Timeframe: from diagnosis of aortic regurgitation (AR) until referral for surgical/interventional therapy

Setting: outpatient setting, inpatient setting, emergency department

Including:

initial assessment based on clinical history and physical examination

identification of causes and differential diagnosis

performance and interpretation of basic diagnostic modalities

interpretation of additional diagnostic modalities

medical therapy

Excluding: performing interventional or surgical therapy

• Medical expert

• Communicator

• Collaborator

• Leader

• Professional

• List the causes of AR

• Describe the haemodynamics of AR

• Describe the pathophysiology of AR and its effect on the heart and circulation

• Describe the symptoms and clinical signs of AR

• Outline the natural history and prognosis of AR

• Describe the values and limitations of diagnostic modalities, in particular echocardiography

• Quantify the severity of AR and its effect on cardiac function

• Plan the follow-up under conservative management of a patient with AR

• Explain the current guidance on endocarditis prophylaxis

• Describe the indications, benefits, and risks of conservative, interventional, and surgical management

• Discuss the impact of aortic root dilatation, concomitant coronary artery disease, and other co-morbidities on the management and outcome of AR

• Take a relevant history and perform an appropriate physical examination

• Select appropriate investigations

• Perform and interpret the following diagnostic modalities:

  •   – ECG

  •   – Exercise ECG

  •   – Cardiopulmonary exercise testing

  •   – Transthoracic echocardiography

• Interpret the following diagnostic modalities:

  •   – Chest X-ray

  •   – Trans-oesophageal echocardiography

  •   – Stress echocardiography

  •   – Cardiac catheterization

  •   – Coronary angiography

  •   – Cardiac CT

  •   – Cardiac magnetic resonance (MR)

• Decide on the strategy and frequency of follow-up

• Identify the appropriate timing for interventional or surgical therapy

• Optimize patient condition in preparation of interventional or surgical therapy

• Assess the benefits and risks of different therapeutic approaches

• Allow adequate time for evaluation of symptoms using, when appropriate, the results of exercise testing

• Limit the investigations to those required to reach a definitive assessment and for planning a therapeutic intervention

• Educate the patient on the cause and likely natural history, and consequences of their AR

• Educate the patient on the necessity for compliance with regular follow-up

• Provide balanced, understandable, and appropriate information to the patient on the benefits and risks of different therapeutic approaches

• Involve the patient in all decisions relating to their care

• Commit to work in a Heart Team involving imaging specialists, interventional cardiologists, cardiac surgeons, anaesthetists, and nurses

• Direct observation/WBA (e.g. DOPS, Mini-CEX, fieldnotes)

• CbD (case-based discussion)/EbD (entrustment-based discussion)

• 5. Able to teach (no supervision)