Abnormalities in Neonatal Intensive Care ............................................................... 39

Immunisation and Immunity............................................................................................................. 40
Pulmonary Hypertension .................................................................................................................. 41
Assessment of Children with Cardiac Disease Prior to Non-Cardiac Surgery ................................... 42
Minimum Requirements ....................................................................................................................... 43

Paediatric Cardiology Post CSCST Curriculum Introduction
Introduction
The Post CSCST Fellowship in Paediatric Cardiology is a one year programme designed to dovetail
with the Higher Specialist Training programme in General Paediatrics. It takes into account the major
areas of competence required by the subspecialist in Paediatric Cardiology and will be supervised by
the Faculty of Paediatrics of the Royal College of Physicians in Ireland. Completion of this program will
ensure the knowledge and competencies in all areas of the curriculum, meeting international standards
for best practice and allowing candidates to practice as a subspecialist in Paediatric Cardiology
Applicants for the Post CSCST Fellowship in Paediatric Cardiology will have successfully completed
the RCPI Higher Specialist Training programme in General Paediatrics within two years of the start date
of the Post CSCST Fellowship programme.
Prior experience in Paediatric Cardiology during General Paediatrics training would be an advantage.
Recruitment and Selection

Post CSCST Fellowship training in Paediatric Cardiology will build on broad basic and early core
specialist training in General Paediatrics. This is in line with training models internationally. Selection of
candidates for Post CSCST Fellowship training in Paediatric Cardiology will be via a competitive
recruitment process coordinated by the relevant Training Body. Recruitment will follow similar timeline
where possible to HST recruitment and post will commence in July of each year (unless otherwise
specified).
Duration and Organisation of Training

The Post CSCST Fellowship in Paediatric Cardiology is a one year training programme designed to
dovetail with the Irish Higher Specialist Training programme in General Paediatrics. The curriculum is
competency-based, however it is anticipated that the candidate will complete training within one
year.
The curriculum takes into account the major areas of competence required by the subspecialist in
Paediatric Cardiology and will be supervised by the Faculty of Paediatrics of the Royal College of
Physicians in Ireland. Doctors who have successfully completed the RCPI Higher Specialist Training
programme in General Paediatrics and are within two years of completion will be deemed eligible to
apply for the Post CSCST Fellowship in Paediatric Cardiology Completion of this program will ensure
the knowledge and competencies in all areas of the curriculum, meeting international standards for
best practice and allowing candidates to practice as a subspecialist in Paediatric Cardiology
Training Programme
The training programme offered will provide opportunities to fulfil all the requirements of the curriculum
of training for Paediatric Cardiology in approved training hospitals. Each post within the programme will
have a named trainer/educational supervisor and the programme will be under the direction of the
Faculty of Paediatrics of the Royal College of Physicians in Ireland.
Trainee Numbers
It is expected that the Post CSCST Fellowship in Paediatric Cardiology will be awarded to one candidate
per year.

Paediatric Cardiology Post CSCST Curriculum Introduction
ePortfolio
The trainee will be required to keep their ePortfolio up to date and maintained throughout their
Fellowship training. The ePortfolio will be countersigned as appropriate by the Trainer to confirm the
satisfactory fulfilment of the required training experience and the acquisition of the competencies set
out in the Curriculum. This will remain the property of the Trainee and must be produced at the end
of year Evaluation meeting. At the end of year Evaluation, the ePortfolio will be examined. The results
of any assessments and reports by the named trainer/educational supervisor, together with other
material capable of confirming the trainee’s achievements, will be reviewed.
Programme Management
 Coordination of the training programme will lie with the Medical Training Department.
 The training year will usually run from July to July in line with HST programmes
 Annual evaluations will usually take place between April and June each year
 Each trainee will be registered to the ePortfolio and will be expected to fulfil all requirements
relating to the management of yearly training records
 Opportunities for audit and research may be available
 Each trainee will be issued with a training agreement on appointment to the training
programme and will be required to adhere to all policies and procedures relating to Post
CSCST Fellowships.

Paediatric Cardiology Post CSCST Curriculum Specialty Section
Specialty Section

Growth and Nutrition
Objective: To be able to recognise nutrition and growth problems related to congenital heart
disease and direct appropriate strategies to optimise nutritional intake and maximise growth
KNOWLEDGE
 The causes of growth failure in congenital heart disease

 How to manage fluid and calorie intake in children with cardiovascular disease
 Understand the principles of how to manage fluid balance after cardiac surgery
 The indications for supplementary feeding regimens including nasogastric tube feeds
 The indications for parenteral nutrition
 Understand the causes of chylothorax, be familiar with the investigations and management
within the specialist centre, including the role and ongoing supervision of a medium chain
triglyceride diet
 How drug therapy may affect appetite and biochemical homeostasis with consequent effects
on growth
 Know the complications of parenteral nutrition
SKILLS
 Understand the management of fluid intake and fluid balance around the time of cardiac
surgery
 Recognise failure to thrive and be able to identify cardiac and non-cardiac causes
 Identify iron deficiency in patients with cyanotic congenital heart disease
 Recognise the complications of long term nasogastric feeding regimens and the role of
specialist speech and language therapists
 Recognise the importance of nursing staff and dieticians in supervising and advising on
nutrition
 Provide information to parents about feeding regimes
 Institute and monitor feeding regimes in children with cardiac failure
 Identify when failure to thrive has not responded to optimising nutrition and make timely
referral to specialist cardiac team for decision regarding potential surgical intervention in
congenital heart disease patients.
 Appropriate referral to the dietetics department
ASSESSMENT & LEARNING METHODS

 DOPS - Fluid and electrolyte balance

Lifestyle
Objective: To know about, promote, and support lifestyle measures to minimise cardiovascular risk
KNOWLEDGE
 The lifestyle risk factors for adverse outcome in patients with cardiac conditions including:
o diet
o exercise
o social deprivation
o occupation
 The effect of obesity on health with particular relevance to cardiac conditions
 The effects of smoking on health with particular relevance to cardiac conditions
 The effects of illicit drugs and alcohol on health with particular relevance to cardiac
conditions
SKILLS
 Promote the importance of healthy lifestyle choices

 Recognise patients' current or emergent lifestyle factors or choices which may lead to
adverse health outcomes
 Raise and discuss issues of lifestyle with patients and their families to enable them to
understand and make healthy lifestyle choices
 Signpost support resources and involve other health professionals to help with lifestyle
changes where beneficial
 Suppress any display of personal judgment
 Appropriate referral to the dietetics department
 Present Health Promotion talk on prevention of childhood obesity

 Develop an Exercise Plan

Evaluation of a Child with a Cardiac Murmur

Objective: To be able to carry out specialist assessment and treatment of children with cardiac
murmurs
KNOWLEDGE
 The range and significance of symptoms associated with congenital and acquired diseases of
the cardiovascular system in all ages
 The physical signs that may be found on examination of the cardiovascular system and how
to interpret those findings
 The characteristic clinical features of different congenital cardiac defects
 The characteristic features of innocent murmurs
 Understand the likely concerns of parents of children who have been referred for evaluation
of a heart murmur
 Understand the limitations of echocardiography and the need to discuss cases with the
specialist cardiologist, when appropriate
SKILLS
 Obtain a relevant history and perform expert cardiac examination

 Discriminate innocent from pathological murmurs on examination
 Make a logical provisional diagnosis on the basis of physical examination
 Refine the provisional clinical diagnosis using ECG and CXR where appropriate
 Use echocardiography to accurately identify normal cardiac structure and function, or
recognise and identify abnormality
 Complete the assessment thoroughly and quickly
 Confidently diagnose normality and explain the meaning of an innocent murmur
 DOPS: Echocardiography
 Record of 400 echocardiograms (250 supervised)
 MiniCex:
 Identification Innocent murmur and normal
 Indications for echocardiogram

Evaluation of the child with Chest Pain, Palpitations or Syncope

Objective: To be able to carry out initial assessment and treatment of children and adolescents with
chest pain, palpitations, pre-syncope or syncope
KNOWLEDGE
 The cardiac and non-cardiac causes of loss of consciousness

 The clinical features that discriminate between arrhythmias, vasovagal syncope and seizures
in patients with loss of consciousness
 The clinical features that suggest an arrhythmia in patients with palpitations
 The causes of chest pain in childhood
 The clinical features that characterise the various causes of chest pain
 The range of structural heart disease that present with chest pain, palpitations or syncope
SKILLS
 The indications for an exercise test, ambulatory ECG, cardiac event recorder and tilt-table
test in the investigation of these conditions and know when these tests should be done
under the guidance of the specialist cardiac centre
 The role of genetic testing in families with possible or proven inherited congenital cardiac
conditions
 Take an appropriate detailed history, eliciting all information that may help discriminate
between cardiac and non-cardiac causes of chest pain, palpitations and syncope
 Make a logical provisional diagnosis on the basis of history and physical examination
 Identify features on the 12-lead ECG that suggest a substrate for an arrhythmia
 Identify ECG evidence of ischaemic heart disease and ventricular hypertrophy
 Use echocardiography to accurately identify normal cardiac structure and function and to
recognise and make a correct initial diagnosis of abnormality
 Make an appropriate plan for further investigation and follow-up
 Complete the assessment quickly in an outpatient setting
 Diagnose normality
 Institute and monitor appropriate treatment for arrhythmias and vasovagal syncope
 Explain the plan for further investigation and the reasons for this line of investigation in
terms understandable to the patient and parents
 Explain the likely diagnosis and its impact on lifestyle
 Provide reassurance where there is no organic cause for symptoms
 Refer appropriately to other specialties when a non-cardiac cause is likely
 DOPS:
o 12 Lead ECG
o Exercise testing
o Echocardiography

 Record of:
o 10 Exercise tests
o 400 Echocardiograms (250 supervised)
 MiniCex

Arrhythmias
Objective: To be able to carry out assessment and treatment of children and adolescents with
arrhythmias in liaison with the specialist cardiac centre
KNOWLEDGE
 The natural history, presentation and clinical features of common arrhythmias from foetus
to adolescent
 Know the mechanisms involved in the development of cardiac arrhythmias
 The genetic disorders associated with cardiac arrhythmias and indications for genetic
referral
 The types of structural heart disease and types of cardiac surgery associated with
arrhythmias
 The characteristic ECG findings of common tachyarrhythmias and bradyarrhythmias, and the
features suggesting risk of arrhythmia in the resting ECG
 The indications for exercise testing, ambulatory monitoring, and external loop ECG recording
 Understand the classification, mechanism of action, interactions, side effects,
contraindications and clinical use of antiarrhythmic drugs in paediatric patients
 Know the indications for DC cardioversion and defibrillation
SKILLS
 Take a history in a patient with palpitations, perform an expert examination and decide
whether an arrhythmia is likely
 Form an appropriate plan of further investigation in a patient with suspected arrhythmias
 Recognise and manage SVT from neonatal to adolescent life, in liaison with SSC or CCC
 Identify the type of arrhythmia present from a 12 lead ECG capturing a rhythm abnormality
 Interpret 24 hour and external loop ECG recordings, and know when to seek further help in
interpretation
 Supervise an exercise test and make an initial interpretation of the results
 Perform vagal manoeuvres, DC cardioversion, and defibrillation appropriately in the
emergency treatment of tachyarrhythmias
 Explain the rationale, side effects and risks of arrhythmia treatments (including expectant
approach) to patients and their families
 Explain the common arrhythmias and their associated risks to patients and their families
 Offer appropriate management options and warning signs to the patient and family
 Provide advice in respect of sports and exercise
 Identify possible inherited cardiac conditions and refer to specialist centre and clinical
geneticist
 Understand the importance of patient education in managing ongoing symptoms and
determining the most appropriate treatment for each individual
 Know limitations and when to refer to a specialist paediatric cardiologist for expert advice,
assessment, and management of arrhythmias
 Perform and interpret an ECG taken during an adenosine challenge

 Select the appropriate emergency treatments and be familiar with the longer term drug
treatments used by the specialist unit for common tachyarrhythmias
 DOPS:
o Vagal manoeuvres
o DC cardioversion
o Defibrillation
o ECG –adenosine challenge
 ACLS or APLS

Cardiovascular Collapse in Infancy

Objective: To be able to carry out preliminary specialist assessment and treatment of infants who
present with cardiovascular collapse
KNOWLEDGE
 The physiology of duct dependent systemic and pulmonary circulation
 The natural history, anatomy, physiology and clinical features of cardiac disorders that cause
collapse in infancy
 The cardiac causes of cardiovascular collapse and likely diagnoses on the basis of the timing
of presentation
 How to distinguish cardiac and non-cardiac causes of cardiovascular collapse
 The indications, contraindications, and side effects of prostaglandin E therapy for duct
dependent systemic and pulmonary circulation
 Know the impact of cardiovascular collapse on other organs
 The indications, limitations and risks of non-invasive and invasive investigation of infants
that present with collapse
 The ECG, CXR and echocardiographic findings in congenital heart disease presenting with
collapse in infancy
 Understand the principles of angiographic and haemodynamic assessment with cardiac
catheterisation for infants who present with collapse and congenital heart disease
 Know the role and risks of catheter intervention and surgery in congenital heart presenting
with collapse
SKILLS
 Take a relevant history and perform an appropriate examination
 Interpret ECG, CXR and blood results and appreciate their importance and limitations in
reaching a diagnosis
 Initiate prostaglandin E where appropriate and know how to monitor its effect and when to
alter the dose administered prior to transfer to SSC
 Recognise and respond appropriately to the urgency of the clinical situation
 Identify cardiovascular collapse and carry out or direct resuscitation, medical treatment
including high dependency care, and stabilisation prior to transfer to SSC
 Use echocardiography as an aid to recognising and/or making a provisional diagnosis of
abnormalities in cardiac structure or function associated with collapse in infancy
 Understand the difficulties in diagnosing some cardiac abnormalities on echocardiography
and to liaise with the SSC or CCC as appropriate.
 Identify where information is incomplete and refer appropriately for to SSC or CCC for
further investigation either by non-invasive imaging or cardiac catheterization

 DOPS
o Echocardiography
 ACLS/APLS

Cardiac Failure in Infants and Children

Objective: To be able to carry out preliminary specialist assessment and treatment of cardiac failure
in infants and children
KNOWLEDGE
 Physiology of cardiac failure caused by:
 Pressure overload
 Volume overload
 Restriction to inflow
 Reduced contractility
 Physiology of pulmonary oedema
 The natural history, anatomy, physiology and clinical features of disorders that cause cardiac
failure at different ages, from newborn to adult life
 The causes of cardiac failure and identify likely diagnoses on the basis of the timing of
presentation
 How to distinguish cardiac failure from other causes of increased respiratory effort
 The indications, contraindications, action and side-effects of drug treatment for cardiac
failure
 The ECG, CXR and key echocardiographic findings in cardiac disorders presenting with
cardiac failure
SKILLS
 Identify cardiac failure in paediatric patients throughout childhood.
 Make a provisional anatomical and physiological diagnosis of the cause of cardiac failure on
the basis of the clinical information and investigations, prior to referral to the specialist
centre
 Optimise nutrition and manage failure to thrive caused by cardiac failure
 Appreciate the role of cardiac nurses and cardiac community nurses in managing chronic
cardiac failure
 Interpret ECG, CXR and blood results and appreciate the importance and limitations of these
investigations in diagnosing cardiac failure and elucidating its underlying cause
 Use echocardiography to look for and/or provisionally diagnose abnormalities in cardiac
structure or function associated with cardiac failure in infants and children prior to timely
transfer to SSC or CCC.
 Identify where information is incomplete and refer appropriately to a SSC or CCC for further
investigation either by non-invasive imaging or cardiac catheterisation
 Institute appropriate drug therapy for cardiac failure and monitor its success and
complications

 DOPS: Echo

Acyanotic Congenital Heart Disease throughout Childhood

Objective: To be able to carry out preliminary specialist assessment and treatment of children with
acyanotic congenital heart disease
KNOWLEDGE
 The principal anatomy, physiology, epidemiology, natural history, associations, and genetic
implications of the main acyanotic congenital heart defects including:
o Atrial septal defect
o Ventricular septal defect
o Atrioventricular septal defect
o Patent arterial duct
o Aortopulmonary septal defect
o Pulmonary stenosis
o Aortic stenosis
o Coarctation of the aorta
o Interrupted aortic arch
o Hypoplastic left heart syndrome
 The impact of left to right shunts on pulmonary vascular resistance and the physiology of
Eisenmenger syndrome
 The nature and timing of clinical presentations and long term complications of the above
acyanotic congenital heart defects
 The key ECG, CXR and echocardiographic findings of the main lesions
 The national recommendations regarding the prevention and management of infective
endocarditis
 The indications, limitations and risks of non-invasive and invasive investigation
 The principles of angiographic and haemodynamic assessment by cardiac catheterisation
 The range of surgical and catheter intervention treatment options including their main
advantages and success rates, disadvantages and complications
 The normal course of postoperative recovery and potential complications after surgery for
the main lesions
SKILLS
 Make a provisional diagnosis and discriminate between acyanotic defects on the basis of
presentation, clinical findings, ECG and CXR
 Use transthoracic echocardiography to make a provisional diagnosis of acyanotic defects and
to define their main anatomical and physiological characteristics

 DOPS: Transthoracic echo

Cyanotic Heart Disease in the Newborn Period

Objective: To be able to carry out initial preliminary specialist assessment and treatment of cyanotic
newborn
KNOWLEDGE
 The physiology of cyanosis caused by:
o Right heart obstruction with right to left shunting
o Parallel circulation
o Common mixing lesions
 Understand the physiology of duct dependent pulmonary circulation
 The natural history, anatomy, physiology and clinical features of congenital heart disease
causing cyanosis in the newborn period
 How to distinguish cardiac and non-cardiac causes of cyanosis in the newborn period
 The indications, limitations and risks non-invasive and invasive investigation in newborns
 The ECG, CXR and echocardiographic findings for the main cyanotic lesions presenting in
infancy
 The indications, contraindications, and side effects of prostaglandin E therapy for duct
dependent pulmonary circulation
 The role and risks of catheter intervention and surgery in congenital heart disease
presenting with cyanosis in the newborn period
 Understand the principles of angiographic and haemodynamic assessment by cardiac
catheterisation for neonates who present with cyanosis and congenital heart disease
SKILLS

 Interpret ECG, CXR and blood results and appreciate their importance and limitations in
reaching a diagnosis
 Make an initial anatomical and physiological diagnosis on the basis of the clinical information
and investigations
 Initiate prostaglandin E where appropriate and know how to monitor its effect and when to
alter the dose administered
 Use echocardiography to recognise and/or provisionally diagnose major abnormalities in
cardiac structure or function associated with cyanosis in the newborn period, and recognise
when further specialist assessment is essential
 Identify where information is incomplete and refer appropriately to a SSC or CCC for further
non-invasive or invasive imaging.
 DOPS
 Echo

Cyanotic Heart Disease beyond the Newborn Period

Objective: To be able to carry out preliminary specialist assessment and treatment of children,
adolescents and adults with cyanotic congenital heart disease
KNOWLEDGE
 The principal anatomy, physiology, epidemiology, natural history, associations and genetic
implications of the main cyanotic congenital heart defects including:
o Pulmonary atresia with intact ventricular septum
o Pulmonary atresia with ventricular septal defect
o Critical pulmonary stenosis
o Tetralogy of Fallot
o Absent pulmonary valve syndrome
o Transposition of the great arteries with intact ventricular septum
o Transposition of the great arteries with ventricular septal defect
o Double outlet right ventricle
o Common arterial trunk
o Total anomalous pulmonary venous connection
o Univentricular atrioventricular connection
o Complex congenital heart disease associated with abnormalities of cardiac position
and situs
 Know the nature and timing of clinical presentations and long term complications of the
above
 The indications, limitations and risks of non-invasive and invasive investigation
 Understand the principles of angiographic and haemodynamic assessment by cardiac
catheterisation for patients with cyanotic congenital heart disease
 Know the normal course of postoperative recovery after surgery for each type of cyanotic
cardiac defect
 The ECG, CXR and echocardiographic findings in patients with cyanotic congenital heart
disease
 The range of surgical and catheter intervention treatment options for cyanotic cardiac
defects including their main advantages and success rates, disadvantages and complications
SKILLS
 Make a provisional diagnosis and discriminate between the various cyanotic defects on the
basis of presentation, clinical findings, ECG and CXR
 Provide first line emergency treatment for cyanotic spells and liaise with the specialist centre
about further management
 Identify when there is cyanosis combined with cardiac failure and initiate medical treatment
when necessary
 Appreciate the concerns and anxiety of parents and other family members
 Liaise with the SSC or CCC for advice and/or evaluation when necessary
 Communicate effectively with the with SSC or CCC for the joint management of patients

 Use transthoracic echocardiography to make an initial diagnosis of cyanotic defects and to

define their main anatomical and physiological characteristics
 Recognise the wider management issues in children with complex cyanotic defects or
syndromes and cooperate with other specialties
 The key anatomical and physiological requirements necessary for a child to tolerate a
cavopulmonary circulation
 The key principles of the management of a cavopulmonary circulations in the postoperative
period
 Recognise where there may be a failing cavopulmonary circulation requiring urgent SSC or
CCC assessment
 Recognise where there may be a failed or failing systemic to pulmonary shunt requiring
urgent SSC or CCC assessment
 Recognise the additional stress on parents when their child cannot undergo corrective
surgery
 Recognise the need for close support of the family when the child has to undergo multiple
procedures
 Recognise when oxygen saturation are inappropriately low in the setting of a cavopulmonary
circulation or systemic to pulmonary shunt
 Make a clinical assessment, including transthoracic echocardiography, to identify key
reasons for failure of a cavopulmonary circulation or systemic to pulmonary artery shunt
 DOPS
o Transthoracic echography

Practical Procedures and Investigations

12 Lead Electrocardiogram (ECG)
Objective: To be able to carry out and interpret the 12 lead ECG throughout childhood
KNOWLEDGE
 The principles of electrophysiology relating to the production of the ECG and limitations of
the ECG and of differing ECG machines
 The standard lead placement for paediatric ECG recording and lead placement for
dextrocardia
 Age related changes in ECG wave forms
 How to evaluate rhythm, hypertrophy, ischaemia, injury and infarction on ECG
 The features of ECG produced using epicardial pacing wires
SKILLS
 Perform a 12 lead ECG with accurate lead placement appropriate to the age of the child
 Interpret ECG in relation to age related changes
 Recognise and interpret abnormal QRS axis, atrial enlargement, normal and abnormal
patterns of atrial depolarisation, ventricular hypertrophy, normal and abnormal patterns of
ventricular depolarisation, normal and abnormal ventricular repolarisation, bundle branch
block, heart block, pre-excitation and tachyarrhythmias on the ECG
 DOPS
o Perform and interpret ECG
 Mini Cex
 Record 300 ECGs

Chest X-Ray
Objective: To be able to interpret a CXR to assist diagnosis and assessment of cardiac conditions
throughout childhood
KNOWLEDGE
 The principles and practice of radiation protection

 The classical abnormalities in cardiac silhouette produced by congenital heart defects
 The characteristic CXR appearances of high and low pulmonary blood flow, pulmonary
oedema and pulmonary vascular disease with pulmonary hypertension
 Know the limitations of the CXR in diagnosing and assessing congenital heart disease
SKILLS
 Diagnose abnormalities in cardiac position and identify when great artery arrangement is
abnormal on CXR
 Interpret patterns of pulmonary vasculature on CXR
 Recognise lung pathology on CXR
 Use information on the CXR to assist in making an anatomical and physiological diagnosis in
congenital heart disease
 DOPS
o CXR
o Interpret 40 CXR

Transthoracic Echocardiography
Objective: To be able to perform transthoracic echocardiography throughout childhood to diagnose
and assess the common forms of congenital and acquired heart disease and recognise where further
more expert assessment is essential
It is recognised that achieving these objectives to a full level of competence will not occur during a
single year. It is essential that this competency is formally assessed during training across the range
of structural and functional heart conditions. (Standards for this assessment are detailed in Appendix
1, Section 4.3). Focused continued professional development will be required and formal accreditation
is strongly recommended. Currently, the only individual certification pathway and revalidation
pathway is via the European route under the auspices of the European Association of
Echocardiography and endorsed by the Association of European paediatric cardiology (AEPC) and
European society of cardiology (ESC). Ongoing regular personal audit and peer review of practice
throughout the doctor's career will be necessary. It is essential that an awareness of personal
limitations and confidence to seek review of findings is maintained and that the implications of a
failure to recognise important abnormality are appreciated.
Trainees and practitioners should recognise that the performance of non-contributory

echocardiography should never lead to a delay in obtaining specialist advice or arranging specialist
transfer when indicated.
KNOWLEDGE
 The physics of 2 dimensional echocardiography, colour Doppler and spectral Doppler

 The factors determining image quality and resolution
 The function of the controls on machines used for echocardiography and Doppler
 The key echocardiographic characteristics of the most commonly encountered congenital
heart defects and how to assess the physiology of shunting defects
 Be aware of the limitations of echocardiography and Doppler
 How to assess valve stenosis and regurgitation
 The commonly used indices of ventricular function
 How to relate the measurements of cardiac structures to body size by indexation or z-scores
 Understand the role of advanced echocardiography techniques (e.g. 3D and 4D, tissue
tracking)
 Understand the practice, indications and limitations of echo-contrast studies
SKILLS
 Perform echocardiography to assist the specialist cardiologist during visiting clinics
 Schedule cases for review and audit of echocardiographic assessment
 Develop and work within guidance regarding the range of appropriate cases agreed with the
specialist centre
 Interpret the significance and reliability of the information obtained by echocardiography
 Demonstrate ability to work with and share expertise mutually with echocardiography
technicians

 DOPS
o Echocardiograpy
 ECHO Course (EAE course)
 EAE Certification exam

Ambulatory ECG and External Cardiac Loop Recorder

Objective: To be able to request and interpret the results of ambulatory ECG and external cardiac
loop recording appropriately in the diagnosis and assessment of children with cardiac conditions
KNOWLEDGE
 The indications for an ambulatory ECG and external cardiac loop recorder
 The normal range of findings on a paediatric 24 hour ECG
 Understand the limitations of these non-invasive ECG investigations
SKILLS
 Scan the results of these investigations select appropriate highlights and produce an
accurate report
 Interpret the results in the clinical context
 DOPS
o Interpret and perform ambulatory ECG
 Record 300 number of ambulatory ECGs

Ambulatory Blood Pressure

Objective: To be able to request and interpret the results of ambulatory blood pressure monitoring
appropriately in the diagnosis, assessment and surveillance of children with cardiac conditions
KNOWLEDGE
 The indications for an ambulatory blood pressure monitoring

 The normal range of blood pressure and variation throughout the daily cycle
 Understand the limitations of ambulatory blood pressure monitoring
SKILLS
 Interpret the results in the clinical context
 DOPS
o Interpret ambulatory blood pressure monitoring

Exercise Tests
Objective: To be able to carry out and interpret exercise tests appropriately in the diagnosis and
assessment of children with cardiac conditions
KNOWLEDGE
 The physiology of cardiovascular response to exercise

 The contraindications and age limitations to exercise testing in children
 The methodology of a treadmill (exercise) test
 The normal heart rate and blood pressure responses to exercise
 Be aware of the sensitivity, specificity and predictive accuracy of exercise ECG
 Understand the limitations of exercise testing in children
SKILLS
 Interpret changes in the ECG during the exercise test

 Interpret changes in heart rate, blood pressure and oxygen saturation during an exercise test
 DOPS
o Perform and interpret exercise tests
 Record 10 exercise tests

ECG with Adenosine Challenge

Objective: To be able to safely carry out and interpret an ECG taken during an adenosine challenge
KNOWLEDGE
 Know the indications for and possible interpretations of adenosine challenges during
tachycardias
SKILLS
 Acquire an ECG during an adenosine challenge with appropriate monitoring and

resuscitation equipment available
 Provide explanation to patients and parents about the effect of adenosine administration
 Diagnose the mechanism of an arrhythmia based on the result of the adenosine challenge
 DOPS
o Perform adenosine challenge ECG
 Record 5 adenosine challenge ECGs

Tilt Table Testing

Objective: To understand the role, principles, practice, and limitations of tilt table testing in patients
with syncope
KNOWLEDGE
 The physiological principles of tilt table testing

 The indications for tilt table testing
 The methodology of tilt table testing
 The risk and limitations, sensitivity and specificity of tilt table testing
SKILLS
 Refer for tilt table testing appropriately and with a clear objective
 Make an initial interpretation of the findings of a tilt table test
 DOPS
 DOPS
o DC cardioversion
 Record of 1 DC cardioversion
 ACLS/APLS

Cardiac Pacing
Objective: To understand the principles of temporary and permanent pacing and pacemaker
monitoring
KNOWLEDGE
 Basic electrophysiology and cardiac anatomy relevant to pacing

 The indications for temporary and permanent pacing
 The problems, limitations, and complications of pacing and pacemaker dysfunction
 About the potential psychosocial impact of requiring a pacemaker on children and their
families
 The main types of pacing, the nomenclature and key features of the surface ECG
 The principles of monitoring, interrogating and programming pacemakers
SKILLS
 Be able to recognize appropriate and non-functioning pacing on the surface ECG
 ECG Course
 DOPS
o Interpret non-functioning pacing on ECG
 Attend 3 pacing clinics

Cardiovascular evaluation of the child with features of a syndrome or genetic

condition
Objective: To be able to carry out cardiac assessment and treatment of children with genetic
disorders and syndromes in liaison with the specialist centre team
KNOWLEDGE
 Know the main cardiac abnormalities found in common genetic disorders and syndromes
including:
o Trisomy 21 (Down syndrome)
o Trisomy 18 (Edwards Syndrome)
o Trisomy 13 (Patau syndrome)
o Monosomy XO (Turner syndrome)
o Noonan syndrome
o Williams syndrome
o Alagille syndrome
o Marfan syndrome
o 22q11 deletion
o CHARGE association
o VACTERL association
o Inherited arrhythmias including channelopathies
SKILLS
 Be aware of the main cardiac abnormalities found in less common genetic disorders and
syndromes including:
o Storage diseases
o Neuromuscular diseases
o Mitochondrial cytopathies
o Hyperlipidaemias
o Inherited Cardiomyopathies
 Know the prognosis of genetic syndromes and their associated cardiac disorders
 Understand the importance and practice of screening for cardiac conditions with a genetic
basis
 Be aware of the importance of fetal cardiology review for future pregnancies
 Recognise the importance of the multidisciplinary team in the management of patients in
this group
 Recognise the impact of other features of the genetic disorder or syndrome on cardiac
management
 Be willing to discuss the possibility of recurrence of the cardiac disorder in subsequent
children whilst recognising the role of the clinical geneticist in expert counselling of parents
about recurrence
 Use transthoracic echocardiography to screen, recognise and/or diagnose specific
abnormalities in cardiac structure or function related to genetic disorders and syndromes

 DOPS
o Transthoracic echography
 Record of 250 Transthoracic echocardiography

Cardiac Evaluation of a Child with Stridor
Objective: To be able to carry out preliminary specialist cardiac assessment of children with stridor
and know when it is appropriate to refer to the specialist cardiac centre for further evaluation or
treatment
KNOWLEDGE
 The embryology, anatomy and natural history of vascular rings and slings and their
association with additional lung pathology
 How to distinguish the cardiac and non-cardiac causes of stridor throughout childhood
 The limitations of transthoracic echocardiography in the identification of vascular rings
 The role and features of vascular rings and slings on CXR, barium swallow, and bronchoscopy
 The role and key features of vascular rings and slings on angiography and MRI
 The role of surgery and main surgical options for release of rings and slings
 Understand the transthoracic echocardiographic findings specific to vascular rings and slings
SKILLS
 Discuss the main causes, natural history and management of stridor with parents, offering
reassurance or referral to the specialist centre as appropriate
 Be aware of the role of thoracic surgeons in children with associated lung abnormalities
 Undertake initial transthoracic echocardiography with the aim of positively identifying the
presence of vascular rings and slings to aid discussion and planning with specialist centre
 Select patients who merit referral to specialist cardiac centre for further investigation by
advanced echocardiography, bronchoscopy, CT, angiography or MRI
 MiniCex

Cardiac Evaluation of a Child with Systemic Hypertension

Objective: To be able to carry out preliminary specialist cardiac assessment of children with
hypertension
KNOWLEDGE
 The physiology of blood pressure control and mechanisms of systemic hypertension

 The methods of single non-invasive and invasive blood pressure evaluation, their pitfalls and
limitations and the role of ambulatory blood pressure monitoring
 The references for normal ranges of blood pressure throughout childhood
 The clinical presentations of systemic hypertension including cardiac and extra-cardiac
symptoms and signs
 The therapeutic strategies for hypertension, their indications, advantages and disadvantages
 The importance of multidisciplinary team working (e.g. nephrology, ophthalmology,
neurology) liaison and the scope of cardiology within this team
SKILLS
 Perform accurate non-invasive blood pressure measurement

 Identify and monitor the cardiac causes and consequences of systemic hypertension using
electrocardiography (ECG) and transthoracic echocardiography
 Refer to other specialists for expert diagnosis and management in cases of systemic
hypertension
 Request additional non-cardiovascular investigations appropriately in the investigation of
systemic hypertension
 MiniCex

Cardiomyopathy and Myocarditis

cardiomyopathy and myocarditis
KNOWLEDGE
 The causes, physiology, pathology, natural history, prognosis and clinical features of
myocarditis
 The role of genetics in cases of cardiomyopathy and importance of working with the clinical
geneticist/inherited cardiovascular disease service
 The range of medical and surgical treatments available for patients with cardiomyopathy
and indications for referral
 Be aware of the available forms of circulatory support (LVAD, ECMO)
 Be aware of the role of cardiac transplantation in end-stage cardiomyopathy
SKILLS
 Be familiar with the main causes, physiology, pathology, natural history, prognosis, genetic
implications and clinical features of dilated, hypertrophic and restrictive cardiomyopathy
 Recognise features in the history and examination of myocarditis or cardiomyopathy
 Initiate management of cardiac failure and low cardiac output caused by myocarditis or
cardiomyopathy and liaise appropriately with the specialist cardiac centre regarding further
management
 Involve the genetics team where appropriate
 Show sensitivity in counselling parents with a child severely affected by cardiomyopathy
 Involve parents in decision making in planning management for end-stage cardiomyopathy
in consultation with the SSC or CCC.
 Carry out an initial diagnostic transthoracic echocardiographic evaluation of a child with
myocarditis or cardiomyopathy including assessment of cardiac function for discussion with
specialist centre
 Exclude conditions which may mimic cardiomyopathy including coronary artery assessment
 Recognise the likely prognosis given by the specialist centre and be able to discuss this with
the family if required
 Consider other aspects of disorders underlying the cardiomyopathy or other organs affected
in planning for treatment in end-stage cardiomyopathy
 MiniCex
 Study Day

Inflammatory Cardiovascular Disease

rheumatic fever, rheumatic heart disease, Kawasaki disease and other inflammatory diseases
affecting the cardiovascular system
KNOWLEDGE
 The pathology and natural history of rheumatic fever, Kawasaki disease and collagen
vascular disease affecting the cardiovascular system
 The cardiac and non-cardiac manifestations of these disorders
 The anatomical and echocardiographic features of these disorders
 The current recommendations for investigation and treatment of acute and chronic
Kawasaki disease
 The current recommended drug therapy for acute rheumatic fever and the long term
sequelae
 Understand the importance of primary and secondary prevention in rheumatic fever
SKILLS
 Recognise the clinical features of Kawasaki disease and carry out transthoracic
echocardiographic examination of the coronary arteries, maintaining an awareness of the
difficulties of such assessment and the importance of specialist centre opinion
 Initiate acute management for Kawasaki disease, and liaise with the specialist cardiac centre
regarding the long-term management and appropriate follow up programme.
 Be able to identify the features suggesting rheumatic heart disease on transthoracic
echocardiography prior to mandatory referral of such cases for specialist centre assessment
 Initiate the acute treatment for rheumatic fever and recognise the indications for referral to
the specialist cardiac centre for intervention or surgery in patients with rheumatic heart
disease
 Cooperate with other specialties in the investigation of collagen vascular diseases with
cardiovascular involvement
 Understand the indications for referral for specialist investigation including coronary
angiography in children with Kawasaki disease
 MiniCex

Prevention and Management of Infective Endocarditis

Objective: To be able to carry out preliminary specialist assessment and shared care management
of children with infective endocarditis and to be able to provide advice in respect of prevention of
endocarditis
KNOWLEDGE
 The epidemiology, pathophysiology, clinical manifestations, anatomical features, course and

prognosis of various types of infective endocarditis
 Which cardiac lesions have the highest risk of endocarditis
 The role of blood cultures, inflammatory markers, transthoracic echocardiography and
referral for transoesophageal echocardiography in the diagnosis of infective endocarditis
 The current recommended antibiotic regimes for endocarditis treatment in children
 The national guidance regarding endocarditis prophylaxis
 The indications for referral to specialist centre for consideration of surgical management for
patients who have acute valvular insufficiency secondary to endocarditis
 Understand the importance of close cooperation with microbiologists in diagnosing and
treating endocarditis
SKILLS
 Identify the cardiac and extra-cardiac manifestations of endocarditis

 Integrate clinical and laboratory findings to plan appropriate management
 Provide patient education in respect of minimising the risk of endocarditis
 Interpret blood results and recognise transthoracic echocardiographic manifestations of
endocarditis and appreciate their importance and limitations in reaching a diagnosis
 Provide support to colleagues and trainees investigating pyrexia of unknown origin
 Case Based Discussion

Management of Critically Ill Children with Cardiovascular Compromise
Objective: To be able to make an assessment and initiate treatment of children who are critically ill
with severe haemodynamic disturbance
KNOWLEDGE
 Understand the principles of oxygen supply and demand

 Understand the factors controlling cardiac output
 Understand compensatory mechanisms maintaining cardiovascular homeostasis
 Know the common causes of haemodynamic instability during childhood and know how to
differentiate sepsis, hypovolaemia, cardiac failure, cardiac tamponade and hypotension
secondary to cardiac rhythm disturbances
SKILLS
 Recognise the clinical signs of low cardiac output and the clinical signs of progression to
shock
 Recognise the biochemical markers of low cardiac output
 Use fluid management and inotropic support appropriately to optimise cardiac output and
tissue oxygen delivery
 Recognise the need for intensive care support for children with haemodynamic instability
and liaise with intensive care colleagues and specialist units as appropriate
 Communicate the findings of the cardiac assessment clearly and logically with colleagues
 Use transthoracic echocardiography to assist in determining the cause of haemodynamic
instability
 Attend intensive care unit

 MiniCex

Cardiovascular Abnormalities in Neonatal Intensive Care

Objective: To be able to carry out preliminary specialist assessment and advise on the treatment of
cardiovascular problems commonly arising in the context of neonatal intensive care. Understand the
physiology of fetal and transitional circulation
KNOWLEDGE
 The pathophysiology, clinical manifestations, echocardiographic features and treatment of

persistent pulmonary hypertension of the newborn (PPHN)
 The pathophysiology, clinical manifestations and echocardiographic features of patent
arterial duct in the preterm child
 The indications and advantages, risks and contraindications of medical and surgical
treatment of patent arterial duct in the preterm child
 Be familiar with published neonatal echocardiography standards documents
 Use transthoracic echocardiography to differentiate PPHN from congenital heart disease,
recognising the importance of specialist centre assessment in cases of doubt
 Use transthoracic echocardiography to aid exclusion of duct dependent systemic and
pulmonary circulation when assessing an infant with a patent arterial duct prior to referral
to the specialist centre
 Understand basic neonatal care and how sepsis, lung disease, neurological problems and
genetic issues influence cardiac management
SKILLS
 Identify probable congenital heart disease in premature and low birth weight infants and
make an initial management plan, including the likely and most appropriate timing of
transfer to specialist cardiac centre

Immunisation and Immunity

Objectives: To understand, practice and support accepted measures to prevent or minimise severity
of infection in children with cardiac conditions
KNOWLEDGE
 The indications for and timing of active and passive immunisation for children with cardiac
conditions (and their families where applicable) in addition to the routine immunisation
schedule
 Indications for prophylactic measures to minimise severe illness following infective
exposures
 The implications of primary and secondary immunodeficiency associated with cardiac
conditions or their treatment, and the potential impact on transfusion, immunisation, and
other prevention strategies
SKILLS
 Recognise which patients should receive additional immunisation and refer or organise this
appropriately
 Screen for primary immune deficiency and refer patients for immunology assessment and
advice when appropriate
 Advise patients, parents and other health professionals about the therapeutic and lifestyle
implications and risks of primary and secondary immune dysfunction
 Offer sound advice to patients and their families regarding the secondary effect of cardiac
therapies on immunity and immunisation

 Record of 5 immunizations for immune deficient asplenic/22q11 patients

Pulmonary Hypertension
Objective: To make a provisional diagnosis of pulmonary hypertension, be involved in shared care
follow up with the specialist cardiac centre, and understand the key management issues for patients
with pulmonary hypertension
KNOWLEDGE
 The main physiological and anatomical mechanisms associated with pulmonary

hypertension
 The congenital heart defects which may lead to or be associated with pulmonary
hypertension
 Physical signs of pulmonary hypertension
 Key features of pulmonary hypertension on ECG, CXR and echocardiography
 Understand the significance of pulmonary hypertension, either alone or in the context of
associated congenital heart disease
 The range of currently available medical and surgical treatments (including lung
transplantation) and their key advantages, limitations, and disadvantages
 Understand the principles of cardiac catheterisation in the diagnosis of pulmonary
hypertension
 To understand how to support and counsel parents and patients about severe incurable
disease
SKILLS
 Perform a complete history and physical examination to recognise the presence or evolution
of pulmonary hypertension
 Interpret ECG in the diagnosis and monitoring of pulmonary hypertension

 Perform echocardiography in the initial diagnosis of the key features of pulmonary
hypertension and to monitor basic progress and response to treatment to assist the dialogue
with specialist centre

 Attend 2 pulmonary hypertension clinics

Assessment of Children with Cardiac Disease Prior to Non-Cardiac Surgery

Objective: To be able to offer local cardiac support during an anaesthetic pre-operative assessment
of children with heart disease prior to non-cardiac surgery and either recommend further specialist
assessment or liaise with SSC/CCC to offer advise on their fitness and the appropriate location for
such surgery
KNOWLEDGE
 The cardiac disorders associated with high risk during general anaesthesia (for which surgery
and any preoperative assessment should be carried out in specialist cardiac centre)
 The role and limitations of play specialists and psychologists in preparing children for surgery
SKILLS
 Identify patients who are at increased risk from anaesthesia and recommend when
appropriate for anaesthetic to be carried out in setting of SSC/CCC as appropriate
 Select patients who require further investigation by ECG, CXR or echocardiography
 Answer questions from patients and their parents about the impact of their cardiac
condition on the safety of anaesthesia and surgery
 Obtain information which would allow determination of the physiology of the cardiac
abnormality and make an assessment of the potential cardiac considerations for anaesthetic
using ECG,
 CXR and echocardiography, and seek full discussion with SCC/CCC regarding any conclusions
 Liaise with the anaesthetist and surgeon with clear advice about the relevance of any cardiac
condition and ensure that the specialist paediatric cardiologist's advice has been sought
prior to consideration of any surgery or anaesthetic in high risk cases
 Liaise with specialist cardiologists to recommend an appropriate fluid regime and how
cardiac drugs are to be administered in the perioperative period
Case based Discussion

Paediatric Cardiology Post CSCST Curriculum Minimum Requirements
Minimum Requirements for Training Post CSCST Fellowship in Paediatric Cardiology

Post CSCST Fellowship in Paediatric Cardiology Minimum Requirements for Training
 These are minimum tracking requirements. This generally means that in practice, trainees will perform above the stated requirements; however, for
record tracking purpose, the following figures have been allocated.
 Where the minimum requirement state “1”, there is no allocated minimum – eLogbook will automatically default to “1”.
Minimum Form
Curriculum Requirement Required/Desirable Requirement Reporting Period Name
Section 1 - Training Plan
Training Programme
Weekly Timetable (Sample Weekly Timetable for Post/Clinical Attachment) Required 1 Form 045
Personal Goals Plan (Copy of agreed Training Plan for your current training year signed by both Training Programme
Trainee & Trainer) Required 1 Form 052
Training Programme
Personal Goals Review Form Desirable 1 Form 137
Training Programme
On Call Rota Required 1 Form 064
Section 2 - Training Activities
Outpatient Clinics
Training Programme
General paediatric clinics Required 80 Form 001
Training Programme
Pacing Clinics Required 3 Form 001
Training Programme
Pulmonary hypertension Required 2 Form 001
Ward Rounds/Consultations
Training Programme
Consultant Led (minimum 1 per week) Required 40 Form 002

Minimum Form
Training Programme
Consultations Required 40 Form 002
Emergencies/Complicated Cases Desirable 1 Training Programme Form 003
Procedures/Practical Skills/Surgical Skills
Echocardiography (250 supervised) Required 400 Training Programme Form 004
Transthoracic echo Required 250 Training Programme Form 004
Exercise testing Required 10 Training Programme Form 004
Interpret ECG (250 supervised) Required 300 Training Programme Form 004
Interpret CXR Required 40 Training Programme Form 004
Adenosine challenge ECG Required 5 Training Programme Form 004
Tilt table testing Required 10 Training Programme Form 004
DC cardioversion Required 1 Training Programme Form 004
Immunization for immune deficient asplenic/22q11 patients Required 5 Training Programme Form 004
Additional/Special Experience Gained Desirable 1 Training Programme Form 005
Relatively Unusual Cases Desirable 1 Training Programme Form 019
Chronic Cases/Long term care Desirable 1 Training Programme Form 066
ICU/CCU Cases Desirable 1 Training Programme Form 090
Management Experience Desirable 1 Training Programme Form 110
Section 3 - Educational Activities
Mandatory Courses
ACLS/APLS Required 1 Training Programme Form 006
ECHO course (EAE) Required 1 Training Programme Form 006
ECG course Required 1 Training Programme Form 006
Non – Mandatory Courses Desirable 1 Training Programme Form 007
Training Programme
Study Days (assist in conducting cardiology or echocardiography study days) Required 3 Form 008
Training Programme
National/International meetings (PECSIG, BCCA or AEPC) Required 1 Form 010
In-house activities

Minimum Form
Training Programme
Grand Rounds (minimum of 1 per month) Required 10 Form 011
Training Programme
Cardiology Meeting (average 1 per week) Required 40 Form 011
Training Programme
Other (minimum of 1 per month from the categories below: )
Training Programme
Journal Club Required 2 Form 011
Training Programme
Radiology Conferences Required 2 Form 011
Training Programme
Pathology Conferences Required 2 Form 011
Training Programme
MDT Meetings Required 2 Form 011
Training Programme
Seminar Required 2 Form 011
Training Programme
Lecture Required 1 Form 013
Examinations
EAE certification Required 1 Training Programme Form 012
Formal Teaching Activity minimum 1 formal teaching session per month from the categories
below:
Lecture
Tutorial
Bed side Teaching
Required 10 Training Programme Form 013
Research Activities Desirable 1 Training Programme Form 014
Training Programme
Audit or Quality improvement activities Required 1 Form 015
Training Programme
Clinical Audit Report form Required 1 Form 135
Training Programme
Publications Desirable 1 Form 016

Minimum Form
Training Programme
Presentations Required 1 Form 017
Training Programme
National/International meetings (minimum 1 per year) Required 1 Form 010
Committee Attendance Desirable 1 Training Programme Form 063
Additional Qualifications Desirable 1 Training Programme Form 065
Section 4 - Assessments
CBD Required 1 Year of Training Form 020
DOPS
Fluid and electrolyte balance Required 1 Training Programme Form 021
Echocardiography Required 1 Training Programme Form 021
Transthoracic echography Required 1 Training Programme Form 021
12 Lead ECG – perform and interpret Required 1 Training Programme Form 021
Exercise Testing Required 1 Training Programme Form 021
ECG – adenosine challenge Required 1 Training Programme Form 021
Vagal maneuvers Required 1 Training Programme Form 021
Defibrillation Required 1 Training Programme Form 021
Interpret CXR Required 1 Training Programme Form 021
Interpret ambulatory blood pressure monitoring Required 1 Training Programme Form 021
Adenosine challenge ECG Required 1 Training Programme Form 021
Tilt table testing Required 1 Training Programme Form 021
Interpret non functioning pacing on ECG Required 1 Training Programme Form 021
Mini-CEX (At least two Mini-CEX assessments) Required 2 Year of Training Form 023
Quarterly Assessments Required 4 Year of Training Form 092
End-of-Post/End-of-Year Assessments Required 1 Year of Training Form 092

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Post CSCST TRAINING IN

© Royal College of Physicians of Ireland, 2017 1

Version Date Published Last Edited By Version Comments

© Royal College of Physicians of Ireland, 2017 2

© Royal College of Physicians of Ireland, 2017 3

Cardiovascular Abnormalities in Neonatal Intensive Care ............................................................... 39

© Royal College of Physicians of Ireland, 2017 4

Recruitment and Selection

Duration and Organisation of Training

© Royal College of Physicians of Ireland, 2017 5

© Royal College of Physicians of Ireland, 2017 6

© Royal College of Physicians of Ireland, 2017 7

Growth and Nutrition

 The causes of growth failure in congenital heart disease

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 8

 Promote the importance of healthy lifestyle choices

ASSESSMENT & LEARNING METHODS

 Present Health Promotion talk on prevention of childhood obesity

© Royal College of Physicians of Ireland, 2017 9

Evaluation of a Child with a Cardiac Murmur

 Obtain a relevant history and perform expert cardiac examination

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 10

Evaluation of the child with Chest Pain, Palpitations or Syncope

 The cardiac and non-cardiac causes of loss of consciousness

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 11

© Royal College of Physicians of Ireland, 2017 12

© Royal College of Physicians of Ireland, 2017 13

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 14

Cardiovascular Collapse in Infancy

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 15

Cardiac Failure in Infants and Children

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 16

Acyanotic Congenital Heart Disease throughout Childhood

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 17

Cyanotic Heart Disease in the Newborn Period

 Take a relevant history and perform an appropriate examination

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 18

Cyanotic Heart Disease beyond the Newborn Period

© Royal College of Physicians of Ireland, 2017 19

 Use transthoracic echocardiography to make an initial diagnosis of cyanotic defects and to

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 20

Practical Procedures and Investigations

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 21

 The principles and practice of radiation protection

ASSESSMENT & LEARNING METHODS

© Royal College of Physicians of Ireland, 2017 22

Trainees and practitioners should recognise that the performance of non-contributory

 The physics of 2 dimensional echocardiography, colour Doppler and spectral Doppler

ASSESSMENT & LEARNING METHODS