Rotation Contact

Rotation Director – Timothy Hoffman, MD ()

Rotation Contact – Melissa Halkovic ()

First Day Information

You will receive an email from Melissa Halkovic prior to starting the rotation.

Resident Expectations

Where and when to present on the first day? Depends on the clinic schedule which will be available through Melissa Halkovic

Schedule for other days? Obtain from Melissa Halkovic

How to communicate individual needs? Email Timothy Hoffman

What to be sure to write in clinical notes? Not applicable; attendings dictate all clinic notes

What to be sure to present on rounds? HPI and physical exam findings, preliminary impression and plan

Specifically call the attending/fellow for? N/A in clinic, will be working with attending 1 on 1 in clinic.

Expectations for interactions with medical students on this rotation? Medical students may also be in the outpatient clinics and may accompany residents in evaluating patients.

Expectations for interactions with others (clinical nurses, ancillary services, etc.)? Utilize expertise of pediatric cardiac sonographers in correlating exam and echo findings.

Expected attendance at didactics or conferences? Attend as many clinics as possible; also attend 1-2 days in the cath lab to observe.

Specific Assignments/Other expectations: Basic interpretation of ECGs through serial reading in clinics.

Goals and Objectives

Overall Educational Goal:

The resident is expected to participate actively in the clinical management of pediatric patients with cardiovascular disease under the direct supervision of a pediatric cardiology attending. The resident will gain evaluative skills on the diagnosis, evaluation, and management of cardiovascular disease as it relates to general pediatric practice.

Objectives:

Obtain a history and perform a physical examination focused on the cardiovascular system, including but not limited to the evaluation of perfusion, respiratory distress, evaluation of peripheral pulses, and auscultation of innocent and pathologic cardiac murmurs. (PC)

Interpret chest radiographs and electrocardiograms in the context of an overall cardiovascular examination. (PC)

Understand the capabilities and limitations of other cardiac imaging modalities, including but not limited to echocardiography and cardiac catheterization. (MK, PC)

Demonstrate an orderly approach to (1) the infant with suspected cardiovascular disease, including infants with congestive heart failure, cyanosis, or undefined cardiac murmurs; and (2) to the evaluation of common cardiovascular problems that present in older children, including chest pain, syncope, and hypertension. (PC)

Understand the use of commonly used drugs that affect the cardiovascular system, including inotropic agents, diuretics, and afterload-reducing agents. (MK)

Understand the natural and unnatural history of cardiovascular abnormalities, including but not limited to structural lesions, endocarditis (including endocarditis prophylaxis), Kawasaki disease, and common arrhythmias such as supraventricular tachycardia. (MK)

Evaluation:

Resident performance is evaluated by direct faculty assessment during clinical activities. An online consensus evaluation is completed at the end of the resident’s rotation. Residents also evaluate their faculty attending(s) and evaluate the overall effectiveness of the rotation.

Learning the Activities of the Rotation:

The principal learning activity of residents during the Pediatric Cardiology rotation involves assessment of outpatients and inpatients, both at UNC Hospitals and at numerous satellite clinics throughout the state, with prompt review by an attending pediatric Cardiologist. Immediate feedback on the resident’s assessment and treatment plan is provided. Residents are expected to read electrocardiograms independently, with review by the attending. Residents are expected to review the syllabus of reading material that has been compiled for their use on the website, and are expected to review the compilation of annotated electrocardiograms that is available.

Readings and Resources

Subject Title Author Date Journal and Citation Info
Arrhythmia Emergency Department Management of the Pediatric Patient with Supraventricular Tachycardia Manole MD, Saladino, RA March 2007 Pediatr Emerg Care. 2007 Mar;23(3):176-85
Basic ECG The pediatric Electrocardiogram: Part II: Dysrhythmias O’Connor M, McDanniel N, Brady WJ March 2008 Am J Emerg Med. 2008 Mar;26(3):348-58.
Kawasaki Disease Kawasaki Disease Newburger JW, Burns, JC 1999 Vasc Med. 1999;4(3):187-202.
Syncope and Chest Pain Chest pain in children and adolescents Cava JR, Sayger PL December 2004 Pediatr Clin North Am. 2004 Dec;51(6):1553-68.
Current approach to pediatric syncope Johnsrude CL November 2000 Pediatr Cardiol. 2000 Nov-Dec;21(6):522-31.
Consultation with the Specialist: Palpitations, Syncope, and Sudden Cardiac Death in Children: Who’s at Risk? Batra AS, Hohn AR August 2003 Pediatr Rev. 2003 Aug;24(8):269-75.
Additional Articles Cyanotic congenital heart disease with increased pulmonary blood flow. Grifka RG April 2003 Pediatr Clin North Am. 1999 Apr;46(2): 405-25.
Cyanotic congenital heart disease with decreased pulmonary blood flow in children. Waldman JD, Wernly JA. Apr 1999 Pediatr Clin North Am. 1999 Apr;46(2):385-404.
Medical management of chronic heart failure in children Ross RD 2001 Am J Cardiovasc Drugs. 2001;1(1):37-44.
Left ventricular outflow obstruction: subaortic stenosis, bicuspid aortic valve, supravalvar aortic stenosis, and coarctation of the aorta. Aboulhosn J, Child JS Nov 2006 Circulation. 2006 Nov 28;114(22):2412-22.
Univentricular heart. Khairy P, Poirier N, Mercier LA Feb 2007 Circulation. 2007 Feb 13;115(6):800-12.
Ebstein’s anomaly. Attenhofer Jost CH, Connolly HM, et al Jan 2007 Circulation. 2007 Jan 16;115(2):277-85.
Transposition of the great arteries. Warnes CA Dec 2006 Circulation. 2006 Dec 12;114(24):2699-709.
Controversies, genetics, diagnostic assessment, and outcomes relating to the heterotaxy syndrome. Cohen MS, Anderson RH, et al. Sept 2007 Cardiol Young. 2007 Sep;17 Suppl 2:29-43.
Contemporary results and current strategies in the management of hypoplastic left heart syndrome. Pigula FA, Vida V, Del Nido P, Bacha E. Fall 2007 Semin Thorac Cardiovasc Surg. 2007 Fall;19(3):238-44.
Preoperative management of hypoplastic left heart syndrome. Graham EM, Bradley SM, Atz AM May 2005 Expert Opin Pharmacother. 2005 May;6(5):687-93.
New developments in the treatment of hypoplastic left heart syndrome. Alsoufi B, Bennetts J, Verma S, Caldarone CA. Jan 2007 Pediatrics. 2007 Jan;119(1):109-17.
Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder [corrected]: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Vetter VL, Elia J, Erickson C, Berger S, Blum N, Uzark K, Webb CL; American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee; American Heart Association Council on Cardiovascular Nursing. May 2008 Circulation. 2008 May 6;117(18):2407-23.
Websites UNC Heart Sounds Project