– Genesis of the University Clinic of Cardiology

The University Clinic of Cardiology (CUC) of the Faculty of Medicine of the University of Lisbon (FMUL) had its origin in 1955 with Professor Eduardo Coelho, who created the Cardiology Service of the Santa Maria Hospital and the Cardiology Centre of the High Culture Institute. In 1987 the clinic is officialised, with its director being Professor Salomão Sequerra Amram, who, along with Professor Fernando de Pádua and Doctor Carlos Ribeiro, stimulated this important academic field. This was followed by Professor Maria Celeste Vagueiro and Professor Hugo C. Madeira at the head of this FMUL unit. In 2005 Professor Mário G. Lopes took on the role as Director of the University Clinic of Cardiology.

On the site Zappiens (http://zappiens.pt/), by the Foundation for National Scientific Computation (FCCN), we have the possibility of discovering many historical data about the University Clinic of Cardiology through the interviews recorded on video with four former directors, at the time when we are celebrating 20 years over the officialisation of this structural unit of our institution.

Professor Salomão Sequerra Amram
http://zappiens.pt/video.php?id=237

Professor Fernando de Pádua
http://zappiens.pt/video.php?id=254
http://zappiens.pt/video.php?id=255

Professor Carlos Ribeiro
http://zappiens.pt/video.php?id=238
http://zappiens.pt/video.php?id=241

Professor Maria Celeste Vagueiro
http://zappiens.pt/video.php?id=253
http://zappiens.pt/video.php?id=252

Functions and Activities 

The University Clinic of Cardiology carries out its activities in three main areas:

1 – Undergraduate teaching of cardiovascular medicine, which is the most common pathology in the adult population and the number one cause of death in Portugal. At the moment we teach almost 400 students per year in the Integrated Masters in Medicine at the FMUL. Added to this are the Erasmus Programme students, who come to our training courses every year. We also participate in post-graduate teaching for cardiologists (in the initial phase and those of refresher courses), as well as other elements of the health team, like nurses and cardiopneumologists.

The teaching activities take place over several different years of the syllabus, with the aim being to stress the rotation in cardiology of the subject of Medicine I of the 4th year (which is attended by all 400 students) and in other optional activities or open to free choice, such as:

• Optional Subject in Cardiology (5th year) – 40 students
• Final work in Masters in the 6th year – 13 students
• Tutored course in Cardiology (5th year) – 6 students
• Research Training periods (5th year) – 4 students
• Open courses in ECG I and II and Echocardiography I and II (4th year) – about 140 students each
• Open Course in Clinical Telemedicine (5th year) – 10 students
• Open Course in Geriatrics I and II (5th year) – 40 students
• Annual Course in Echocardiography
• E-learning using the Moodle platform (campus.ul.pt)
• 6th Pocket Computer course in medicine

2 – in the field of scientific research, the University Clinic of Cardiology has a long and successful tradition, which can be seen today with seven active full professors (and another six who have retired), who received their titles at the University of Lisbon in such different subjects as vectocardiography, coronariography, echocardiography, sudden death, techniques of diagnosis in cardiology, advanced imagiology, cardiac scintigraphy, stress echocardiography, hypertrophic myocardiopathy and cardiovascular genetics. In 2009 a graduate successfully completed his PhD at our University Clinic and our cardiology intern was accepted for the PhD programme at the Calouste Gulbenkian Foundation.

The University of Lisbon Cardiology Centre is the structure that supports our research.

More recently, other lines of research have been introduced, dealing with the inflammatory phases of acute coronary syndromes, intervention cardiology (coronary angioplasty, closing of intra-cardiac shunts, occlusion of the left auricular appendix), a cardiac re-synchronisation, optimization of methodologies of permanent cardiac pacing, implanted cardioverter-defibrillator, cardiac magnetic resonance, the new techniques of echo cardiography (strain, 3D) and telecardiology.

Participation in the scientific organisations, which is the responsibility of the Cardiology Society (Portuguese or European, among others), has been intense, both in presenting conferences, communications and moderating sessions, and also in the carrying out of functions on these institutions. The current director of the University Clinic of Cardiology has been designated as the President-elect of the Portuguese Society of Cardiology for the two year period of 2011/2013.

3 – The community activity of the University Clinic of Cardiology is that which carries the most weight (quantitatively and qualitatively) for the available human resources. All of our members have functions in the Service of Cardiology I at the North Lisbon Hospital Centre – Santa Maria Hospital, where the head of the service is taken on by the director of the University Clinic of Cardiology. The university service functions 24 hours per day, 7 days a week, in the main Portuguese NHS Hospital, where the Emergency Admissions Service for adults is as many as 800 patients per day.

Cardiovascular pathologies are highly prevalent, and are the cause of urgent internment in about a third of all admissions. The service has 39 beds, practises all cutting edge diagnostic and therapeutic techniques in cardiology for non-invasive diagnostic techniques and invasive intervention techniques (haemodynamics, coronary intervention and others and invasive electrophysiology and pacing).

The hospital indicators that are shown in the table clearly document the intensity, variety and complexity of our daily activity. Quality control, application of telemedicine and health economy in cardiology are specific operational research areas with responsibility for assistance in which the University Clinic of Cardiology participates.

– Pedagogical Mission 

Our pedagogical mission is to participate in the teaching of the 400 students who annually reach the clinical years and who demand an updated training in cardiovascular medicine within the perspective of lifelong learning. The teaching-learning process is based on the methodology of the solving of clinical cases, whether real ones or virtual ones in training classes for decision making.

Besides the traditional methodologies (theoretical classes, theoretical-practical classes, and practical classes), we have been investing in the use of new IT Technologies in the process of teaching-learning of clinical medicine. Since 2005 we have digitally published virtual classes (both on the FMUL intranet and on DVD), using the Adobe Presenter or Microsoft Producer applications, with the active collaboration of the faculty’s Unit of Information Technology – Audiovisual Mediums. We have published 33 classes, dealing with subjects that the University Clinic of Cardiology has been teaching: Cardiology, Methodologies of Learning, Geriatrics and IT. These classes can be accessed on http://www.fm.ul.pt/#3103.

– Material Resources and Premises 

The University Clinic of Cardiology has a varied and intense activity. Its material resources and, mainly, its premises are insufficient. For several years we have been waiting for the upgrades we need to improve our performance. The most pressing need among these lacks is secretarial support, which at the moment does not exist.

– University Clinic Team

In 2009 the University Clinic of Cardiology team was made up of nine teachers, including five PhDs (three of whom working 100% in the FMUL): a Full Professor, two associated professors (one with aggregation) and two invited auxiliary professors (30%). We also had the collaboration of two invited professors that we shared with the subject of pre-clinical studies, and three invited assistants. The team also has the collaboration of three (free) volunteer teachers. Professor Hugo C. Madeira, retired in 2008, has kept up a regular activity, both in the area of scientific research and in teaching, guaranteeing the teaching for the students on the Erasmus programme. The University Clinic of Cardiology team has no additional specific support.

– Partnerships within the Lisbon Academic Centre 

Connection to the North Lisbon Hospital Centre (CHLN) and to the Institute of Molecular Medicine Molecular (IMM) is daily and intense. The University Clinic of Cardiology actively participates in aid activities, post-graduate training for doctors (currently with seven interns in the Specialty of Cardiology and a Special Study Cycle of Invasive Arrhythmia), post-graduate training of other graduates (nurses, cardiopneumologists) and in clinical research, namely in clinical testing.

With the IMM the main lines of collaboration are centred on cardiovascular genetics in some cardiovascular pathologies: hypertrophic myocardiopathies, long and short QT, paramyloidosis of the Portuguese type and aneurism of the aorta.

– Future Expectations 

The University Clinic of Cardiology has a long and noble past and an active present. Our vision for the future includes the continuation of the improving of our capacity to comply in the several different areas of our responsibility (scientific research, teaching-training and community support), so we can continue to stand shoulder to shoulder with equivalent units in Europe and the advanced world.

Professor Mário G. Lopes
mario.lopes@hsm.min-saude.pt