INTRO TO THE CARDIOVASCULAR SYSTEM

Nadine Gauthier, MDDivision of Cardiology

Content Expert - Cardio

OUTLINE

• What to expect during the next 5 weeks…

• Cardiology 101– Basic anatomy– Physiology of the cardiovascular system– Functional differences between the right and

left ventricle– Cardiovascular medicine

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Cardiovascular: 5 Weeks

Oncology: 1 Week

Thrombosis: 1 Week

Lymphoma: 1 Week

PERSPECTIVE

Homeostasis: 1 Week

Respiratory/ENT: 5 Weeks

Renal: 4 Weeks

Week Mon Tue Wed Thu Fri

1Normal

Intro to Unit + “Block” (1h)Electrical Activation of the Heart (2h)Myocardial Contraction (1h)

CBL 1 (2h) Ventricular Function (1h)Smooth Muscle + Coronary Physiol (1h)ECG Seminar #1 (2h)

Heart Anatomy (1.5h)Heart Histology (1.5h)Autonomic Nervous System (1.5h)

CBL 2 (3h)

Week Review (1h)

2CHF

Physiology of Abnormal Ventricular Function (1h)Heart Failure (1h)Introduction to Cardiac Imaging Part 1 (2h)

CBL 1 (2h) Acute Decompensated Heart Failure (1h)Shock (1h)ECG Seminar #2 (2h)

Pressure-Volume Loops (1.5h)Fluid Dynamics (1.5h)Cardiomyopathy (1.5h)

CBL 2 (3h)

Week Review (1h)

3CAD

Ischemia (1h)Atherosclerosis (1h)Myocardial Ischemia Testing (2h)

CBL 1 (2h) Acute Coronary Syndromes (1h)Antithrombotic and Reperfusion Therapy (1h)ECG Seminar #3 (2h)

Vessel Anatomy (1.5h)Vessel Histology (1.5h)Ischemia and Infarction (1.5h)

CBL 2 (3h)

Week Review (1h)

4Valves

Physiology of Valvular Heart Disease (2h)Pulmonary Hypertension (1h)Surgery of Valvular Heart Disease (1h)

CBL 1 (2h) Endocarditis (1h)Pericardial Disease (1h)Mechanisms of Arrhythmia (2h)

Echo Lab: Heart and Valve Function (1.5h)Pathology of Valve Disease (1.5h)Aortic Pathology and PVD (1.5h)

CBL 2 (3h)

Week Review (1h)

5Con-

genital

Cardiovasc. Embryology (2h)Physiology of Congenital Heart Disease (1h)Introduction to Cardiac Imaging Part 2 (1h)

CBL 1 (2h) Outline of Congenital Heart Disease (2h)

ECG Seminar #4 (2h)

Treatment of Arrhythmia (1.5h)Arrhythmia Review (1.5) Clinical Problems in Pediatric Cardiology (1.5h)

CBL 2 (3h)

Week Review (1h)

The Cardiology “Block” of Unit 1

Electives:1-2/week

Physician SkillsDevelopment

(PSD)3h every Thu PM

PLUS:

Whole-Class Teaching; Part-Class Teaching; Small-Group Teaching

Self-LearningModules (SLMs)

1-2/week

Society,Individual,Medicine

(SIM)2h every Tue AM

TEACHING AND LEARNING

• Different types of teaching sessions– Lectures, workshops– SLM, SIM, PSD, Lab– CBL

• Different teaching styles• Be prepared, be engaged• Resources

– Lilly, LS, éd., Pathophysiology of Heart Disease, 5e édition, 2011

CARDIO BLOCK

• What students have liked best about Cardio:

– Structure, organization, flow

– CBL tutors, lecturers, teachers

– Textbook: Lilly

ANATOMY

• A complex organ, more than meets the eye!!!• This is not what the human heart looks like…

• What the heart really looks like:

Size :Human fist

Weight :300 g (women)325 g (men)

HEART POSITION

ANATOMY

THE HEART IS A PUMP

• Inlets• Priming Chambers• Valves• Pumping

Chambers• Valves• Outlets

THE HEART IS A DOUBLE PUMP

Right Heart Left Heart

Inlet Venae Cavae Pulmonary veins

Intake ports Right atrium Left atrium

Valves Tricuspid valve Mitral valve

Motor Right ventricle Left ventricle

Valves Pulmonic valve Aortic valve

Discharge ports Pulmonary artery Aorta

•Triggered and coordinated by an integrated electrical system…

COMPLEX MATCHED ELECTRICAL AND MECHANICAL ACTIVITY

Distinct territories of coupled electrical and mechanical activity

PHYSIOLOGY

• Heart main function: mediates blood oxygenation

Nutrients + O2↓

Energy + CO2

HOW DOES IT DO THAT?

In 2 steps:1. It receives (relatively) deoxygenated (and

CO2-rich) blood from the body and pumps it to the lungs;

2. It receives oxygenated (and CO2-poor) blood from the lungs and pumps it to the body

QUESTION 1: TRUE OR FALSE?

Venous (“deoxygenated”) blood is blue:

QUESTION 1: TRUE OR FALSE?

Venous (“deoxygenated”) blood is blue: FALSE!

Venous blood is dark red:Arterial blood is bright red:

QUESTION 2

• How many times will the average heart beat over the course of a lifetime?

1. 3 million times2. 3 billion times3. 3 trillion times4. 3 quadrillion times

QUESTION 3

• What is the lowest recorded resting (physiologic) heart rate recorded in human?

1. 48 bpm2. 38 bpm3. 28 bpm4. 18 bpm

Martin Brady (UK, b. 24 March 1969) who was tested at the Guernsey Chest and Heart Unit, Channel Islands, UK on 11 August 2005.

CARDIOVASCULAR MEDICINE

• So much emphasis is placed on the fancy and the expensive…

CARDIOVASCULAR MEDICINE

• But so much of what cardiovascular medicine has to offer is simple and cheap:

CARDIOVASCULAR MEDICINE

• Diagnosing heart disease by history:

– “Doctor, I get a squeezing discomfort in the center of my chest every time I carry the laundry back up from the basement.”

THE STETHOSCOPE…

• Diagnosing heart disease on physical examination:

PHYSICAL EXAM SKILLS

• Practice makes perfect• Be patient• Easier to learn with pathology• Use the resources available to you

– Heart sounds CD and websites– Harvey the manequin (SIM centre)– Important website (designed by a local

cardiologist)http://www.cvtoolbox.com

CARDIOVASCULAR MEDICINE

• Diagnosing heart disease with simple investigations: ECG

CARDIO SKILLS TEACHING WEBSITE

• www.teachingmedicine.com• Create a login/password• You will receive an email/link inviting to

participate in this strongly recommended online modules

• Non-mandatory modules – Week 1:

• Module 1: Basic Electric Stuff• Module 2: Analyze the Waveforms• http://www.teachingmedicine.com/faculty.aspx

CARDIOVASCULAR SPECIALTY MEDICINE

• Postgraduate Training• Not as bad as it seems…

Cardiac Surgery

Anesthesiology

CardiologyInternal Medicine

CardAnesth

“Basic Training” = 6 years Additional Training = 1-3 years

THE HEART IS #1

It is a vital organ Simple yet complex It is a selfless organ

Leading cause of death in both men and women

#1 = CV disease #2 = Infectious disease #3 = malignancy

#1 Organ In Spoken EnglishHappy

Light-heartedTake heartHeartenedDoes your heart goodWarms the cockles of your heart

LoveSweetheartHeartthrobSteal your heart

Kind/GenerousBig-heartedFrom the heartHeart in the right placeHeart of goldCold hands, warm heart

SincerelyHeartfeltWhole-heartedFrom the bottom of my heart

Strong/BraveLion-heartedBrave-hearted

Compassion/ConcernDon’t have the heart toMy heart goes out to youSoft place in my heartTug at your heartstrings

Excited/FrightenedHeart skipped a beatHeart in your throatHeart-pounding

SadHeavy-heartedDisheartenedHeartbrokenHeartacheBroken hearted

Cowardly/WeakChicken-heartedFaint-hearted

Med SchoolSet your heart onEat your heart outLearn it by heartCross your heartKeep heart

#1 ORGAN IN MOVIES

• Of 4631 movies (1900-2003) containing body parts in their titles:

– Heart(s) 985 21.3%– Blood 651 14.1%– Eye(s) 633 13.7%

#1 ORGAN IN MUSIC

• Of 341,145 songs (1850-2003) containing body parts in their titles:

– Heart(s) 96,989 28.4%– Eye(s) 65,985 19.3%– Head 37,281 10.9%

EXAMPLES: “WINNERS”

• Academy Awards for Best Song– “A Dream Is a Wish Your Heart Makes” (Snow White)– “My Heart Will Go On” (Titanic)

• Number 1 Hits– 1972: “Heart of Gold” (Neil Young)– 1987: “Open Your Heart” (Madonna)– 1989: “Cold Hearted” (Paula Abdul)

EXAMPLES: OTHERS

• “Achy Breaky Heart”– Like father, like daugher

• “Please Bypass This Heart”• “I’ve Been Flushed from the Bathroom of Your

Heart”• “I Don’t Want Your Body if Your Heart’s Not in It”• My Heart Will Go On was also a #1 hit in 1998

FINAL THOUGHTS

• CBL tutors are first-line resources for questions about content

• Questions about exam format– Unit Chair

• Other questions: ngauthier@toh.on.ca – cc: class president(s)

NO SUCH THING AS A LITTLE HEART ATTACK

QUESTIONS?• HAVE FUN !!!• ASK QUESTIONS !!!

ngauthier@toh.on.ca