Timeframe: from diagnosis of tricuspid regurgitation (TR) until referral for surgical/interventional therapy

Setting: outpatient setting, inpatient setting, and 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 primary and secondary causes of TR

• Describe the haemodynamics of TR

• Describe the pathophysiology of primary and secondary TR and its effect on the heart and circulation

• Describe the symptoms and clinical signs of TR

• Outline the natural history and prognosis of TR

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

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

• Plan the follow-up and medical management of a patient with TR

• Explain the current guidance on endocarditis prophylaxis

• Describe the indications, benefits, and risks of medical, interventional, and surgical therapy

• Discuss the impact of concomitant coronary artery disease, co-existing disease of other heart valves, and other co-morbidities on the management and outcome of TR

• Take a relevant history and perform an appropriate clinical 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

  •   – Cardiac catheterization

  •   – Coronary angiography

  •   – Cardiac CT

  •   – Cardiac MR

• Decide on the strategy and frequency of follow-up

• Identify the appropriate time for interventional or surgical therapy

• Optimize patient condition in preparation for interventional or surgical therapy

• Manage HF with optimal medical therapy and devices in a patient with secondary TR

• Assess benefits and risks of different therapeutic modalities according to patient characteristics

• Evaluate symptoms carefully using patient history and exercise testing

• Restrict the use of diagnostic modalities to those required for reaching a definitive diagnosis or for planning a therapeutic intervention

• Educate the patient on the cause, natural history, and consequences of TR

• Educate the patient on importance of compliance with regular follow-up

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

• 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)