Student Name (Block Capitals):______

Cardiovascular Module

Cardiovascular Studies

Semester 5.1

Student Name (Block Capitals):______

Student Number: ______

Photo:

Cardiovascular Module Logbook

Confidentiality

Any breach of confidence in a clinical case is taken extremely seriously by the medical school and the persons involved may be liable for disciplinary action. The student is referred to the Code of Conduct as outlined in the 5.1 Handbook.

You must sign this prior to commencing the module

I have read and understood the University Code of Conduct and will abide by this.

______

Signature Date

CARDIOLOGY (TWO WEEKS)

INPATIENT AND EMERGENCY CARDIOLOGY (ONE WEEK)

CCU/Wards (Two days)

What do I need to do?

The purpose of the CCU/ward day is to give you an insight into the workings of the high dependency aspects of cardiology. The patients in the coronary care unit are generally post-MI, or have decompensated heart failure, or some other critical CVS illness, so the learning opportunities here are extensive. The patients on the ward are generally less unwell but still provide excellent learning opportunities. In order to get the most of the day, you are obliged to have done the following prior to the morning ward round:

Have taken three patient histories for presentation on the ward round
Have examined the same patients
Have looked up their recent clinical course, investigations, current medications, and plans for further management in the patient chart. This includes bloods, xray and CVS investigations such as ECG and echo

On the morning ward round you should present a succinct summary of the current patient status using the following format:

Brief summary of HPC, PMH and inpatient course
The patient's subjective symptoms over the last 24 hours
Your objective clinical findings
Results of recent investigations
Plans for further management

Time is limited on the ward round, so you need to deliver as much information as you can in as short a time as is possible- remember, the consultant or registrars will usually be aware of the patient's history, so your job is to update them as much as possible. The SHOs and nurses can help you to prepare.

Patients presented - CCU

Patient's initials and identifier DateSignature of Tutor

1 ______

2 ______

3 ______

Patients presented - Wards

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

3 ______

Cardiology Ward Rounds (CCU/Wards)

DateSignature of Tutor

1 ______

2 ______

3 ______

4 ______

Daily: Start 8.30, Cardiology Department Tutorial Room

Tutor assessment: in each case the student: (circle)

Knew the patient historyYESNO

Had examined the patientYES NO

Knew the patient's recent investigationsYESNO

Had a broad idea of the plan for further managementYESNO

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

Patient Histories

Use this space to write a brief summary of each patient you saw in the CCU or on the wards. This is subject to evaluation at the end of your rotation.

Patient 1

Patient 2

Patient 3

Patient 4

ED/MAU (Two days)

What do I need to do?

The emergency department and medical assessment unit provide ample opportunity to interview, examine and evaluate patients under close supervision. There is an SHO on duty to the ED and MAU every day (pager number 182) who will have you to find patients and will listen to your case presentations. During each ED/MAU day, you should see at least three patients. At the end of one of the ED/MAU days, you go on call until 10pm. This is mandatory. If you do not go on call, you will not be signed off.

Cardiology Emergency Admissions Clerked and Presented

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

3 ______

4 ______

5 ______

6 ______

7 ______

8 ______

Tutor assessment: in each case the student: (circle)

Knew the patient historyYESNO

Had examined the patientYES NO

Knew the patient's recent investigationsYESNO

Outlined a general plan for further managementYESNO

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

This Student has been on call for cardiology (Pass/Fail)

Signature of Tutor: ______Date: ______

Inpatient and Emergency Cardiology: Procedures Performed

Supervised IV Cannulation

Patient's initials and identifier DateSignature of Tutor

1 ______

2 ______

3 ______

4 ______

Daily, wards and angiography suite; liaise with intern

ECGs

Patient's initials and identifier DateSignature of Tutor

1 ______

2 ______

3 ______

Available every day on wards and in cardiac investigations unit. Liaise with interns and technicians.

Patient histories

Use this space to write a brief summary of each patient you saw in the MAU or in the ED. This is subject to evaluation at the end of your rotation.

Patient 1

Patient 2

Patient 3

Patient 4

Patient 5

Patient 6

Patient 7

Patient 8

OUTPATIENT CARDIOLOGY AND INVESTIGATIONS (ONE WEEK)

Stress Tests Observed

Patient's initials and identifier DateSignature of Tutor

1 ______

Daily, cardiac investigations unit

Holter Monitor Interpretation Observed

Patient's initials and identifier DateSignature of Tutor

1 ______

Daily, cardiac investigations unit

Pacemaker/ICD Interrogation Observed

Patient's initials and identifier DateSignature of Tutor

1 ______

Daily, cardiac investigations unit

Echo (TTE or TOE) Observed

Patient's initials and identifier DateSignature of Tutor

1 ______

Daily, cardiac investigations unit

CATH LAB DAY

What to do

The reason we ask you to attend the cath lab is not to stand on the darkness for hours- it is so you are exposed to the patients undergoing a cardiac procedure. If you attend at the cath lab, you will quickly begin to understand why patients have angiograms, why some of them get stents, what the indications for pacemaker insertion are, why we put in ICDs, and so on. Much of cardiology nowadays involves some form of intervention, with which you need to be familiar, no matter where your career might take you. It is also a near-certainty that you will be admitting/clerking/referring a patient for a cardiac intervention at some stage in the future, so now is the time to learn how to do it! You should arrive early, so as to start clerking patients and be ready to present to the registrar or consultant.

How to admit a patient for angiography

The decision to send the patient for angiography has already been made, so your don't need to dwell too long on the HPC; in general, the patient will have experienced chest pain or dyspnoea. When admitting a patient for any procedure, you need to establish a few things:

Why the procedure is being performed.
What the patient's past medical history is (with specific regard to renal function in cases of angiography)
What medications the patient is on
If they have any allergies
If there is any obvious contraindication to the procedure
If there are any examination findings which may preclude angiography (specifically, is there an easily palpable femoral pulse)

Is the patient on dual antiplatelet therapy?

This is the question the consultant is most likely to ask you- not being on dual antiplatelet therapy precludes stent insertion, so ask the patient this question specifically.

Admission care pathways are available from the cath lab staff. Liaise with the interns. Remember, each patient will also need an IV line!

Patients Clerked for Angiography / Pacemaker / ICD

Patient's initials and identifier DateSignature of Tutor

1 ______

2 ______

3 ______

4 ______

Daily, Angiography Suite; patients arrive at 8am; start clerking then; liaise with the duty intern

Diagnostic Angiography Observed

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

Daily, angiography suite

Record the abnormalities below

Percutaneous Coronary Intervention Observed

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

Daily, angiography suite

Record the abnormalities below

Pacemaker/ICD Insertion Observed

Patient's initials and identifier DateSignature of Tutor

1 ______*

Daily, angiography suite

Tutor assessment: in each case, the student:

Knew the patient history and indication for procedureYESNO

Had examined the patientYESNO

Knew the indications for and complications of the procedureYESNO

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

Patient Histories

Use this space to write a brief summary of each patient you saw during your cath lab day (procedure, indication, intervention, medications on discharge). This is subject to evaluation at the end of your rotation.

Clinic Day

What to do

There are two types of patient in clinic: the new patient and the review patient. With a new patient, you take a full history, perform a full examination, come up with a differential diagnosis and think of what investigations you want to perform. You then present the patient to the registrar or consultant, go see the patient together and come up with a plan.

With review patients, the diagnosis has already been made and the patient is presenting for routine evaluation of symptoms and their clinical condition. Here, a SOAP format is useful- ask the patient about relevant subjective symptoms, examine them for objective clinical findings, put these together to get an assessment of their condition and make a plan for further investigation or management.

Times and places

The main cardiology clinics are on all day Wednesday (9.45 – 1pm and 2pm-5pm) and on Thursday morning (9.45 – 1pm), on the first floor of the outpatient department. There is also a heart failure clinic on Friday mornings after journal club.

Cardiology Clinic – Patients Clerked and Presented

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

3 ______

4 ______

5 ______

Wednesday 10am -5pm, Thursday 10am-1pm, First Floor, Outpatient Department

Three Sessions, two to three students per session

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

Patient histories

Use this space to write a brief summary of each patient you saw in clinic. This is subject to evaluation at the end of your rotation.

Patient 1

Patient 2

Patient 3

Patient 4

Patient 5

Consultations

What to do

The cardiology department runs a busy inpatient consult service. In such cases, a medical or surgical team submits a formal consult, which is a request for a cardiology opinion on further management of the patient. For example, a routine blood test post-op may demonstrate an elevated troponin; the team may be unsure how to interpret the test result and ask for a formal consult. This usually involves a review of the patient's history, physical examination, a review of investigations and formulation of a set of recommendations. You should see at least two patients.

When you go to see a consult, you should link with the consult registrar before and after you have seen the patient; before so they can tell you what to look for, after so you can present your history. The consult registrar may be contacted on page 761. You should only take a copy of the consult- the original should stay with the SpR.

Cardiology Consults – Patients Clerked and Presented

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

3 ______

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

Patient histories

Use this space to write a brief summary of each patient you saw on consults. This is subject to evaluation at the end of your rotation.

Allied services

In addition to seeing patients in clinic, in the cath lab, and on consults, you should attend the cardiac rehabilitation services and the nurse-led heart failure clinic. These services provide excellent learning opportunities- you get a chance to see patients in the few weeks post-MI when they are coming to terms with their illness and in a good position to describe the effects it has had on their lives. Similarly, attending the heart failure clinic gives good insights into the realities of having a chronic long-term illness.

In addition, there is a journal club and case conference every Friday that the people on the cardiology part of the rotation should attend.

Cardiac Rehabilitation Session Attended (1 hour)

DateSignature of Tutor

______

Daily, Cardiac Rehabilitation Unit, Link Corridor to Obs/Gynae

Nurse-Led Heart Failure Clinic Attended (1 hour per student)

DateSignature of Tutor

______

Daily, HF Unit, Link Corridor to Obs/Gynae

Cardiology Journal Club Attended

DateSignature of Tutor

1 ______

2 ______

Friday 8 am-9am, Cardiology Department

VASCULAR SURGERY (ONE WEEK)

Go-to people

Mr Wael Tawfick (Lecturer in Vascular Surgery)

Mr Sultan (Consultant Vascular Surgeon)

What to do

During the vascular surgery week you should aim to see all aspects of vascular surgery- inpatient, outpatient, investigations and surgical management of vascular disease. You should attend all available ward rounds (with patients clerked and ready to present), clinics, and theatre sessions. You should also attend the vascular lab and observe an ABPI, Arterial and venous duplex. Finally, a minor vascular clinic is conducted Monday to Thursday in the ArtAssist room; here, patients with peripheral vascular disease and vein disease are evaluated- this is an excellent learning opportunity.

Why should I bother turning up?

Vascular disease is very common and is seen with great frequency in clinical practice (and in clinical examinations!). Having a knowledge of how to evaluate and treat vascular disease will serve you well regardless of what specialty you end up in.

Do I really have to go on-call?

Yes. If you don't, you don't get signed off.

Schedule – Team Activities

Monday / Tuesday / Wednesday / Thursday / Friday
7:45 am / Ward Round
St Nicholas' Ward / Ward Round
St Nicholas’ Ward / Vascular/
Radiology MDM Conference
Vascular Department 1st Floor / Vascular Journal Club
Vascular Department
1st Floor
8:00am / Surgical Grand Rounds
8:30am / Ward Round
St Nicholas’ Ward / Ward Round
St Nicholas’ Ward / Ward Round
St Nicholas’ Ward
9:00 am / Arrange with Vascular Lab for time to attend / Theatre 12
(All Day) / Theatre 12
(All Day) / Major Vascular OPD (2nd Floor)
(Morning)
10:30 am / Vascular Core Topic Tutorial
CSI: Room 315 / Minor Vascular Veins/Ulcer Clinic / Vascular Bedside Tutorial / Minor Vascular Veins/Ulcer Clinic
14:00 pm / Minor Vascular ArtAssist Clinic / Minor Vascular Veins/Ulcer Clinic / Minor Vascular ArtAssist Clinic / Minor Vascular Veins/Ulcer Clinic
Monday -Friday: Vascular Lab
Monday-Thursday: Minor Vascular Clinic, ArtAssist Room, Ground Floor, Outpatient Department
(Monday/Wednesday: Peripheral Vascular Disease; Tuesday/Thursday: Veins/Ulcers)

Vascular Surgery Ward Rounds Attended

DateSignature of Tutor

1 ______

2 ______

3 ______

4______

5______

Times as scheduled in previous timetable, St Nicholas' Ward. Liaise with Vascular team

How to clerk a patient for vascular surgery

When admitting a patient for surgery, the decision to operate has already been made, so the emphasis is placed more on ensuring the patient can safely go through with the operation. This involves:

Full history and examination
ECG
Chest Xray, and usually pulmonary function testing
Bloods, including renal function, FBC, coagulation studies, and grouping and crossmatching blood
Anaesthesia assessment

You should liaise with the vascular NCHDs in this regard- they will help you admit the patient and will supervise you in performing procedures such as IV cannulation

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

Ward Patients clerked for Vascular Surgery

Patient's initials and board numberDiagnosisSignature of Tutor

1 ______

2 ______

3 ______

4 ______

Inpatients admitted on the wards – liaise with surgical intern/SHO

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

Vascular Surgeries Observed

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

3 ______

4 ______

Note: of these surgeries, at least one should be aortic (open or endovascular), one peripheral revascularisation, and one carotid surgery. The availability of surgeries may vary. You should have clerked the patient before the surgery.

Major Vascular Clinic – Patients Clerked and Presented

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

3 ______

4 ______

Friday 9am – 1pm Outpatient Department

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

Minor Vascular Clinic – Patients Clerked and Presented

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

3 ______

4 ______

Monday – Thursday (ArtAssist/Venous Clinic) Outpatient Department

Tutor comments

Overall assessment Excellent
Good
Satisfactory
Unsatisfactory

Signature of Tutor: ______Date: ______

Emergency Vascular Surgery Admissions Clerked and Presented

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

Emergency Department. Liaise with duty SHO

This student has been on-call for vascular surgery (pass/fail)

Signature of Tutor: ______Date: ______

Vascular Lab Session – Procedures Observed

Patient's initials and identifier DiagnosisSignature of Tutor

1 ______

2 ______

Daily, Vascular Lab, Outpatient Department

Vascular Surgery Bedside Tutorial

DateSignature of Tutor

______

Wednesday Mornings, 10:30am, St Nicholas Ward

Vascular/Angiography MDM Conference Attended

DateSignature of Tutor

______

Thursday Mornings, 7:45am, Western Vascular Institute, First Floor, Admin Dept

Vascular Journal Club Attended

DateSignature of Tutor

______

Friday Mornings, 7:45am, Western Vascular Institute, First Floor, Admin Dept

CARDIOTHORACIC SURGERY (ONE WEEK)

Go-to people

Mr Mark DaCosta

Mr Deve Veerasingham

What to do

The cardiothoracic part of the rotation gives you an opportunity to observe the surgical treatment of cardiovascular and respiratory disease. You should place emphasis on seeing patients in the outpatient and inpatient settings, particularly patients going for surgery. It is also mandatory to attend the cardiothoracic intensive care unit for at least half a day.

How to follow patients

During the CTS rotation, you should clerk your inpatients on Monday or Tuesday then follow their progress for the week- that is, watch their surgery, evaluate them in CT-ICU and follow their clinical course.

Schedule of Activities- Cardiothoracic Surgery