Certificate in Advanced Veterinary Practice
C-VC.2 Veterinary Cardiology
Cardiovascular Diagnostics
Module Outline
Module Leader:
Simon Dennis BVetMed MVM MRCVS DipECVIM-CA (Cardiology)
European Veterinary Specialist in Small Animal Cardiology
CPD Unit
Royal Veterinary College
Hawkshead Lane
North Mymms
Hertfordshire
AL9 7TA
Tel: +44 (0)1707 666201
Fax: +44 (0)1707 666877
Email: [email protected]
www.rvc.ac.uk/certavp
LEARNING OUTCOMES
The module is focused on making a diagnosis of cardiovascular disease using the appropriate
techniques. It is not concerned with the therapeutics or management of animals with cardiovascular
disease as this is the concern of modules C-VC.3.
The module is aimed at veterinary surgeons in private practice, or at a veterinary school with a
substantial case load of small or large animals, or a mixture, of which a significant number have
primary cardiovascular disease, or require thorough examinations of their cardiovascular system for
investigation of other systemic illnesses, or injury. At least 200 of these should be examined and
assessed primarily by the candidate.
The module may be taken from a large animal or a small animal perspective, or a mixture of the two.
It is suggested that candidates intending to proceed to a Certificate in Advanced Veterinary Practice
(Cardiology) via modules C-VC.1 and C-VC.3, will present a C-VC.1 made up of a balanced
distribution of species with at least 2 being represented. Alternatively, if candidates are intending to
proceed to the advanced clinical practice (cardiology) with a large animal/equine bias) via Equine
Practice, the case diary should be made up of 90% large animals. Candidates not wishing to use the
module to attain the certificate in advanced Veterinary Practice (Cardiology) can present case books
made up exclusively from small, or large animal cases.
Module C-VC.2 is mandatory for those aiming to achieve the CertAVP (Cardiology).
LEARNING TOPICS
At the end of the module, candidates should be able to:
To select appropriate diagnostic techniques for small or large animal patients based on their
history and clinical findings (auscultation, physical examination)
To be able to diagnose acute cardiac failure and shock
To show an understanding of the balance between patient care and patient stabilisation before
extensive diagnostic procedures are undertaken
To show competence in acquiring the appropriate diagnostic materials from the tests and
procedures selected, for example, electrocardiographs, radiographs and echocardiographs
must all be of diagnostic quality and the scope of each examination sufficient to satisfy the
diagnostic question being asked
To have the ability to critically assess and measure the diagnostic material once it has been
derived
To show competence in interpreting all of the diagnostic material that the candidate has
acquired from each case and integrating all of the elements of their diagnostic work up to
determine a final diagnosis
To provide an accurate diagnosis after their series of diagnostic tests have been completed
For the purposes of the case log the candidate MUST have performed a full clinical examination on
each animal entered
1. Clinical examination:
Auscultation—presence of murmurs, gallop sounds, arrhythmias or inappropriate rates,
examination of the respiratory system
Pulse palpation—rate, character and rhythm
Mucous membranes and peripheral perfusion—assessment of mucous membrane colour and
refill time and adequacy of peripheral perfusion
Examination for extra-cardiovascular manifestations of cardiovascular disease and failure
The candidate is then expected to choose appropriately from the following core list of ancillary
diagnostic aids, or if clinical examination is sufficient to make a final diagnosis of the cardiovascular
abnormality e.g. in a case of hypovolaemic shock, the candidate can proceed to this as a final
diagnosis in the case log.
2. Ancillary Diagnostic aids
a) Electrocardiography
The candidate must then be able to:
- Calculate heart rate
- Assess heart rhythm
- Assess cardiac conduction and waveform shapes
- Detect evidence of cardiac enlargement
- Understand the application of Holter or other long term ECG monitors
b) Measurement of arterial blood pressure
Direct and indirect methods
c) Radiology
The candidate should understand the basic principles of radiography and recognise
common film faults
Additionally the candidate should demonstrate an understanding of:
radiographic anatomy of the cardiovascular and respiratory system
radiographic changes in all organs associated with cardiovascular disease
radiographic changes in cardiac failure
principles and indications for angiography
d) 2-D and M-mode Echocardiography—acquisition, recognition, measurement and interpretation of
standard 2D and M-mode images;
The candidate should
- understand the basic principles of echocardiography, recognise common faults and
be familiar with and capable of obtaining the standard views of the heart
appropriate to their species bias
recognise and describe normal echocardiographic anatomy. (Candidates should
possess a detailed knowledge of normal cardiac anatomy of the dog, cat and horse
and of the variations with breed and age, as appropriate to the case log
an understanding of how common cardiovascular diseases affect the cardiac
chambers and the standard measurements made
a knowledge of common artefacts and an understanding of the potential pitfalls of
an echocardiographic study
e) The basic principles and applications of Doppler echocardiography including knowledge of
common artefacts and an understanding of the potential pitfalls of Doppler
echocardiographic methods.
f) Laboratory tests—in particular renal function, liver enzymes, electrolytes, blood gases and
haematology. Knowledge of specific laboratory tests for cardiac disease e.g. cardiac
troponins etc.
For radiography and echocardiographic images, the candidate will be expected to demonstrate via
their case reports that they are able to recognise and explain faults, when present in their
diagnostic material
ASSESSMENT
Case log of 50 cases with broad range of tests - list the case details and diagnostic procedures
used for each case.
At the end of the case log candidates should include a 1,000 word synopsis of what they have
learned from the cases. This might include what has changed in their approach to a case, any
new procedures or investigations that are now considered, any additional reading which was
helpful, and/or any unexpected features of a case which will influence decision making in the
future.
Two case reports, each of up to 2,000 words in length. These cases should be selected to
demonstrate that the candidate has developed proficiency in the skills and understanding of
the learning objectives outlined in the module content. It should include personal reflection
which should critically evaluate their management of the case. Appropriate cases might
include those where a candidate can discuss what went well, what went badly, challenging
decision making and alternative management options.
Article critique (up to 800 words) from a chosen list of journal articles about an aspect of
diagnosis in veterinary cardiology and how this article would alter their management of
cases. Include comments on how the paper had affected the candidates own practising of
cardiology in relation to diagnosis and how this may have informed their learning.
Candidates are encouraged to make reference to related veterinary literature in the reference
critique. The selection of articles will be emailed to candidates.
A one hour examination to consist of multiple answer questions and/or short answer
questions.
ANNUAL ASSESSMENT TIMETABLE
1st March Case log, synopsis, two reports and reference critique to be submitted
by 1st March
July Formal examination to be held in July - date to be confirmed
Candidates are strongly advised to have a supervisor with which they can discuss cases. Ideal
supervisors would have post-graduate qualifications in your area of interest. The module leader will
not be discussing case management with any candidate.
CASE REPORT GUIDELINES
The case report should be written in the third person in a style suitable for publication in a Journal
(for example Journal of Small Animal Practice).
The following frame work should be used as a guide to the structure of the case report:
Identification of patient
History
Clinical signs
Problem list and differential diagnoses
Investigation
Diagnosis
Treatment (including postoperative care/instructions)
Follow up
Result
Discussion
References
INSTRUCTIONS FOR SUBMITTING CASE REPORTS / ESSAYS
Please ensure that at the beginning of your case report/reflective essay is included:
your name
module name
title
word count (excluding the above, tables, photo titles and references)
Case reports/reflective essays should be referenced and references cited in a standard format.
Use The Veterinary Record or The Journal of Small Animal Practice as guidance to both
citation of references within the text and format of references in the reference list.
The Harvard Guide to Referencing is also available to candidates enrolled for learning
support or online (various web sites allow the guide to be downloaded).
Please submit your case report/reflective essay as a
MS Word document (97-2003 format or later)*
and your case logs as a
MS Excel spreadsheet (97-2003 format or later)*
attached to an e-mail and send it to: [email protected]
Please ensure digital images are submitted in a compressed format so that they can be easily
transferred via e-mail.
*(Please note that as case reports/essays in alternative formats have been unreadable in MS Office any
other format will be sent back to the candidate)
SUGGESTED READING
General cardiology:
BSAVA Manual of Canine and Feline Cardiorespiratory Medicine, 2nd edn. Eds: V Luis Fuentes,
LR Johnson, S Dennis. 2010, BSAVA, Gloucester.
Topics in Cardiology. An Issue of Veterinary Clinics: Small Animal Practice (The Clinics:
Veterinary Medicine). Volume 40, Number 4, July 2010. Ed: JA Abbott. TheClincs.com.
Manual of Canine and Feline Cardiology, 4th edn. Eds: LP Tilley, FWK Smith Jr, M Oyama, MM
Sleeper. 2008, Elsevier Ltd, London.
Cardiovascular Disease in Small Animal Medicine. Ed: WA Ware. 2007, Manson Publishing Ltd,
London.
Notes on Cardiorespiratory Diseases of the Dog and Cat, 2nd edn. Eds: M Martin, B Corcoran.
2006, Blackwell Publishing, Oxford.
Textbook of Canine and Feline Cardiology: Principles and Clinical Practice, 2nd edn. Eds: PR Fox,
D Sisson, NS Moïse. 1999, W.B. Saunders, Philadelphia.
Cardiac auscultation:
Cardiac Auscultation and Phonocardiography in Dogs, Horses and Cats. Eds: C Kvart, J
Häggström. 2002, Clarence Kvart, Uppsala.
Electrocardiography:
Small Animal ECGs: An Introductory Guide, 2nd edn. Ed: M Martin. 2007, Blackwell Publishing
Ltd, Oxford.
ECG: Electrocardiography for the Small Animal Practitioner (Made Easy). Eds: LP Tilley, NL
Burtnick. 1999, Teton New Media, Jackson.
Radiography:
BSAVA Manual of Canine and Feline Thoracic Imaging. Eds: T Schwarz, V Johnson. 2008,
BSAVA, Gloucester.
Textbook of Veterinary Diagnostic Radiology, 5th edn. Ed: DE Thrall. 2007, Saunders Elsevier, St
Louis.
Echocardiography:
Manual of Veterinary Echocardiography. Ed: JA Boon. 1998, Williams & Wilkins, Baltimore.
Small Animal Diagnostic Ultrasound, 2nd edn. Eds: TG Nyland, JS Mattoon. 2002, WB Saunders,
Philadelphia.
CRITERIA FOR THE CASE LOG OF THE VETERINARY CARDIOLOGY C MODULES
The scope of the examination is related to the recognition and diagnosis of conditions that commonly affect the cardiovascular systems of the domestic species
that are regularly encountered in general veterinary practice. Therefore, in selecting cases for the log, candidates should choose a representative sample of
cases to encompass these conditions:
acute cardiac or cardiovascular failure
chronic cardiac failure
acquired heart disease, including valvular and myocardial disease
congenital heart disease
pericardial disease
cardiac arrhythmias
thromboembolic disease
cardiac disease secondary to other systemic diseases
An acceptable case log should have at least one case representing each of the preceding conditions. Case logs representing only one species and cases
presenting for screening are not acceptable. Cases with the same disease (e.g. degenerative mitral valve disease) should not represent more than 20% of the log
and no more than 10% of cases should be listed as second surgeon. All abbreviations should be explained
The diary is meant to be a continuous log of all cardiology cases performed by the candidate up to the time of submission therefore they should be listed in
chronological order. The same procedure in a different patient can be used again. Cases can be collected from up to 12 months prior to the date of enrolment
on the CertAVP programme.
Information to be included in the log:
a) Date
b) Name / case number / unique identifier
c) Signalment: inc. breed, age
d) Brief list of presenting signs e.g. cough, collapse, exercise intolerance
e) Abnormal auscultation and physical exam findings pertinent to the cardiovascular system; murmur, gallop, arrhythmia, Heart rate if abnormal,
other; e.g. inspiratory rates. Increased respiratory rate, abdominal distension, pyrexia etc.
f) List of ancillary diagnostic tests in the order in which they were performed and their most significant outcomes, for example:
- ECG: sinus rhythm
- Radiographs: slight LA enlargement
- Echocardiography : irregular mitral valve thickening and left atrial enlargement on 2D, MR detected by pulsed wave Doppler
g) Final diagnosis
EXAMPLE CARDIOLOGY CASE LOG (BASED ON ACVIM CARDIOLOGY CASE LOG)
Date Case
number
and
client
name
Age,
sex,
breed
EC
G
XR
AY
MM
OD
E
2D
DO
PP
LE
R
Other diagnostics Diagnosis Treatment and follow-up
5.1.09 697708
Smith
12 yo
MC
LABR
x x x x x Blood tests DCM, left sided CHF,
VPCs
Furosemide,
Pimobendan,
Benazepril
Recheck 1
Week
5.1.09 697718
Brown
9 yo
FS
DSH
x x x x x Doppler
systolic blood
pressure
HCM Benazepril
Example key:
MC male castrated FS female spayed
LABR Labrador retriever DSH Domestic Shorthair
CHF Congestive heart failure VPCs Ventricular premature complexes
HCM Hypertrophic cardiomyopathy
Version 3 19/07/2011
Marking Regulations
1.
Course: RCVS – Certificate of Advanced Veterinary Practice
2.
Section: C Module C-VC.2 Veterinary Cardiology Cardiovascular Diagnostics
3.
Applicable to Academic Year: 2010/11 onwards
4.
Aspects of course covered by Examination CertAVP C-VC.2 Veterinary Cardiology Cardiovascular Diagnostics learning outcomes
and topics
5. Requirement to be completed to permit entry to the examination:
1. Appropriate enrolment to the C module
2. Candidates are advised that they should achieve a pass grade in the B Practice
Module
6.
Form of Examination
1. Case log (50 cases)
2. 1,000 word synopsis
3. 2 x 2000 words case reports
3. Reference critique (800 words)
4. One hour exam – short answer and extended matching questions
7.
Marking Criteria
1. Case log – approval of appropriate numbers and timeline as described in course
literature
2. Case log synopsis – grading on the RVC 0-100 (17 point) marking scheme
3. Case reports – grading on the RVC 0-100 (17 point) marking scheme
4. Reference critique – grading on the RVC 0-100 (17 point) marking scheme
8.
Allocation of Marks and any additional requirements
First Submission
- Re-submission Only those parts of the module identified as failing in the initial submission will be re-
marked.
Version 3 19/07/2011
9.
Requirements to Pass Overall Work must be submitted and assessed within the 10 year registration period, or if
enrolled after 1st July 2010, within the 2 year registration period.
First Submission
Approval of the case log 50% or greater in the grading of the case log synopsis
50% or greater in the grading of each case report
50% or greater in the grading of the reference critique
50% or greater in the examination
Re-submission
Sections graded below 50% in the first submission are re-graded on re-
submission and the following criteria must be reached taking that new grading
into account: - Approval of the case log - 50% or greater in the grading of the case log synopsis - 50% or greater in the grading of each case report - 50% or greater in the grading of the reference critique - 50% or greater in the examination
10.
Consequences of Failure
1. A candidate who fails at their first submission will be required to re-submit or re-
sit the sections they have failed in the next or a future assessment cycle, or
withdraw from the Certificate.
2. A candidate who does not meet the requirements to pass overall after taking all the
allowed opportunities to resubmit their work will normally be required to
relinquish the course of study but s/he will have the right of appeal as described in
the College Regulations.
3. Should a candidate successfully appeal to be re-admitted to the Certificate they
would normally have to repeat the entire module with new case material and
would incur a further assessment fee.
11.
Classification
The examination is only classified as a Pass or a Fail. Candidates that pass the
examination will be allocated 10 credits in the CertAVP structure and the RCVS will be
appropriately informed.
12. Disclosure of Marks Candidates will be advised of their marks by email and they can request a letter
confirmation.
13. Late submission of work Work that is submitted after the annual deadline cannot be accepted for grading in that
year. Work may stay on file for grading at the next submission date or the candidate
may re-submit before that date.