Cardiovascular Pathology

Goals and Objectives

At the completion of training, the resident will have acquired the following competencies and will function effectively as:

Medical Expert/Clinical Decision-Maker

General Requirements

  • Demonstrate diagnostic skills for accurate pathological diagnosis of cardiovascular and peripheral vascular disease.
  • Access and apply relevant information to clinical practice.
  • Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements

  • Demonstrate the ability to perform the cardiovascular component of post- mortem examination, with appropriate full description and diagnosis at gross and microscopic levels. Residents must be able to interpret their findings in light of the clinical history and communicate these in an effective written and oral fashion.
  • Demonstrate an in-depth knowledge of the appropriate dissection and sampling of cardiovascular surgical specimens.
  • Demonstrate knowledge of the indications for ancillary tests (special stains, immunohistochemistry and electron microscopy) and the technical principles underlying these.
  • Understand the risk factors, morphology, complications and treatment of atherosclerotic coronary artery disease.
  • Demonstrate the knowledge of the evolution of morphological changes of myocardial infarction and recognize the early and late complications.
  • Understand the classification and histological features of myocarditis.
  • Understand the distinguishing features of primary and secondary forms of cardiomyopathy
  • Demonstrate the knowledge of the genetics and pathology of hypertrophic, arrhythmogenic, and restrictive and left ventricular non compaction cardiomyopathy.
  • Understand the etiology, classification, histology and ancillary tests of Amyloidosis related cardiac disease.
  • Discuss the etiology (embryologic basis), pathogenesis, and clinical features of congenital heart disease including cardiovascular shunts (e.g., atrial septal defect (ASD), ventricular septal defect (VSD), atrioventricular septal defect, and patent ductus arteriosus (PDA)
  • Understand the common benign and malignant cardiac tumors and describe their typical clinical presentations
  • Demonstrate the knowledge of acute cellular and antibody mediated rejection. Residents should also be able to recognize findings of acute ischemic (preservation) injury, healing and healed previous biopsy sites and lymphocytic infiltrates (Quilty effect).
  • Understand the etiology, pathology and treatment of valvular heart disease.
  • Understand the classification, clinical features and pathology of vasculitis.
  • Demonstrate the knowledge of the etiology, pathology and complications of aortic aneurysms.

Communicator

General Requirements

  • Establish effective relationships with consulting physicians and surgeons.
  • Listen effectively.
  • Discuss appropriate information with the health care team relating to the diagnosis and workup of various surgical and autopsy patient cases.

Specific Requirements

  • Assist in the continuing education of physicians and other members of the hospital staff by presenting at pathology, cardiology, and cardiac surgery rounds.
  • Act as a consultant to clinical colleagues on the interpretation and relevance of pathological findings, with particular regard to their significance in the management of the patient.
  • Understand the information pathology should provide in a given clinical situation and be able to communicate it effectively in an oral and written form.

Collaborator

General Requirements

  • Consult effectively with other physicians and health care professionals.
  • Contribute effectively to other interdisciplinary team activities.

Specific Requirements

  • Utilize experience in clinical medicine and surgery to achieve a sound understanding of the effects of disease and the role of pathology in its management.
  • Demonstrate the ability to advise on the appropriateness of obtaining histologic specimens and following examination of these, to advise on further appropriate investigations.

Manager

General Requirements

  • Utilize resources effectively to balance patient care, learning needs, and outside activities.
  • Utilize the resources of the anatomical pathology laboratory to make an accurate and timely diagnosis.
  • Allocate finite health care resources wisely.
  • Work effectively and efficiently in a health care organization.
  • Utilize information technology to optimize patient care, life-long learning and other activities.

Specific Requirements

  • Demonstrate knowledge of the methods of quality control in the laboratory as it related to ensuring the appropriate methods to allow the evaluation of cardiac and vascular tissues.

Health Advocate

General Requirements

  • Identify the important determinants of cardiovascular health affecting patients.
  • Identify factors that may need to be relayed for discussion to the consultants in regards to modifiable risk factors for the patient and their family

Specific Requirements

  • As members of an interdisciplinary team of professionals responsible for individual and population health care, the anatomical pathologist will endeavour to ensure that laboratory practices and test selection are regularly evaluated to determine that they meet these community needs.

Scholar

General Requirements

  • Develop, implement and monitor a personal continuing education strategy for continuing medical education in cardiac diseases.
  • Critically appraise sources of medical information.
  • Facilitate learning of patients, house staff/students and other health professionals by attending and presenting at rounds at various venues.
  • Contribute to development of new knowledge.

Specific Requirements

  • There should be consideration of completing a short research project or case report dealing with Cardiovascular Pathology during an elective. This might be presented at various national, international or local meetings.

Professional

General Requirements

  • Deliver highest quality care with integrity, honesty and compassion.
  • Exhibit appropriate personal and interpersonal professional behaviours.
  • Practice medicine ethically consistent with obligations of a physician.
  • Demonstrate the knowledge, skills and attitudes relating to gender, culture, and ethnicity pertinent to anatomical pathology.

Specific Requirements

  • Act as an appropriate role model for students and others.
  • Demonstrate a professional attitude to colleagues, as well as to other laboratory staff.
  • Have an appreciation of the crucial role of the anatomical pathologist in providing quality patient care. This will include knowledge of individual professional limitations and the necessity of seeking appropriate second opinions.

Specific Tasks

The residents on cardiovascular rotation should perform the following:

  • Gross explant and autopsy heart specimens (hearts with grafts, coronary arteries with stents, cardiomyopathies etc.).  Gross cardiovascular surgical specimens (valves, aortas, tumors etc.). The number of grossed cases will be recorded at the end of the rotation and incorporated in the final evaluation.
  • Review the slides, work up the cases and check prior history.
  • A test will be given to all residents when they finish the one block rotation. The test will include 10 glass slides and a written part with 8 to 10 Short Answer Questions. This exam has the purpose of identifying the areas that need improvement.

Evaluation

  • The resident will be given an evaluation based on the objectives and practical examination at the end of the rotation.

Review Of Collection Slide Sets

  • Myocardial infarction and its complications
  • Amyloidosis
  • Myocarditis
  • Cardiomyopathies
  • Cardiac Tumors
  • Vasculitis

Recommended Reading

  • Robbins' Pathologic Basis of Disease.
  • Diagnostic Pathology: Cardiovascular by Dylan V. Miller and Monica P. Revelo
  • Diagnostic Pathology: Normal Histology by Matthew R. Lindberg
  • Practical Cardiovascular Pathology by Allen P. Burke MD and Fabio Tavora MD

 

Updated April, 2020

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