Congenital Cardiac Physiology

Information for Healthcare Professionals

Introduction

Congenital cardiac physiologists are cardiac physiologists who have specific and specialised roles within the diagnosis and management of congenital heart disease. Our physiologists are involved in the care of patients of all ages, from fetal life through to adulthood.

The areas of Physiology we cover include:

Non-invasive techniques:

Echocardiography

i. Fetal echocardiography

ii. Transthoracic echocardiography in children and / or adults

iii. Advanced functional analysis

iv. 3D echocardiography – structural/anatomical

v. Transoesophageal echocardiography

Cardiac Rhythm management

i. Electrocardiograms (ECG)

ii. 24 hour/event/holter recorder analysis

iii. Electrophysiology (EP)

a. Radiofrequency ablation monitoring

b. Electrophysiology studies

iv. Pacemaker/Device implantation and assessment

Non-invasive physiological testing

i. Ambulatory blood pressure monitoring

ii. Exercise testing (Treadmill/Bicycle) (ETT)

iii. Cardiopulmonary exercise testing (CPET)

iv. 6-minute walk test

v. Tilt testing

Invasive techniques

i. Cardiac catheterisation monitoring e.g. haemodynamics

ii. XMR haemodynamic monitoring

Congenital cardiac physiologists are a key departmental resource, maintaining high levels of competence. They are central to the development and delivery of education to both physiologists and trainee doctors, with the goal of attaining specialist accreditations (such as the EACVI Accreditation in Transthoracic Congenital Heart Disease Echocardiography or BSE Congenital accreditation). The roles of physiologists vary between centres, especially between different levels.

The British Congenital Cardiac Physiologists (BCCP)

The British Congenital Cardiac Physiologists (BCCP) group was originally started as a working group with the aim of trying to establish and improve training pathways into congenital cardiac physiology. Our constitution can be found here

Our group consists of physiologists from all over the United Kingdom and Ireland, with a membership including physiologists working in both Echocardiography and Cardiac Rhythm Management. We work in all areas of congenital heart disease, fetal echocardiography, paediatric cardiology and adult congenital heart disease.

Our aims:

· To improve and standardise the diagnostic care of patients with CHD nationally

· To increase collaboration and communication amongst physiologists from different centres

· Share resources and develop clinical practice relating to congenital cardiac physiology

· To establish national guidelines for safe practice

· Increase awareness of the speciality within other professional groups

· Educate members and others in relation to the specialty

· Ensure robust and effective training routes for the profession are established and implemented by collaboration with the relevant bodies

· Provide peer support and guidance to specialist practitioners within CHD

· Increase collaboration with other similar national and international groups

· To have representation within relevant bodies and promote good communication and cooperation with these groups (e.g., BCCA, BSE, BHRS, SCST, EACVI)

· To promote audit, quality assurance and research practices nationally

To express interest in joining the BCCP please register here:

Education and Training

Recently training in this subspecialty has is now part of the Modernising Scientific Careers programme (MSC) under the Academy of Healthcare Science. Interested students should consult the NHS Careers website or The National School for Health Care Sciences for further information (see links below).

Currently, there is no direct pathway to Congenital Heart Physiology other than at Higher Specialist Scientific Trainee (HSST) level (visit page on Modernising Scientific Careers).

Students interested in a career in congenital heart disease are advised to apply for the STP adult-focused Cardiac Physiology, preferentially in a centre with close links to a suitable congenital/paediatric unit where cross site training can be facilitated.

The Bristol Heart Institute (BHI) and Bristol Royal Hospital for Children (BRHC) have developed a pathway for training in ACHD echocardiography which incorporates the objectives, stages and competencies that are required in attaining proficiency – the link for this can also be found below within the key documents.