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December 2017 Version 2.0
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Cardiovascular Module – Phase 1
Faculty of Medical Sciences
University of Sri Jayewardenepura
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Introduction
Welcome to the Cardiovascular Module! This is a very exciting module that
will be very important to your future work as doctors. The module has been
designed in a novel way that will make your learning both interesting and
productive.
During this module, you will be encouraged to learn the structure and function
of the cardiovascular system in an integrated manner: this means that what was
previously categorized into subjects such as Anatomy, Physiology and
Biochemistry, will be learnt and assessed together (horizontal integration). We
will also help you learn the basic sciences in a way that is relevant to their
clinical applications (vertical integration). We are taking this approach in order
to prepare you better for your future work as doctors, where patients will come
to you with clinical problems, which are not categorized by discipline names.
In order to help you learn in this integrated manner, we have arranged the
learning of basic sciences around a few key health-related situations (real life
situations), which you are likely to encounter as first year medical students. You
will be expected to think about these scenarios and complete worksheets. You
may do this individually or with your colleagues. It will also help to focus your
attention on what you need to gain from the lectures, practicals and tutorials
that have been scheduled during this module.
Module Committee
Dr. C. Hewage(Chairperson,Department of Physiology)
Dr. S. Shiyanth(Convener, Department of Anatomy)
Senior Prof. H. Peiris (Department of Biochemistry)
Dr. Varuni Tennakoon (Department of Anatomy)
Dr. Sajith Edirisinghe (Department of Anatomy)
Dr. Chandimani Undugodage (Department of Physiology)
Dr. Dinesha Sudusinghe (Department of Physiology)
Dr. P.P.R. Perera (Department of Biochemistry)
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General Objectives
At the end of the cardiovascular module, the student should be able to:
1. explain the normal structure of the heart, including its musculature,
coverings, blood supply, nerve supply and its development.
2. explain the surrounding thoracic structures, surface marking of heart and
great vessels
3. explain the normal function of the cardiovascular system by learning and
applying the relevant basic sciences.
4. apply the above knowledge to a few common real life situations
(Hypertension, Myocardial Infarction, Shock, Congenital heart disease ) to
explain how the anatomy, physiology and biochemistry are altered in the
given situations.
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Main Content Areas
Main Content Area Lectures
(Hours)
Practical/Dissections
No. of (3hrs)
sessions
Tutorials/SGD
No. of (2hrs) sessions
1. Contents of the mediastinum and structure of the heart
(Anatomy)
06 06 02
2.Arterial & venous system and embryology of the heart
(Anatomy)
03 02 01
3.Posterior mediastinum (Anatomy) 01 02 01
4.Cardiac conduction system and ECG (Anatomy, Physiology) 00,03 01,01 -
5.Cardiac cycle, heart sounds, arterial & venous pulses and
cardiac output (Physiology)
04 - 01
6.Structure of blood vessels, haemodynamics of the circulation
and normal blood pressure (Anatomy, Physiology)
01,02 01,01 00,01
7.Cardio vascular system regulation (Physiology) 02 - 01
8.Coronary circulation and regulation (Physiology,
Biochemistry)
02,02 - -
9.Cardiovascular adjustments during exercise (Physiology) 02 01 -
10.Pathophysiology of shock, hypertension, heart failure and
syncope (Physiology) 07 - 01
11. Cardio-pulmonary resuscitation (Physiology) - 01 -
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Real life situations
Real life situation 1: Myocardial Infraction
Real life situation 2: Hypertension
Real life situation 3: Shock
Real life situation 4: Congenital heart disease
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Cardiovascular Module – Phase I
A-Essential to know B- Good to know C- Nice to know
1. CONTENTS OF THE MEDIASTINUM AND STRUCTURE OF THE HEART
Intermediate Objectives Broad Content Areas Activity Duration Department
Define the mediastinum & its divisions
Describe the structures and their relationships in
superior mediastinum
Describe the contents of middle mediastinum
Describe the structure of the atria and ventricles
Divisions & contents of the
mediastinum(A)
Boundaries, structures at plane
through sternal angle:
arch of aorta, SVC, brachiocephalic
veins, carotid, subclavian and
brachiocephalic arteries,
ligamentumarteriosum, cardiac
plexus,phrenic and vagus nerves.(A)
Pericardium
- Fibrous and serous
- Oblique and transverse sinus(A)
Openings of the SVC & IVC into
the right atrium, right
atrioventricular valve, coronary
sinus, crista terminalis,
musculipectinati, interatrial septum,
fossa ovalis & limbus, Value of the
IVC and coronary sinus.(A)
Openings of the right ventricle,
Lecture
Dissection &
prosected
specimens
Tutorial
Dissection &
prosected
specimens
Dissection &
prosected
specimens
Tutorial
Lecture
1 hr
5 hrs
2 hrs
3 hrs
6 hrs
2 hrs
2 hrs
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
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1. CONTENTS OF THE MEDIASTINUM AND STRUCTURE OF THE HEART(continued)
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the major vessels from the heart
Describe the nerve supply of the heart
Describe the histology of cardiac muscle
Surface mark the cardiac borders, heart valves,
main arteries of the heart and the entrance of
superior and inferior vena cava to the heart
atrioventricular valve & its opening,
pulmonary valve & its opening,
trabeculae carneae, chordae
tendinae, papillary muscles & the
conus arteriosus.(A)
Opening of the left ventricle & the
features of their valves, papillary
muscles & the muscular &
membranous parts of the
interventricular septum(A)
Internal features of left atrium & its
openings(A)
Describe the branches of pulmonary
trunk and distribution of left and
right pulmonary arteries, aorta,
ascending aorta(A)
Sympathetic supply,
parasympathetic supply and cardiac
plexus(A)
Microscopy of cardiac muscle (A)
Surface marking
- Cardiac borders
Dissection &
prosected
specimens
Lecture
Lecture
Lecture
3 hrs
1 hr
1 hr
1 hr
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
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1. CONTENTS OF THE MEDIASTINUM AND STRUCTURE OF THE HEART(continued)
Intermediate Objectives Broad Content Areas Activity Duration Department
Interpret the imaging anatomy of the heart
- Atrioventricular, pulmonary and
aortic valves
- Origin of aorta, brachiocephalic
trunk,subclavian and common
carotid arteries, pulmonary arteries
- Entrance of superior and inferior
vena cava (A)
Cardiac borders, great vessels and
cardiac chambers (A)
Démonstrations
1 hr
Anatomy
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2. ARTERIAL & VENOUS SYSTEM AND EMBRYOLOGY OF THE HEART
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the arterial supply & venous drainage of
the heart
Describe the development of the heart
Describe the development of sinus venosus, atria,
ventricles and intracardiac septa and associated
congenital heart defects
Describe the development of the atrioventricular,
aortic and pulmonary valves and associated
congenital heart defects
Outline the development of the arterial & venous
system and associated congenital heart defects
Coronary arteries
Coronary sinus & great cardiac vein
(A)
Embryology of the heart(A)
Right and left atria
Right and left ventricles
Inter-atrial & inter-ventricular septa
ASD, VSD, Fallot’s tetralogy (A)
Atrioventricular valves aortic &
pulmonary valves (B)
PDA, Coarctation of aorta (A)
Dissection
Lecture
Lecture
Tutorial
Prosected
specimens
3 hrs
1 hr
2 hrs
2 hrs
3 hrs
Anatomy
Anatomy
Anatomy
Anatomy
Anatomy
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3. POSTERIOR MEDIASTINUM
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the boundaries and contents of the
posterior mediastinum.
Describe the course and relation of thoracic aorta
Describe course and relation of thoracic duct
Describe the course and relations of oesophagus.
(Cervical and abdominal part of oesophagus will be
covered in Head & Neck and GIT module
respectively)
Describe the azygos system of veins.
Describe the sympathetic trunk and splanchnic
nerves
Boundaries
Contents – thoracic aorta, lymphatic
system, thoracic duct, oesophagus,
azygos system of veins and
sympathetic trunk (A)
Course, branches(A)
Course, relations(A)
Relations, blood supply(A)
Course, draining structures(A)
Relations of sympathetic trunk
Course of splanchnic nerves (B)
Dissection
Dissection &
prosected
specimens
Lecture
Tutorial
3 hrs
3 hrs
1 hr
2 hrs
Anatomy
Anatomy
Anatomy
Anatomy
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4. CARDIAC CONDUCTION SYSTEM AND ECG
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the conduction system of the heart and
spread of cardiac excitation within the heart.
Explain the genesis of pacemaker potentials at the
SA node
Identify the factors affecting the discharge from the
SA node
Draw a diagram of the action potential of cardiac
muscle.
Explain the genesis of the ECG wave in relation to
its cardiac electrophysiology
Place the unipolar and bipolar leads in an adult &
describe the appearance of the normal ECG
recording from lead II and explain the waves. .
Calculate heart rate, PR interval and determine the
mean electrical axis.
Position of the SA node, AV node,
AV bundle, bundle branches and
their significance. (A)
Significance of innervation of the
heart (A)
Electrical activity of the heart (A)
Genesis of ECG wave (A)
Placing of electrodes and
description normal ECG (A)
Calculation of
- Heart rate (A)
- PR interval(A)
- Mean electrical axis(B)
Dissection
Lecture
Lecture
Practical/
demonstration
on ECG
Practical/Skills
lab
3 hrs
1 hr
1 hr
3 hrs
Anatomy
Physiology
Physiology
Physiology
Physiology
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4. CARDIAC CONDUCTION SYSTEM AND ECG (continued)
Intermediate Objectives Broad Content Areas Activity Duration Department
Outline the uses of ECG
Diagnostic uses of ECG - identify
- Abnormally slow/ rapid/
irregular rhythm
- Abnormal spread of excitation
- Changes in cardiac size
- Ischemic damage to heart
- Hypo and hyperkaleamia
(B)
Lecture
1 hr Physiology
5. CARDIAC CYCLE, HEART SOUNDS, ARTERIAL & VENOUS PULSES AND CARDIAC OUTPUT
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the light & electron microscopic features
of cardiac muscle
Describe the sequence of events that occur in the
heart during the cardiac cycle
Illustrate the pressure changes that occur in a single
cardiac cycle
Relate the genesis of arterial & jugular venous
pulses to underlying cardiac events & describe the
jugular venous pressure (JVP) and the value of
central venous pressure (CVP) measurement
Cardiac cycle - Mechanical events
(A)
Intra-atrial, intra-ventricular and
aortic - pressure changes(A)
Genesis of arterial and venous
pulses(A)
JVP/CVP(B)
Recall/Self
Study
Lecture
SGD
Lecture
2 hrs
2 hrs
1 hr
Anatomy
Physiology
Physiology
Physiology
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5. CARDIAC CYCLE, HEART SOUNDS, ARTERIAL & VENOUS PULSES AND CARDIAC OUTPUT
(continued)
Intermediate Objectives Broad Content Areas Activity Duration Department
Explain the mechanism of the production of heart
sounds
Describe the function of the heart valves and
genesis of murmurs & state the timing of the
murmurs produced by valvular defects &
congenital heart disease
Define cardiac output and state its relationship to
stroke volume and heart rate
List and explain the factors that regulate cardiac
output
Explain the principles of measuring the cardiac
output
State the changes in cardiac output in selected
conditions
Heart sounds (A)
Function of the heart valves
&murmurs (A)
Cardiac output – definition (CO)
(A)
Factors that regulate CO (A)
Principles of measuring CO (B)
Effect of selected conditions on CO
(B)
Lecture
1 hr
Physiology
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6. STRUCTURE OF BLOOD VESSELS, HAEMODYNAMICS OF THE CIRCULATION AND NORMAL BLOOD
PRESSURE
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the light & electron microscopic
features of the arterial & venous system
Describe the types of blood flow
Describe the relationship between flow,
pressure & resistance in the vascular system
Compare Windkessel vessels & resistance
vessels
Define systolic blood pressure, diastolic blood
pressure and mean arterial pressure.
List the methods available to measure the blood
pressure
Classification of arteries & veins
Features of 3 types of arteries and
veins
- Light microscopic(B)
- Electron microscopic (C)
Haemodynamics
- Types of blood flow(B)
Factors that affect blood flow (A)
Windkesselvs resistance vessels (C)
-Resistance -Pressure
-Volume -Flow
Definitions of arterial blood
pressure(A)
Methods of blood pressure
measurement(A)
Lecture
Practical
(Histology)
Lecture
SGD
Lecture
1 hr
3 hrs
1 hr
2 hrs
1 hr
Anatomy
Anatomy
Physiology
Physiology
Physiology
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6. STRUCTURE OF BLOOD VESSELS, HAEMODYNAMICS OF THE CIRCULATION AND NORMAL BLOOD
PRESSURE(continued)
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the physiological basis of measuring
blood pressure using a sphygmomanometer
List the physiological & pathological variations in
blood pressure
Perform a physical examination of the
cardiovascular system
Physiological principles of BP
measurement (A)
Variation of blood pressure (B)
- Physiological
- Pathological
Cardiovascular system examination
- Arterial and venous pulses,
blood pressure, heart sounds (A)
Practical
3 hrs
Physiology
7. CARDIO VASCULAR SYSTEM REGULATION
Intermediate Objectives Broad Content Areas Activity Duration Department
Explain the effects of altered blood flow
Describe the importance of regulation of
cardiovascular system and the factors affecting it
Importance of regulation
Factors involved
- Local mechanisms
o autoregulation,
o paracrine secretion
- Systemic mechanisms
o circulating substances
o neural mechanisms (A)
Lecture
SGD
2 hrs
2 hrs
Physiology
Physiology
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8. CORONARY CIRCULATION AND REGULATION
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the anatomy of the left and right coronary
arteries and their branches & describe venous
drainage of the heart
Describe areas of the myocardium supplied by
these arteries
Describe coronary blood flow in relation to the
cardiac cycle
Describe the regulation of the coronary blood flow
Describe the mechanism of atherosclerosis and the
factors affecting it
Describe the effects of coronary artery occlusion
and principles of diagnosis & management
Anatomy of coronary circulation
(CVS Gen. Obj. 2) (A)
Changes in coronary blood flow in
relation to cardiac cycle (A)
Regulation
- Chemical & neural factors that
affect coronary bloods flow (A)
Classification of hyperlipidaemia
Effects of oxidized LDL, Lp(a) and
homocysteine (A)
Ischaemia and Myocardial
infarction
Uses of ECG, plasma enzymes and
proteins (AST, LDH, CK,
troponins)in diagnosis of ischaemia
and myocardial infarction(A)
Selection of diagnostic tests
Physiological basis for treatment
modalities(B)
Recall
Lecture
Lecture
Lecture
1 hr
1 hr
2 hrs
Anatomy
Physiology
Biochemistry
Physiology/
Biochemistry
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9. CARDIOVASCULAR ADJUSTMENTS DURING EXERCISE
Intermediate Objectives Broad Content Areas Activity Duration Department
Changes in muscles during isometric / isotonic type
of exercise
Cardio – respiratory adjustments during isometric /
isotonic type of exercise
Perform tests to determine the function of the
autonomic system
Physiological changes in muscles
during isometric / isotonic type of
exercise (A)
Physiological adjustments in
athletes to increase exercise capacity
Beneficial effects of regular form of
exercise
Effect of cardio respiratory diseases
on exercise tolerance
(A)
Cardiopulmonary testing (A)
Lectures
Practical
2hrs
3 hrs
Physiology
Physiology
10. PATHOPHYSIOLOGY OF SHOCK, HYPERTENSION, HEART FAILURE AND SYNCOPE
Intermediate Objectives Broad Content Areas Activity Duration Department
Define shock
Describe the four major causes of shock and
explain giving examples the pathophysiology of
each one.
Explain the physiological basis of signs and
symptoms of different types of shock
Shock – definition (A)
Causes of shock with examples (A)
Physiological basis of clinical
features (A)
Lecture
3 hrs
Physiology
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10. PATHOPHYSIOLOGY OF SHOCK, HYPERTENSION, HEART FAILURE AND SYNCOPE(continued)
Intermediate Objectives Broad Content Areas Activity Duration Department
Describe the physiological basis of treatment of
each type of shock
Explain the short and long-term physiological
compensation of shock
Define heart failure
Explain the physiological basis of the common
clinical manifestations of heart failure
Describe the different types of heart failure
Describe the haemodynamic, neuroendocrine &
cellular changes that occur in heart failure
Describe the physiological basis of the treatment
principles in heart failure
Define syncope and list the causes of syncope
Physiological basis of treatment(B)
Physiological compensation(A)
Definition of heart failure(A)
Physiological basis
Common clinical manifestations
(A)
Types
- Left/right heart failure
- Systolic/diastolic HF
- Acute/chronic HF(A)
Haemodynamic, neuroendocrine &
cellular changes in heart failure(A)
Treatment principles(B)
Definition of Syncope(A)
Main causes(A)
Lecture
Lecture
2 hrs
1 hr
Physiology
Physiology
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10. PATHOPHYSIOLOGY OF SHOCK, HYPERTENSION, HEART FAILURE AND SYNCOPE(continued)
Intermediate Objectives Broad Content Areas Activity Duration Department
Explain the pathophysiological basis for the
occurrence of syncope in each of these cases
Explain the compensatory measures that maintain
the blood pressure on rising from supine positions
Define hypertension
List the causes of hypertension
Describe the pathophysiology of hypertension
Explain the physiological basis of the treatment
principles in hypertension
List the complications of hypertension (CVA, IHD
etc.)
Pathophysiological basis for
syncope (A)
Blood pressure regulation when
rising from supine position (A)
Hypertension – definition (A)
Causes (A)
Pathophysiology (A)
Treatment principles (B)
Complications (B)
Physiological basis of clinical
features, principles of treatment and
diagnosis of above abnormalities in
cardiovascular system (A)
Lecture
SGD
1 hr
2 hrs
Physiology
Physiology
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11. CARDIO- PULMONARY RESUSCITATION
Intermediate Objectives Broad Content Areas Activity Duration Department
Define cardiac arrest & cardio pulmonary
resuscitation
List the types and causes of cardiac arrest
Outline the components and stages of CPR
Perform basic life support accurately
Understand the basic principles of advanced life
support
Define cardiac arrest and CPR (A)
Types and causes of cardiac arrest
(A)
Airway, Breathing and Circulation
of resuscitation (A)
Anatomical considerations in
- Opening up the airway
- Establishing airway
- Establishing breathing and
circulation
- Maintaining breathing &
circulation
(A)
Establish A B C in advanced life
support (B)
Practical
3 hrs
Physiology
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Real life situation-1
Myocardial Infarction
Topic: Myocardial Infarction
Scenario:
You are a first year medical student. One evening, your friend from next door,
who is also a first year medical student, rushes to your home saying that his
father is ill. He asks you to come and help.
You find that your friend’s father is complaining of a severe chest pain. You
also notice that he is sweating, and he complains that he feels ‘vomitish’.
You and your friend are unsure of what to do, but from what you have heard,
you feel that the patient needs immediate medical attention. You calm the
patient, and arrange for him to be transported to the teaching hospital of your
medical faculty. The patient receives immediate treatment and undergoes a
number of investigations.
After a few days, your friend comes over to thank you, and says that the
diagnosis card indicated that his father had a ‘myocardial infarct’. He says that
he would like to know more about how to look after his father from now on, and
also wants to understand more about the disease. He asks whether you could
join him in finding out the relevant information.
You are keen to find out as much as possible to help your friend. You realize
that you already know a few things about ‘heart attacks’, but you also know that
you are unsure about many aspects. That evening, you decide to make a list of
what you already know, and the issues that you would like to find out more
about.
You then wonder how you can find out the necessary information. You are
aware that a number of lectures, practicals and tutorials are scheduled in your
medical course, and decide to look through your timetable to see whether they
may be useful. You realize that these will help you with only some of the
learning issues that you have listed above, but you decide to concentrate on
these only at this stage.
You decide to look for other sources of information that may be helpful, at a
later stage.
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Real life situation-2
Hypertension
Topic: Hypertension
Scenario:
Your uncle is thrilled to hear that you have entered the medical faculty. He
comes to you and says that now he can depend on you to measure his blood
pressure regularly, and provide necessary advice. You reluctantly tell him that
you are only a first year medical student, and that you are as yet unable to help
him. You advise him to continue visiting his regular doctor, but promise to start
helping him as soon as possible.
You are now keen to find out more about blood pressure, how the body controls
it normally, and what causes blood pressure to be high in some persons. You
decide to make a set of notes that will help you understand this condition better.
As a first step, you make a list of what you already know about blood pressure
and what more you would like to find out in order to understand this condition
better.
You are aware that a cardiovascular module is available in your medical course,
and eagerly await its commencement. You learn as much as possible about the
areas that you identified above, and complete your set of notes as far as
possible. You become aware that you can only address some of the areas at this
stage of your medical study, and decide that this is sufficient for now.
You carefully note down the areas that you want to learn about later in your
medical course.
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Real Life Situation-3
Shock
Topic: Shock
Scenario:
You are a first year medical student. On your way to the hostel after lectures
you see a group of people calling for help. When you go to the spot you see a
middle aged man lying on the road with a stab injury on the left lower aspect of
the chest. There is bleeding from the wound.
After a few minutes paramedics arrive at the scene and check his pulse and
blood pressure. His blood pressure was 90/60mmHg and pulse rate was 120
beats/min. The paramedics mention the “shock”. They elevate his legs and
insert two cannulae and start transfusion of intravenous fluids. The patient is
then rushed to the Kalubowila hospital.
Now you are interested in finding out what the paramedics meant by the term
“shock” and how it occurs. You know your CVS module is the next module.
Before the commencement of that module, you decide to list out what you
would like to learn about shock and related topics. You then proceed to make
some notes about “shock” with the help of reading material in the library and
the IT lab.
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Real Life Situation-4
Congenital heart disease
Topic: Congenital heart disease
Scenario:
You are a first year medical student. One of your neighbor visits your
home, with her 3 months old child seeking your help to know details in the
diagnosis card given at CSTH about her child’s health condition. On inquiry,
she further states that her child’s lips were turning to bluish colour gradually
over last two months. Child also experienced sudden loss of conscious attacks.
As you keenly went through the diagnosis card it further stated, that child was
diagnosed as having Tetralogy of Fallot.
Even though you didn’t start CVS module, you are interested in finding
out what the term “Tetralogy of Fallot” means and why the child turned into
blue. You know your CVS module is the next module. As you glance through
the contents of the CVS module, you found the Tetralogy of Fallot comes under
the congenital heart disease. You also got to be aware that a sound knowledge
in development of the heart is essential in better understanding. With the core
knowledge you had acquired in basic embryology, you proceed to learn about
the development of the heart with the help of lecture, text books and accepted
references using internet. (Please go to peer reviewed referenced sites)
December 2017 Version 2.0
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Recommended readings
Note- Students are expected to read the latest edition
Anatomy
Cunningham's Manual of Practical Anatomy by G. J. Romanes
Clinical Anatomy – Applied Anatomy for students and Junior Doctors by
Harold Ellis Vishy Mahadevan
Grant’s Atlas of Anatomy by Anne M.R.Agur and Arthur F. Dalley
Human Embryology by Indebir Singh
Langman’s Medical Embryology by by Thomas W. Sadler
Wheater's Functional Histology: A Text and Colour Atlas by Barbara
Young, Geraldine O'Dowd and Phillip Woodford
Biochemistry Lecture notes on Clinical Chemistry – L.G. Whitby, A.F. Smith and I.W.
Percy-Robb
Clinical biochemistry by William Marshall, Marta Lapsley and Andrew Day
Physiology Ganong’s Review of Medical Physiology by Kim E. Barrett, Susan M.
Barman, Scott Boitano and Heddwen L. Brooks
Guyton and Hall Textbook of Medical Physiology by John E. Hall
Hutchison's Clinical Methods by Michael Glynn and William M. Drake
Pathophysiology of Disease: An Introduction to Clinical Medicine by Gary
D. Hammer and Stephen J. McPhee
Chapters on cardiovascular disorders,
Vascular disease & cardiovascular disorders: heart disease
Kumar & Clark’s Clinical Medicine by Parveen Kumar & Michael Clark
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