outcome of the undergraduate curriculum -...
TRANSCRIPT
1
Cardiovascular System Module
Faculty of Medicine
King Abdulaziz University
Phase 2, MBBS1429/1430 H (2008/ 2009)
Phase 2 2003/2004 Year 2
TABLE OF CONTENTS TOPIC Page
THE OUTCOMES OF THE UNDERGRADUATE CURRICULUM 4
CURRICULUM MAP 5PHASE 2 5STRUCTURE OF THE MODULE 6INTRODUCTION 7AIMS & OBJECTIVES 8TEACHERS CONTACTS 6ASSESSMENT 11ICONS 13TOPIC OUTLINES 14
NO. LECTURES (NAMES)1 Introduction to the cardiovascular system: 152 Cellular events in the heart 173 The Heart as a pump// 194 Anatomy of the Mediastinum and Pericardium . 215 External Features of the Heart and coronary vessels 236 The control of the cardiac output 257 Cardiac Cycle 278 Plasma lipoprotein-composition, structure and function 299 internal Features of the Heart. 3110 Normal development of the heart 3311 The Electrical activity of the heart and the ECG 3512 Cardiac arrhythmias 3713 Congenital anomalies of heart 3914 The autonomic nervous system and the cardiovascular system 4115 Relationship between pressure, flow and resistance 4316 Cholesterol and triglycerides transport pathways 4517 Myocardial & Pericardial Diseases 4718 Pressure and flow in systemic circulation 49
19 Predict how CVS will react in common situations: eating a meal, exercise and changes in posture 51
20 Special circulations: Coronary , Pulmonary , Cerebral and Skeletal circulation 53
21 Atherosclerosis and Aneurysm 5522 Ischemic heart Disease 57
King Abdul Aziz University Faculty of Medicine and Allied Sciences
Phase 2 Cardiovascular Module Year 223 Antihypertensive drugs 5924 Tissue fluid formation and Edema 6125 Valvular Heart Diseases 6326 Infective Endocarditis. 6527 Hypertension and Effects on Blood Vessels and Heart 6728 Vasculitis & Cardiovascular Tumors 6929 Anti-anginal drugs 7130 Anti-arrhythmic drugs 7331 Hyperlipoproteinamias and hypolipoproteinaemias 7532 Diagnostic cardiac enzymology 7733 Drugs used in heart failure 7934 Cardiovascular Investigations 8135 Cardiovascular causes of chest pain 82NO. PRACTICAL (Names)
1 Middle mediastinum, heart in situ 852 Heart sounds – prediction of timing of uncomplicated murmurs 863 External features of the heart and coronary vessels 874 Internal features of the heart 885 ECG Recording 896 Determination of lipoproteins/plasma lipids 907 Atherosclerosis 918 Cardiac enzymes and proteins 929 Myocardia Infarction/ Valvular Heart Diseases 9310 Effects of Drugs on Isolated Mammalian Hear 94
TUTORIALS
1 Anatomy of the Heart and coronary vessels 95
2 Atherosclerosis /MyocardiacInfarction/ Valvular Heart Diseases/ Hypertension 96
INDEPENDENT LEARNING
1 Study Histology of blood vessels and relate structure to function in the circulation 97
2 Embryology of the heart and great vessels 983 Study of common congenital defects 994 Factors affecting tissue perfusion 100
PROBLEM BASED LEARNING (PBL)1 Case studies of patients with chest pain 1022 Case studies of heart failure 1073 Case studies of valvular disease 1114 Case studies of circulatory shock 115
King Abdul Aziz University Faculty of Medicine and Allied Sciences3
Phase 2 Cardiovascular Module Year 2
Undergraduate Program Learning Outcomes
CodeLearning Outcomes
KnowledgeBy the end of the program the graduate will be able to:
A1 Describe normal human development across the life-span and how these affect normal structure and function.
A2 Describe normal structure and function of the major systems and how they interrelate.
A3 Describe the molecular, biochemical and cellular basis essential for maintaining homoestasis.
A4 Demonstrate knowledge of the basic medical sciences that explain causes and mechanisms of disease.
A5 Describe the alterations in structure and function of major body systems as a result of illness or injury.
A6 Demonstrate knowledge and understanding of the pharmacological principles of treatment using drugs, their efficacy in the management and symptomatic relief of diseases, as well as their side effects.
A7 Discuss the implications of basic ethical principles, including confidentiality, informed consent, truth telling, and justice, for the care of patients.
A8 recognize the legal background of medical practiceA9 Explain the causes and mechanisms of intoxication.A10 Describe the role of family, community, and culture as factors influencing
patient presentations, interpretations of illness episodes and adherence to treatment episodes.
A11 Demonstrate knowledge and understanding of the natural history of disease and relationships with risk factors and disease prevention.
A12 Recognize and discuss the principles of disease surveillance and screening, disease prevention, communicable disease control, health promotion, and health needs assessment.
A13 Describe strategies to support life-long learning via print and electronic sources to assist in making diagnostic and treatment decisions and to remain current with advances in medical knowledge and practice.
A14 Demonstrate knowledge of how to use the basic medical sciences and clinical skills for clinical decision making and problem solving in the care of patients.
A15 Recognize the scientific basis of health, disease, and medicine in the management of common and high impact conditions in the society.
A16 Demonstrate knowledge of the functional approach to managing chronic conditions, including knowledge of the impact of chronic illness on function.
A17 demonstrate basic knowledge of the global health care delivery system in the community including physicians, hospitals, outpatient centres, health agencies and the role of community agencies in that system.
A18 Recognize the management of common emergencies and the initial and the life saving management steps for other emergencies.
A19 Identify the "Red flags" indicating seriousness in the different clinical presentations.
King Abdul Aziz University Faculty of Medicine and Allied Sciences4
Phase 2 Cardiovascular Module Year 2Cognitive Skills
By the end of the program the graduate will be able to:
B1 Recognize, define and prioritize problems.
B2 Demonstrate the ability to acquire new information and data.
B3 Critically appraise validity and applicability of acquired information to one’s professional decisions.
B4 Organize, record, research, present, critique, and manage clinical information.
B5 Recognize the limitations of knowledge in medicine and the importance of triangulation of evidence before reaching a decision.
B6 Evaluate the patient’s medical problems.
B7 Formulate accurate hypotheses to serve as the basis for making diagnostic and treatment decisions.
B8 Reflect on one’s thinking process and decisions and apply rational processes.
B9 Use appropriate intellectual strategies to deal with uncertainties when they arise.
B10 Demonstrate an understanding of research methodology.
B11 Formulate research questions.
B12 Draw research hypotheses.
B13 Choose appropriate research methodologies and designs.
B14 Select appropriate methods of data collection.
B15 Analyse and interpret collected data.
Interpersonal Skills & ResponsibilityBy the end of the program the graduate will be able to:
C1 Display the personal attributes of compassion, honesty, and integrity in relationships with patients, families, communities and the medical profession.
C2 Exhibit appropriate value for the sensitive nature of the doctor/patient relationship and the importance of active listening, with attention to the patient’s familial, cultural, and spiritual circumstances.
King Abdul Aziz University Faculty of Medicine and Allied Sciences5
Phase 2 Cardiovascular Module Year 2C3 Demonstrate professionalism and high ethical standards in all aspects of
medical practice, specifically competence, honesty, integrity, respect for others, professional responsibility and social responsibility.
C4 Exhibit a capacity for self-evaluation, moral reflection and ethical reasoning to form the basis for a self-directed, lifelong engagement in the responsible, committed, compassionate practice of medicine.
C5 Apply the four principles of ethical and legal knowledge, namely respect for autonomy, beneficience, non-maleficience and justice.
C6 Demonstrate awareness and understanding of the legal and professional responsibilities; and report inappropriate medical practice.
Communication, Information Technology & Numerical SkillsBy the end of the program the graduate will be able to:
D1 work effectively as part of a health care team
D2 communicate effectively with patients, their families and colleagues, both verbally and in writing
D3 retrieve information by all means including electronically
D4 present information clearly in written, electronic and oral forms
D5 work within a changing, multi-task environment
Psychomotor SkillsBy the end of the program the graduate will be able to:
E1 Elicit accurate comprehensive and focused medical history by employing techniques that facilitate the patient’s sharing of information.
E2 Conduct a both effective and accurate comprehensive and focused physical examination.
E3 Formulate a differential diagnosis.
E4 Select the appropriate laboratory tests and radiographic studies and interpret their results and use them in making diagnostic and treatment decisions.
E5 Formulate and implement a plan of care for both the prevention and treatment of disease.
E6 Educate patients about their health problems and to motivate them to adopt health promoting behaviors.
King Abdul Aziz University Faculty of Medicine and Allied Sciences6
Phase 2 Cardiovascular Module Year 2E7 Use pharmacotherapeutic agents and other therapeutic modalities
effectively.
E8 Demonstrate appropriate technique for performing Basic Life Support and Advanced Life Support.
E9 Undertake tasks to initiate and be involved in the care of acutely ill patients.
King Abdul Aziz University Faculty of Medicine and Allied Sciences7
Phase 2 Cardiovascular Module Year 2
CURRICULUM MAP YOU ARE HERE…
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Internship
Phase I Phase II Phase III
Phase 2, is the first stage towards achieving the objectives specified in the curriculum. The aim is to lay down a solid foundation for the subsequent full-time clinical study in phase 3 of the MBBS program. This foundation will include knowledge, skills and attitudes, particularly attitudes toward the learning process. The curriculum philosophy in Phase 2 is enforcing the development of a mixture of teaching approaches including “student-directed learning”. By the end of Phase 2, you should be ready to be much more involved in the control of the learning process
SECOND YEAR
3RD SEMESTER 4TH SEMESTER
Cells and Tissues General Anatomy (2)
Biochemical Basis of Medicine (1) Biochemical Basis of Medicine (2)
General Anatomy (1) Basic Emergency Care
Embryology Cardiovascular System
Pathology (1) Respiratory System
Communication Skills (1) Immune, Blood lymphatic System
Musculoskeletal System Islamic Studies (4) and Medical Ethics
Islamic Studies (3) Arabic Language (2)
King Abdul Aziz University Faculty of Medicine and Allied Sciences8
Second Year Courses
Phase 2 Cardiovascular Module Year 2
TIMETABLED HOURS:
STUDENT DIRECTED LEARNING:
TEACHING DEPARTMENTS:
MODULE COORDINATOR:
35 Lectures + 2 Tutorials + 10 Practicals presentations + 4 PBL seminars
4 Topics
e.g.Anatomy, Physiology, Pharmacology, pathology, Clinical Biochemistry, Medicine, Radiology, paediatric
Dr. Mohamed Ajab Noor
MODULE MEMBER CONTACTS Contacts
E-mailExtMobilPagerDept.PostName
[email protected] 221000555649250Clinical biochemistry
Head prof. Mohameed Ali Ajab noor
[email protected] 1824305055361081516Internal medicine
coordinatorDr. Aish mukarrm siddiqui
[email protected] 0500959327anatomyMemberprof. Ashraf youssef nasr naeem
[email protected] 202180501834576pharmacologyMemberprof.Abdelmoneim mohamoud osman
Abdelrahman.fahmy@hotmail
221110507620596physiologyMemberProf.Abdelrahman fahmy
[email protected] 2107721035
05623943173426pathologyMemberDr.Taha motamad hassan
[email protected] Ahmad mimish
[email protected] Bader
[email protected]. Sawsan Raheem.
[email protected] 050938357321177
21197AdministrativeCoordinator
Moataz Alshafei
050369658123075AdministrativeHanan Alghassal
King Abdul Aziz University Faculty of Medicine and Allied Sciences9
STRUCTURE OF THE MODULE
Phase 2 Cardiovascular Module Year 2Coordinator
INTRODUCTION:
Welcome to the Cardiovascular System Module. Our objective over the next four weeks
is not to teach you to be a cardiologist, or even to teach you all you need to know about
Cardiology to qualify in medicine. Our objective is to lay down the foundations on which
you can build, for yourselves, the knowledge of Cardiovascular medicine that you will
require in whatever branch of medicine you choose to follow.
The Cardiovascular system is of particular significance for the following reasons:
Cardiovascular disease account for the biggest single group of disorders
presenting to the primary care physician.
The heart is intimately associated with respiratory function due to the pulmonary
circulation.
Integrity of the cardiovascular system is central to the proper functioning of other
major systems such as the Central Nervous System and Respiratory System.
Therefore, treatment of cardiovascular failure is central to resuscitation in life-
threatening conditions e.g., trauma, drug over dose and shock.
The cardiovascular system, like the heart itself, is at the very centre of medicine. We hope
you enjoy the next four weeks. There will be other modules ahead, but a good grounding
in Cardiovascular module will be an important stage of your journey through this system-
based course.
Revision:Before you start the cardiovascular module, we recommend you to revise the
following subjects:
The histological structure of the major tissues of the body, such as epithelia, endothelia
and smooth muscle
The composition of blood and the cell types it contains, and the principles of
haemostasis.
The process of formation of tissue fluid and oedema.
King Abdul Aziz University Faculty of Medicine and Allied Sciences10
Phase 2 Cardiovascular Module Year 2
Aims:The aims of this module are to:
Study the structure and function of the human cardiovascular system and compare it
with abnormal structure and function.
Study the assessment of the cardiovascular system and how its function is altered in
common disease states.
Acquire skills and working knowledge and understanding of the principles and
concepts applicable to the cardiovascular system in general provide the basis for the
study of common clinical conditions and disorders, and for the clinical examination
together with performing simple clinical procedures related to the cardiovascular
system and its management.
ObjectivesBy the end of this module you should be able to:
Describe the structure and relations of the heart and major blood vessels of the body
and relate their structure to function in the circulation
Describe the operation of the heart as a pump, including the function of the heart
valves, and be able to use your understanding of the cardiac cycle as a basis for
physical examination of the heart.
Describe the development of the heart, some common congenital defects, and the
pathology of valvular problems.
Describe the factors influencing blood flow to individual tissues and the mechanisms
of control of vascular resistance.
Describe in general terms the role of the autonomic nervous system in the control of
cardiovascular function, including the concepts of local and central control.
Describe the mechanisms controlling cardiac output in the normal individual, and how
they operate in common situations such as exercise.
Describe the special features of the pulmonary, cerebral, coronary, skin and skeletal
King Abdul Aziz University Faculty of Medicine and Allied Sciences11
Phase 2 Cardiovascular Module Year 2muscle circulations
Describe the features of the normal electrocardiogram and their relation to electrical
events in the heart, and be able to interpret changes in the ECG produced by common
clinical conditions.
Describe the molecular and cellular events underlying the cardiac cycle, the principles
of altering heart rhythm and contractility by drugs
Describe the structure and properties of the coronary circulation, and the pathology and
effects of ischemic heart disease.
Describe basic material relevant to the assessment, diagnosis and treatment of a patient
presenting with acute chest pain
Describe some common reasons for and the major effects of chronic heart failure.
Describe the possible reasons for, effect of, and principles of treatment of
hypertensions.
King Abdul Aziz University Faculty of Medicine and Allied Sciences12
Phase 2 Cardiovascular Module Year 2
Transferable Skills:By the end of this module, you will demonstrate the ability to:
Assimilate and integrate information from lectures, practical sessions, tutorials, clinical
presentation sessions and independent learning activities
Gain practical skills associated with the dissection of the cadaver and the examination
of the living
Interpret two-dimensional images of the cardiovascular system radiographic techniques
Explain the pathology of cardiovascular system and drug action in relation to the
underlying processes.
Cross modular themes1) Concurrent modules:
The work on the overall structure of the circulation will relate closely to the
musculoskeletal module, where students study the circulation of the limbs.
The work on the autonomic nervous system and cellular and molecular events in the
heart will closely relate to the material in other core courses of the second year.
Physical examination of the cardiovascular system will be learned within the clinical
stream and practical of the module
The study of myocardial infarction and other aspects of ischemic heart disease will be
reinforced by material discussed in clinical presentations.
2) Future modules:
The respiratory system module will pick up on the properties of the pulmonary
circulation
Both renal-urinary system and gastrointestinal system modules will deal with their
respective special circulations.
The renal urinary system module will deal with the control of blood volume, and pick
up again the them of hypertension
The reproductive system module will deal again with the foetal circulation
King Abdul Aziz University Faculty of Medicine and Allied Sciences13
Phase 2 Cardiovascular Module Year 2
Assessment: (EXAMPLE)
1. Formative:
This form of assessment is designed to give you feedback to help you to identify areas
for improvement. It includes a mixture of MCQs, short answer-questions (SAQs),
extended matching questions (EMQs), problems-solving exercises and independent
learning activities in all subjects. These will be given during tutorial sessions and
practicals. The Answers are presented and discussed immediately with you after the
assessment. The results will be made available to you.
2. Summative
This type of assessment is used for judgment or decisions to be made about your performance. It serves as:
a. Verification of achievement for the student satisfying requirementb. Motivation of the student to maintain or improve performancec. Certification of performanced. Grades
In this Course your performance will be assessed according to the following:
1. Continuous Assessment 40 Marks
2. Final End of Semester Exam (Two Hours) 50 Marks
3. Final OSPE (Practical) 10 Marks
Total = 100 Marks
Write short description about assessment tools for example………….
Exams: Written Exams will include short answer and multiple choice questions (MCQs).
They will cover material presented in lecture, readings, and discussion. All exams must be
taken on the date scheduled. In case of an emergency, the coordinator must be notified.
No make-up exams will be provided if you fail to notify and discuss your situation with
the coordinator. Practical Exam will be in an OSPE (Objective Structured Practical Exam)
format, where you will pass through several stations representing all the subjects.
King Abdul Aziz University Faculty of Medicine and Allied Sciences14
Phase 2 Cardiovascular Module Year 2
Assignment paper: The purpose of the work is to provide you with the opportunity to
explore an area of basic medical sciences or medical education in depth. The paper is to be
a 10-15 page literature review of the topic will constitute 20% of your final grade. Policy:
Topics must be approved in writing by the coordinator. Directions for topic submission
will be discussed during the first week of class. Topics that have not been approved will
not be accepted.
All papers must reference a minimum of eight references from refereed journals. All
papers must be typed, double-spaced, have 1 inch margins.
Note: We will be making the journey from "womb to tomb" in 15 weeks. Therefore, this
course requires an intensive coursework load. Class attendance and participation are
extremely important to your learning and as such are considered in the evaluation of your
course grade. This course is recommended for students that can make the required time
and energy commitment. If there is anything that the coordinator can do to assist you
during the course, please feel free to contact him.
Course work:
You are required to complete satisfactorily one piece of work during the course. This may involve a variety of activities, from essays to problem-solving papers and short answer-questions to posters and presentation.
Icons (standards)
The following icons have been used to help you identify the various experiences you will be exposed to.
Learning objectives
King Abdul Aziz University Faculty of Medicine and Allied Sciences15
Phase 2 Cardiovascular Module Year 2
Content of the lecture
Independent learning from textbooks
Independent learning from the CD-ROM. The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Problem-Based Learning
Self- Assessment (the answer to self-assessment exercises will be discussed in tutorial sessions)
The main concepts
King Abdul Aziz University Faculty of Medicine and Allied Sciences16
Phase 2 Cardiovascular Module Year 2
Topic Outlines
King Abdul Aziz University Faculty of Medicine and Allied Sciences17
LECTURES
Phase 2 Cardiovascular Module Year 2
Lecture 1:Introduction to the cardiovascular system
Department: PhysiologyLecturer: Prof. Hossam Awad Prof. Maha Hegazi
By the end of this lecture the student will study the functional structure parts of the heart and circulatory system
1. Outline the different functional structure of the heart
2. Describe the component of the circulatory system
3. Match the specific vascular structure with its particular function
4. Describe how the arterioles are responsible for the peripheral resistance
5. Define the capacitance vessels6. Describe the importance of the cardiac valves
1. Distinguish between the contractile, conductive and pace maker tissues of the cardiac muscle
2. Summarize the conduction pathway of impulse over the heart
3. Identify how the impulse is auto-generated in the cardiac muscle
Student Notes: .
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences18
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 1:Introduction to the cardiovascular system
See the Study guide of CV module
Try to access CD-ROM series about the CVS, just look to the main topics in each CD-ROM and be sure you know how to run it for future independent learning.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key word – Cardiovascular System –in the search engine google (www.google.com). The aim is to be able to use the search engine and also to recognize the rich resources in the web. Don’t read any details at this stage. Later in the course, we will direct you to specific useful sites.
http://www . Google.com
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences19
Phase 2 Cardiovascular Module Year 2
Lecture 2:Cellular events in the heart
Department: Physiology
Lecturer :Prof. Hossam Awad Prof. Maha Hegazi
By the end of this lecture you should be able to describe the following:
understand the cardiac property (Automaticity)
understand the cardiac property (Excitability) Apply his information on a different
situations
1. Explain cardiac automaticity
2. distinguish between slow and fast action potential
3. predict the effects of ionic, chemical and neural changes on cardiac automaticity
4. Summarize myocardial excitability phases
5. Explain the significance of plateau phases in prolongation of ARP
6. Related the phases of cardiac action potential to excitability and contractility
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences20
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 2:Cellular events in the heart
King Abdul Aziz University Faculty of Medicine and Allied Sciences21
Phase 2 Cardiovascular Module Year 2
Ganong, Review of Medical Physiology, 20th edition,
page: 528 - 532
You have the opportunity to watch the CD-ROM about the electrical activity of the heart. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web sites about the cardiovascular system but these should not used in isolation. I would recommend you look at the following web site:
http://www.cvphysiology.com/Arrhythmias/A007.htm
Self-assessment
Draw the action potential of ventricular cell and compare it with the action potential of a single sinatorial cell.
Answer MCQs (8) in Ganong, Review of Medical Physiology, 20th edition, page: 761
Student Notes: .
Lecture 3:The Heart as a pump King Abdul Aziz University Faculty of Medicine and Allied Sciences22
Phase 2 Cardiovascular Module Year 2
Department: Physiology
Lecturer: Prof. Hossam Awad Prof. Maha Hegazi.
At the end of the lecture you should be able to:
Understand the cardiac property (Conductivity ).
Understand the cardiac property (Contractility).
Apply his information on a different situations
1. Explain how the excitation wave is conducted to the contractile muscle fibers
2. Explain the excitation contraction coupling in cardiac muscle.
3. Predict the importance of Ca++ om cardiac contraction
4. List factors affecting contractility5. Define Frank-Starling law, and explain its
mechanism.6. Discuss the effect of sympathetic stimulation on
cardiac contractility and explain its mechanism.7. Compare between the increased cardiac
contraction force and stroke volume by the increased preload and the sympathetic stimulation (as regard the mechanism, the O2 consumption, the limitation, and the benefits).
.
Think of the heart as an elastic band – the more you stretch it initially, the further you can fire it. This will help you understand Starling Law. Remember, however, that the force of contraction can also be affected by other extrinsic factors, e.g. sympathetic stimulation. Starling’s law is not the only factor that affects Stroke volume.
Student Notes: .
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences23
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 3:The Heart as a pump
Ganong, Review of Medical Physiology, 20th edition,
page: 545 and page 552- 553
You have the opportunity to watch the CD-ROM about the Cardiac contractility. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system but these should not used in isolation. I would recommend you look at the following web sites:
http://www.elon.edu/shouse/physiology/physiol22/Lecture14.html
Self-assessment
Briefly answer the following short question:
It takes several months for nerves to grow into transplanted hearts. However, before the nerves grow in patients with transplanted hearts, exercise increases their cardiac output. What is the mechanism involved, and how does it operate?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences24
Phase 2 Cardiovascular Module Year 2
Lecture 4: Anatomy of the Mediastinum and Pericardium Department: AnatomyLecturer: Prof. Dr. Said Zaghloul Prof. Dr. Amira El-haggagy
At the end of the lecture you should be able to:
1) List the subdivision of the mediastinum and
their components.
2) Boundaries and contents of different mediastina
3) Describe the types of the pericardium
4) Identify the pericardial sinuses
5) Describe the innervation and arterial supply of
pericardium
* Mediastinum: Definition, Boundaries and parts.* Describe the boundaries, contents and relations of
each part.* Pericardium: types, cavity, sinuses, blood and
nerve supply and clinical importance.
King Abdul Aziz University Faculty of Medicine and Allied Sciences25
Phase 2 Cardiovascular Module Year 2
Continue … Lecture4:
Richard S. Snell. Clinical Anatomy for Medical students, 7th edition, Lippincott, Williams
and Wilkins.
* Lectures notes in the Department of Anatomy Web Sites and its attached links: WWW.kauanatomy.com
Self Assessment* Prepare a simple presentation about one of the following topics:- Middle mediastinum (boundaries and contents).- Fibrous pericardium- Pericardial sinuses
King Abdul Aziz University Faculty of Medicine and Allied Sciences26
Phase 2 Cardiovascular Module Year 2
Lecture 5: External Features of the Heart and coronary vessels
Department: AnatomyLecturer: Prof. Dr. Said ZaghloulProf. Dr. Amira El-haggagy
At the end of the lecture you should be able to:
1- Shape, surfaces, and borders of the heart
2- Chambers forming base & apex of the heart
3- Chambers forming sternocostal and diaphragmatic
surfaces of the heart
4- Chambers forming upper, lower, left and right
borders of the heart
5- Grooves on the external surface of the heart and their
content.
6- Coronary arteries (origin and branches of each artery)
7- Venous drainage of the heart
- External features of the heart: shape, surfaces, borders, apex, base and grooves.- Arterial supply of the heart- Coronary sinus (position, termination and tributaries)- Cardiac plexuses (superficial and deep)
Richard S. Snell. Clinical Anatomy for Medical students, 7th edition, Lippincott, Williams and Wilkins.
King Abdul Aziz University Faculty of Medicine and Allied Sciences27
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 5 :
* Lectures notes in the Department of Anatomy Web Sites and its attached links:WWW.kauanatomy.com
Self Assessment
* Prepare a simple presentation about one of the following topics:- Surface anatomy of heart borders- Surface anatomy of heart valves & best sites of their auscultation
King Abdul Aziz University Faculty of Medicine and Allied Sciences28
Phase 2 Cardiovascular Module Year 2
Lecture 6:The control of the cardiac output
Department: Physiology
Lecturer: Prof. Hossam Awad Prof. Maha Hegazi
By the end of this lecture you will be able to:1- Know the factors that affect the cardiac output, 2- Know the relation of cardiac output to the body surface area.3- How the cardiac output is influenced by the heart rate and stroke volume. 4- Know the effect of increased arterial blood pressure on the cardiac output.
1. Define cardiac output, cardiac index & ejection fraction.
2. Explain the effects of heart rate changes on CO.3. Explain how the stroke volume is influenced by
the venous return(preload) which in turn affects the cardiac output
4. Explain & describe how the cardiac output is regulated.
5. List what the factors that affect venous return.6. Explain the effect of changes in arterial blood
pressure (after-load) on cardiac output.7. Compare between the effects of starling law &
the sympathetic stimulation on the CO.8. Explain why trained athletes can achieve higher
cardiac output than non athletes. 9. Define the O2 consumption by the heart &
explain why it is more in the left ventricle than the right.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences29
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 6:The control of the cardiac output
Remember that cardiac output is limited by venous return; without integrated regulation of the cardiovascular system, an increased heart rate will be compensated by reduced stroke volume.
Ganong, Review of Medical Physiology, 20th edition,
page: 550 - 555
You have the opportunity to watch the CD-ROM about the Cardiac output. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web sites about the cardiovascular system. I would recommend you to use the key words – Cardiac, output, control –in the search engine google (www.google.com). The aim is to be able to use the search engine and also to recognize the rich resources in the web.
http://www . Google.com
Self-assessmentBriefly answer the following in a short essay:
Which methods are commonly used to measure cardiac output?
Answer MCQs (1- 5) in Ganong, Review of Medical Physiology, 20th edition, page: 761
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences30
Phase 2 Cardiovascular Module Year 2
Lecture 7Cardiac Cycle
Department: Physiology
Lecturer : & Prof. Hossam Prof. Maha Hegazi & Dr.Azra Kiramani
At the end of the lecture you should be able to: 1-Understand the mechanical events (phases) of the cardiac cycle.2-Understand the changes in the venous pressures, arterial pressures, heart sounds, and ECG that take place during each cardiac beat.
1. analyze the changes in ventricular volume and or pressure and the opening and closing of valves during the cycle
2. Relate the mechanical events of the cardiac cycle to the ECG.
3. Predict the causes of first and second heart sounds
4. Describe & draw the jugular pulse curve & relate its waves to the phases of cardiac cycle.
5. Analyze the arterial pulse curve, and explain the causes of diacrotic notch & wave
The cardiac cycle is the sequence of pressure and volume changes that takes place during cardiac activity. A cycle time of 0.8 s is taken at rest
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences31
Phase 2 Cardiovascular Module Year 2
King Abdul Aziz University Faculty of Medicine and Allied Sciences32
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 7Cardiac Cycle
Ganong, Review of Medical Physiology, 20th edition,
page: 545 - 558
You have the opportunity to watch the CD-ROM about the Cardiac Cycle. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system but these should not used in isolation. I would recommend you look at the following web site:
http://www.elon.edu/shouse/physiology/physiol22/Lecture13.html
Self-assessment
Which of the following is incorrect? 1. The action potential is longer in cardiac muscle than in
skeletal muscle 2. Cardiac muscle can not undergo tetany because cardiac
muscle uses external Ca++ 3. The AP of cardiac muscle lasts almost as long as the
muscle contraction 4. Muscle contraction in cardiac muscle lasts 100 msec.
Which of the following is incorrect? Under normal conditions, the pressure in the
1. Vena cava is 8 mm Hg and the pressure in the right ventricle is 4 mm Hg.
2. Right atrium is 4 and the pressure in the right ventricle is 20/4 mm Hg (this is a systolic pressure of 20 and a diastolic pressure of 4).
3. Right ventricle in 20/4 mm Hg and the pressure in the left ventricle is 120/8 mm Hg.
4. Pulmonary artery is 120/8 mm Hg and the pressure in the left atrium in is 8 mm Hg.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences33
Phase 2 Cardiovascular Module Year 2
Lecture 8 :Plasma lipoprotein-composition, structure and function
Department: Biochemistry.
Lecturer Prof. Mohd Ali Ajab Noor – Dr. Enayat Hashem
At the end of this lecture you will be able to:
1) Describe the general structure and composition
of a typical plasma lipoprotein.
2) Classify human plasma lipoproteins on the basis
of their particle size, physical properties,
composition and transport function.
3) Discuss the clinically important methods for
analysis of plasma lipoproteins.
In general nature of lipoprotein systems will be
described and discussed before looking in detail at
the lipoproteins found in the human plasma. The
structure, composition, and physical properties of
chylomicrons, very low density, low density and
high density lipoproteins will be reviewed and
methods of clinical importance for the analysis of
plasma lipoproteins will be described.
Lipoprotein A is a prothrombotic lipoprotein that is
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences34
Phase 2 Cardiovascular Module Year 2particularly involved in coronary disease, while high
levels of high-density lipoprotein are protective
Continue … Lecture 8 :Plasma lipoprotein-composition, structure and function
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences35
Phase 2 Cardiovascular Module Year 2
Rubin & Farber, Essential Pathology, 2nd edition. PP 249 - 260
You have the opportunity to watch the CD-ROM
about the Hyperlipidemias” You can access the CD-
ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “Hyperlipidemias” –in the search engine google (www.google.com).
http://www . Google.com
Self-assessment
Answer MCQs (4 and 8) in Ganong, Review of Medical Physiology, 20th edition, page: 745
King Abdul Aziz University Faculty of Medicine and Allied Sciences36
Phase 2 Cardiovascular Module Year 2
Lecture 9: internal Features of the Heart.
Department: AnatomyLecturer: Prof. Dr. Said Zaghloul Prof. Dr. Amira El-haggagy At the end of the lecture you should be able to:
1) Identify the chambers of the heart
2) Identify the internal features of the chambers
of the heart
3) Describe the smooth and rough parts of each
cardiac chamber
4) Describe the anatomy of heart valves
(tricuspid, mitral, aortic, and pulmonary
valves)
5) Papillary muscles in the right and left
ventricles
Chambers of the heart* Features of the cavities of right atrium, ventricle,
left atrium and ventricle and the valves.* Papillary muscles* Cusps of the heart valves
King Abdul Aziz University Faculty of Medicine and Allied Sciences37
Phase 2 Cardiovascular Module Year 2
Continue … Lecture9
Richard S. Snell. Clinical Anatomy for Medical students, 7th edition, Lippincott, Williams and Wilkins.
* Lectures notes in the Department of Anatomy Web Sites and its attached links:WWW.kauanatomy.com
Self Assessment
* Prepare a simple presentation about one of the following topics:- Surface anatomy of the heart and its valves- Anatomy and mechanisms of action of the heart
valves- Anatomy of the conducting system of the heart.
King Abdul Aziz University Faculty of Medicine and Allied Sciences38
Phase 2 Cardiovascular Module Year 2
Lecture 10: Normal development of the heart
Department: Anatomy
Lecturer: Prof. Dr. Said Zaghloul Dr. Eman Abd El-aal
At the end of the lecture you should be able to:
1- Describe the process of angiogenesis.2- List the parts of primitive heart tube3- Describe the process of the interatrial septum
development4- Describe the development of the
interventricular septum5- Embryological origin of smooth and rough
part of each cardiac chamber6- Development of cardiac valves (tricuspid,
mitral, aortic, and pulmonary valves)
Angiogenesis. Establishment of the cardiogenic field. Formation and position of the heart tube. Folding of the heart tube. Formation of the cardiac loop. Formation of the cardiac septa. Development of the heart valves.
Sadler TW. Langman’s Medical Embryology, 10th edition. Lippincott, William and Wilkins.
King Abdul Aziz University Faculty of Medicine and Allied Sciences39
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 10 :
- Lecture note in the department of Anatomy web site and its attached links:
www.kauanatomy.com
Self-Assessment
* Prepare a simple presentation about one of the following topics:- Angiogenesis- Development of the atria - Development of the heart septa.
King Abdul Aziz University Faculty of Medicine and Allied Sciences40
Phase 2 Cardiovascular Module Year 2
Lecture 11:The Electrical activity of the heart and the ECG
Department: Physiology Department
Lecturer : Prof. Hossam Awad Prof. Maha Hegazi & Dr.Azra
By the end of this lecture you should be able toKnow the normal ECG waves, segments, and intervals, understand their significances, and know the significance of ECG recordings in diagnosis of diseases and follow up patients.Understand the following General rouls:
Spread of the depolarization wave toward the +ve electrode records
a +ve wave. And vice versa. Spread of the repolarization wave toward the
+ve electrode records a – ve wave. And vice versa.
T wave is +ve because the spread of repolarization wave of the ventricles occurs from epicardium to the endocardium (due to relative ischemia of endocardium during ventricular systole). So, it spreads away from the recording electrode +ve wave.
1. list the relationship between the ECG waves, segments, and intervals and the cardiac depolarization and repolarization.
2. describe the normal origin and spread of the cardiac action potential.
3. list the information you can get from an ECG recording
4. define the normal sinus rhythm, sinus tachycardia, and sinus bradycardia.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences41
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 11:The Electrical activity of the heart and the ECG
The various parts of the conduction system and, under abnormal conditions, parts of the myocardium are capable of spontaneous discharge.
Ganong, Review of Medical Physiology, 20th edition,
page: 528 - 534
You have the opportunity to watch the CD-ROM about the ECG you can access the CD-ROM during your spare time.
http://endeavor.med.nyu.edu/courses/physiology/courseware/ekg_pt1/ekgmenu.html
Self-assessment
Briefly answer the following in a short essay:
Describe how the action potential is conducted through the heart and how the ECG helps to identify conduction abnormalities
Indicate whether each statement is true or false:
In the Electrocardiogram:a) The Q wave is caused by atrial repolarization.b) The PR interval is prolonged in atrial
hypertrophy.c) The QT interval will give you the duration of
ventricular systole.d) The first heart sound occurs at the same time as
the P wave.e) The R wave coincides with the depolarization of
the apex. Answer MCQs (1-4) in Ganong, Review of Medical Physiology, 20th edition, page: 760
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences42
A nice tutorial on the normal ECG. In particular, section 3 "Parts of the EKG" and section 4 "The Sequence of Cardiac Depolarization and Repolarization" are useful (and brief).
Phase 2 Cardiovascular Module Year 2
Lecture 12:Cardiac arrhythmias
Department: PhysiologyLecturer : & Prof. Hossam Prof. Maha Hegazi & Dr. Azra
At the end of the lecture you should be able to:
1) Understand the types of rhythm and conduction abnormalities, their possible causes and, their ECG changes.
2) Describe the basic mechanisms of cardiac
arrhythmias.
3) Identify the common cardiac arrhythmias on an
ECG rhythm strip and explain the mechanism of
its production.
1-List the types of sinus arrhythmias and explain their ECG changes. 2-List the types of atrial arrhythmias (atrial extrasystole, flutter, and fibrillation) show the ECG changes in each. 3-Define reentry and link it to the mechanism of arrhythmis. 4-List the ventricular arrhythmias, discuss their ECG changes. 5-Compare the ECG changes between atrial and ventricular extrasystole.
6-Explain the compensatory pause in ventricular extrasystole and the rhythm shift in atrial extrasystole.
7-List the types of conduction abnormalities, and show the ECG changes in each.
Arrhythmias are usually classified clinically as supraventricular and ventricular.
Supraventricular – originating in the atrium or atrioventricular node.
Ventricular – originating in the ventricle.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences43
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 12:Cardiac arrhythmias
Ganong, Review of Medical Physiology, 20th edition,
page: 535 - 539
You have the opportunity to watch the CD-ROM about the Cardiac arrhythmias. You can access the CD-ROM during your spare time.
ECG tutorial site. A bit more than we need to know, but the quizzes are useful. Try them!
http://medlib.med.utah.edu/kw/ecg
Self-assessment
Briefly answer the following in a short essay:
Describe the pathophysiological
principal of the cardiac arrhythmias.
Classify cardiac arrhythmias using a
simple concept map.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences44
Phase 2 Cardiovascular Module Year 2
Lecture 13: Congenital anomalies of heart
Department: Anatomy
Lecturer: Prof. Dr. Said Zaghloul Dr. Iman Abd El-aal
At the end of the lecture you should be able to: - 1- Describe the common congenital heart diseases
with their clinical presentation and sings.2- Explain the components of the Fallot’s
tetralogy.3- Explain the complication of the congenital heart
diseases.
General local causes of the heart defects. Anomalies of the cardiac loop. Dextrocardia. Situs inversus. Atrial and ventricular septal defects. Transposition of the great vessels. Tetralogy of Fallot. Valvular stenosis and atresia.
King Abdul Aziz University Faculty of Medicine and Allied Sciences45
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 13 :
Sadler TW. Langman’s Medical Embryology, 10th edition. Lippincott, William and Wilkins.
Rubin and Farber, Essential Pathology, 2nd edition.
- Lecture note in the department of Anatomy web site and its attached links:
www.kauanatomy.com
Self-Assessment
* Prepare a simple presentation about one of the following topics:- Fallot tetralogy.- Ventricular septal defect - Types of interatrial septal defects.
King Abdul Aziz University Faculty of Medicine and Allied Sciences46
Phase 2 Cardiovascular Module Year 2
Lecture 14:The autonomic nervous system and the cardiovascular system
Department: Physiology
Lecturer: Dr. Al-hazimi –Dr. Zeinab Al Refaei
By the end of this lecture you will be able to:
Outline the neural mechanisms that control arterial blood pressure and heart rate, including the receptors, afferent and efferent pathways, central integrating pathways, and effector’s mechanisms involved.
1. Define and list central control of the heart and blood vessels.
2. Discuss the autonomic control of the heart and blood vessels.
3. Discuss the Baroreceptors reflex & gravity 4. Discuss volume receptors &Bainbridge
reflex chemoreceptors reflex. 5. Discuss central “reflexes” vasovagel syncopy
& temperature.
.
There are several very important humoral mechanisms including circulating catecholamines, the renin-angiotensin system, vasopressin (antidiuretic hormone), atrial natriuretic peptide, and endothelin. Each of these humoral systems directly or indirectly alter cardiac function and vascular function.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences47
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 14:The autonomic nervous system and the cardiovascular system
Ganong, Review of Medical Physiology, 20th edition,
page: 579 - 583
You have the opportunity to watch the CD-ROM about the nervous regulation of cardiovascular system. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system but these should not used in isolation. I would recommend you look at the following web sites:
http://www.cvphysiology.com/Blood%20Pressure/BP007.htm
Self-assessmentBriefly answer the following short essay:
Compare the function of the carotid and aortic baroreceptors with the function of baroreceptors in the atria and great veins.
What are the effects of baroreceptor denervation?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences48
Phase 2 Cardiovascular Module Year 2
Lecture 15:Relationship between pressure, flow and resistance
Department: Physiology
Lecturer: Prof. Hosam Awad – Prof. Maha Hegazi
By the end of this lecture you will be able to:
1) Describe the relationship between flow, pressure, and resistance in the vascular system.
2) Define laminar flow and critical closing pressure.3) Explain why the radius of a vessel is such an
important determinant of flow.4) Define the law of Laplace, and list three example
of its operation in the body.
Physical principles and equations that are applicable
to the description of the behaviour of perfect fluids
in rigid tubes have often been used to explain the
behaviour of blood vessels. However, blood vessels
are not rigid tubes, and the blood is not a perfect
fluid but a two-phase system of liquid and cells.
Therefore, the behaviour of the circulation deviates,
sometimes markedly, from that predicted by these
principles.
The physical principles are of value when used as an
aid to understand what goes on the body rather than
as an end in themselves or as a test of memorizing
ability.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences49
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 15:Relationship between pressure, flow and resistance
Ganong, Review of Medical Physiology, 20th edition,
page: 560 -564
You have the opportunity to watch the CD-ROM about the blood flow. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system but these should not used in isolation. I would recommend you look at the following web sites:
http://www.cvphysiology.com/Hemodynamics/H001.htm
Self-assessment
Briefly answer the following short essay:
Where in cardiovascular system is turbulent flow normally found? What produces them?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences50
Phase 2 Cardiovascular Module Year 2
Lecture 16:Cholesterol and triglycerides transport pathways
Department: Biochemistry
Lecturer Prof. Mohd Ali Ajab Noor - Dr. Enayat Hashem
At the end of this lecture you will be able to:
1) Describe the transport, functions and
metabolism of chylomicrons and chylomicron
remnants.
2) Describe the transport, functions and metabolism
of VLDL and VLDL remnants (IDL).
3) Describe the transport functions and metabolism
of LDL.
4) Give examples of defects in lipoprotein
metabolism which result in
hyperlipoproteinaemias
Two lipoprotein transport pathways will be
described in detail:
The transport of dietary triaglycrol and
cholesterol by very low density and low
density lipoproteins.
The transport of endogenous
triacylglycerole and cholesterol by very low
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences51
Phase 2 Cardiovascular Module Year 2density and low density lipoproteins.
King Abdul Aziz University Faculty of Medicine and Allied Sciences52
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 16:Cholesterol and triglycerides transport pathways
Fagan, cardiovascular system, Physiology, 2nd edition, page: 80 - 82
You have the opportunity to watch the CD-ROM about the Cholesterol and triglycerides transport. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “Cholesterol and triglycerides transport” –in the search engine google (www.google.com).
http://www . Google.com
Self-assessment
How defects in lipoprotein metabolism result in
hyperlipoproteinaemias?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences53
Phase 2 Cardiovascular Module Year 2
Lecture 17: Myocardial & Pericardial Diseases
Department: Pathology
Lecturer:Dr. Taha Moatamad &Dr. Rana Bokhary
At the end of the lecture you should be able to:
Describe the pathogenesis, morphology & clinical features of:1. Myocarditis.2. Pericarditis.3. Pericardial effusions.
The lecture will cover the following topics:
1. Causes, morphology & clinical features of myocarditis.
2. Causes, morphology, clinical features & outcomes of pericarditis & pericardial effusions.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences54
Phase 2 Cardiovascular Module Year 2
Continue .... Lecture 17: Myocardial & Pericardial Diseases
Robbins Basic Pathology, 8th edition.Chapter 11 – The Heart. Pages 414-417.
You can check more information on the pathology of the cardiovascular system from:www.pathguy.com& see nice gross & microscopic pathology pictures on:http://library.med.utah.edu/WebPath/webpath.html
What are the causes of myocarditis? What are the causes of different types of
pericarditis & pericardial effusions?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences55
Phase 2 Cardiovascular Module Year 2
Lecture 18:Pressure and flow in systemic circulation
Department: Physiology
Lecturer: Prof. Hosam Awad Prof. Maha Hegazi
By the end of this lecture you will be able to:
1) Describe the factors that affecting arterial blood pressure
2) Know the mechanism of arterial blood pressure regulation.
1- List physiologic factors that affect BP e.g.
age, sex, etc…).2- Describe different regulatory mechanisms for
ABP:3- Describe Role of kidney in blood volume
regulation: renin-angiotensin system.
As the pressure pulse moves away from the heart, the systolic pressure rises and the diastolic pressure fall. There is also a small decline in mean arterial pressure as the pressure pulse travels down distributing arteries due to the resistance of the arteries. Therefore, when arterial pressure is measured using a sphygmomanometer (i.e., blood pressure cuff) on the upper arm, the pressure measurements represent the pressure within the brachial artery, which will be slightly different than the pressure measured in the aorta or the pressure measure in other distributing arteries.
Systemic vascular resistance (SVR) refers to the resistance to blood flow offered by all of the systemic vasculature, excluding the pulmonary vasculature. This is sometimes referred as total peripheral resistance (TPR).
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences56
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 18:Pressure and flow in systemic circulation
Ganong, Review of Medical Physiology, 20th edition,
page: 565 - 568
You have the opportunity to watch the CD-ROM about the arterial blood pressure. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system but these should not used in isolation. I would recommend you look at the following web sites:
http://www.cvphysiology.com/Blood%20Pressure/BP002.htm
Self-assessment
Briefly answer the following short essay:
What are Korotkoff’s sounds and what produces them?
What are the main factors that affect the arterial blood pressure in a normal person?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences57
Phase 2 Cardiovascular Module Year 2
Lecture 19: Predict how CVS will react in common situations: eating a meal,
exercise and changes in posture
Department: PhysiologyLecturer: Dr. Atef Abood Dr. Azra keramani
At the end of this lecture you should be able to:1- Outline the compensatory mechanisms that maintain blood pressure on rising from the supine to the standing position.2- Describe and explain the circulatory changes that occur during exercise.3- Outline the main beneficial effects of athletic training on the cardiovascular system in the body.4- Describe the cardiovascular changes that accurse after a heavy meal.5-Understand the meaning of cardiac reserve, wok metabolism and the O2 consumption by the heart.
1. Define cardiac reserve, and discuss its parameters and limitations.
2. Discuss cardiac metabolism, and compare it to the skeletal muscle metabolism.
3. Define mechanical efficiency of the heart.4. Define cardiac work and discuss O2
consumption by the heart.5. Discuss the changes in the heart rate, stroke
volume, peripheral vascular resistance and arterial blood pressure that take place during eating, exercise, and postural changes
.
Exercise is associated with very extensive alterations in the circulatory and respiratory systems. For convenience the circulatory adjustments are considered in this lecture. However, It should be emphasized that they occur together in integrated fashion as part of the homeostatic responses that make moderate to severe exercise possible.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences58
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 19: Predict how CVS will react in common situations: eating a meal, exercise and changes in posture
Ganong, Review of Medical Physiology, 20th edition,
page: 609 - 611
You have the opportunity to watch the CD-ROM about the Cardiovascular response to exercise. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – Cardiovascular system, exercise –in the search engine google (www.google.com). The aim is to be able to use the search engine and also to recognize the rich resources in the web.
http://www . Google.com
Self-assessment
Briefly answer the following short essay:
Describe the main changes in cardiovascular system during exercise.
Why do people faint when rise from supine to standing position?
Student Notes: .
(Insert here handouts and additional
King Abdul Aziz University Faculty of Medicine and Allied Sciences59
Phase 2 Cardiovascular Module Year 2pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences60
Phase 2 Cardiovascular Module Year 2
Lecture 20:Special circulations: Coronary , Pulmonary , Cerebral and Skeletal circulation. Department: PhysiologyLecturer : Dr. Atef Abood Dr. Azra
By the end of this lecture you will be able to:1- Describe the basic principals of coronary regulation.2- Know the regulation of the pulmonary circulation.3- Know the regulation of the cerebral circulation.
4- Know the regulation of the skeletal muscle blood
flow at rest and during exercise.
In this lecture we will describe:
1. The nervous and the mechanical factors affecting the coronary blood flow.
2. The role of the metabolic factor affecting the coronary blood flow.
3. The auto-regulation of the cerebral blood flow.
4. The nerve supply of the skeletal blood vessels and the skeletal blood flow during muscular exercise.
5. Compare and contrast between systemic and pulmonary circulation.
The body is good at diverting blood to where it is
needed. However, some circulations (e.g. cerebral
and renal) are special in that their blood flow is
usually preserved at the expense of others.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences61
Phase 2 Cardiovascular Module Year 2
Continue Lecture 20: Special circulations: Coronary , Pulmonary , Cerebral and Skeletal circulation.
Ganong, Review of Medical Physiology, 20th edition,
page: 588 - 606
You have the opportunity to watch the CD-ROM about the Coronary, cerebral, skeletal and pulmonary circulation You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “Circulation for special regions” –in the search engine google (www.google.com).
http://www .Google.com
Self-assessment
Briefly answer the following in a short essay:
What is reactive hyperaemia? Where dose it occur?
Answer MCQs (1- 16) in Ganong, Review of Medical Physiology, 20th edition, page: 765
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences62
Phase 2 Cardiovascular Module Year 2
Lecture 21: Atherosclerosis and Aneurysm
Department: PathologyLecturer: Dr. Ali Sawan & Dr. Sawsan Jalalah
At the end of this lecture you will be able to:
1) Outline the epidemiology, major and minor risk
factors implicated in atherosclerosis.
2) Describe the hypothesis to explain the
pathogenesis of atherosclerosis.
3) Outline the morphology of atherosclerosis.
4) Describe the complications of atherosclerosis.
5) Describe the clinical problems of atherosclerosis
as related to the pathological findings.
6) Describe causes of aneurysms.
7) Explain pathogenesis of AAAs.
The lecture will cover the following topics:
1) The importance of atherosclerosis is obvious from knowledge of its epidemiology of atherosclerosis and incidence in various countries.
2) The role of risk factors (major and minor) in the pathogenesis of atherosclerosis.
3) The detailed pathogenesis of atheroma formation.
4) The morphology of atheroma. 5) Definition of aneurysm and mechanism of its
most common causes.
Hyperlipidemia (LDL) must be remembered as controllable causes of coronary heart disease, especially in the young.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences63
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 21: Atherosclerosis and Aneurysm
.
Robbins Basic Pathology 8 th editionChapter 10; Pages: 343-352
You can check more information on the pathology of the cardiovascular system from:www.pathguy.com& see nice gross & microscopic pathology pictures on:http://library.med.utah.edu/WebPath/webpath.html
Self-assessment
Describe the acute plaque changes.
Describe the complications that may occur as a
result of these changes.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences64
Phase 2 Cardiovascular Module Year 2
Lecture 22: Ischemic heart Disease
Department: PathologyLecturer : Dr. Ibrahim Alzahrani & Sawsan Jalalah
At the end of this lecture you will be able to:
1) Evaluate the epidemiology and pathogenesis of the
ischemic heart diseases.
2) Differentiate between the various types of angina.
3) Explain the pathogenesis of myocardial infarction.
4) Explain the morphology of myocardial infarction.
5) Correlate the complications of MI with the tissue
pathology.
6) Explain chronic ischemic heart diseases and sudden
cardiac death.
The lecture will cover the following topics:
1) types of Ischemic heart disease (IHD) 2) causes and pathogenesis of IHD 3) types of angina pectoris4) myocardial infarction: pathogensis, location,
size, morphology and complications.5) pathogensis of chronic ischemic heart diseases.6) Causes of sudden cardiac death.
Unstable angina should be considered a medical emergency since it has a high mortality and it may rapidly lead to myocardial infarction. Rapid access to treatment will prevent this.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences65
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 22: Ischemic heart Disease
King Abdul Aziz University Faculty of Medicine and Allied Sciences66
Phase 2 Cardiovascular Module Year 2
Robbins Basic Pathology 8 th editionChapter 11; Pages: 388-398.
You can check more information on the pathology of the cardiovascular system from:www.pathguy.com& see nice gross & microscopic pathology pictures on:http://library.med.utah.edu/WebPath/webpath.html
Self-assessment
What are the complications of myocardial
infarction?
Which of these is considered a late complication?
Lecture 23:Antihypertensive drugs
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences67
Phase 2 Cardiovascular Module Year 2Department: PharmacologyLecturer:Prof. Abdel- Moneim Osman - Dr. Magda Hagras
At the end of this lecture you will be able to:
1) Outline antihypertensive drugs
2) Outline drugs which can be used for treatment
of angina
3) Describe drugs used in treatment of heart failure
Beta-blockers - decrease HR, contraction & renin;
bradycardia, increased lipids, (bronchoconstriction) ACE inhibitors - suppress formation of angiotensin II,
vasodilatations; cough, dysguesia, depress renal function
Ca2+antagonists - block Ca channels of the heart, dilate arterioles & veins modestly; oedema & constipation
alpha1-antagonists - vasodilatations; ortho hypotension, syncope, tachycardia, syncope
vasodilators - decrease peripheral resistance against which the heart must pump; arteriolar, veno-, combined acting vasodilators, +diuretic (ACE inhibitors)
diuretics - removal of retained salt & water, reduce blood volume, diminished venous congestion (thiazides & loop), rapid relief, K-sparing to protect against digitalis-induced arrhythmias
inotropic agents (digoxin) - increase contractility of failing heart (without elevating oxygen requirement), reverses all CHF manifestations, inhibition of Na-K activated ATP pump, increase intracellular calcium = increase force of contraction, electrical effects, aglycone+sugars, from foxglove, nursing implications (Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences68
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 23:Antihypertensive drugs
D. R. Laurance & P. N. Bennett, Clinical pharmacology, PP. 407 – 433.Katsung, Basic and Clinical Pharmacology, Chapter 11
You have the opportunity to watch the CD-ROM about the treatment of hypertension. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – Cardiovascular system, drugs –in the search engine google (www.google.com). The aim is to be able to use the search engine and also to recognize the rich resources in the web.
http://www . Google.com
Self-assessment
Briefly answer the following short essay:
Write short essay about anti-hypertensive drugs
Write short account about the treatment of heart failure
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences69
Phase 2 Cardiovascular Module Year 2
Lecture 24: Tissue fluid formation and Edema
Department: PhysiologyLecturer : Dr. Atef Abood Dr. Azra
By the end of this lecture you will be able to:1- Understand the forces that cause tissue fluid formation. 2- Describe the factors affecting lymph flow. 3- Describe the disturbances that cause tissue fluid
accumulation and edema.
In this lecture we will describe:
1- The starling forces that cause tissue fluid formation.2- The role of the capillary pressure and the
colloidal osmotic pressure of plasma proteins in the formation of the tissue fluid.
3- The role of the lymphatic obstruction as a cause of edema
4- The role of increased venous pressure in formation of edema.
5- Edema, its types, and its mechanism.
Hypo-proteinemia as in liver and renal diseases,
increased venous pressure as in heart failure and the
lymphatic obstruction as in Filariasis are causes of
edema.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences70
Phase 2 Cardiovascular Module Year 2
Continue Lecture 24: Tissue fluid formation and Edema
Ganong, Review of Medical Physiology, 20th edition,
page: 588 - 606
You have the opportunity to watch the CD-ROM about the lymphatic circulation You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “Lymph, Tissue fluid formation, and Edema” –in the search engine google (www.google.com).
http://www .Google.com
Self-assessment
Briefly answer the following in a short essay:
Define edema, describe its causes.
Answer MCQs (1- 16) in Ganong, Review of Medical Physiology, 20th edition, page: 765
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences71
Phase 2 Cardiovascular Module Year 2
Lecture 25: Valvular Heart DiseasesDepartment: Pathology
Lecturer: Dr. Taha Moatamad & Dr. Rana Bokhary
At the end of the lecture you should be able to:
Describe the pathogenesis, morphology & clinical features of:
1. Rheumatic valvular disease.2. Calcific aortic stenosis.3. Myxomatous mitral valve.4. Prosthetic cardiac valves.
The lecture will cover the following topics:
Major causes of valvular heart disease "congenital & acquired" with special attention to:
1. Definition, epidemiology, & pathogenesis of rheumatic fever.
2. Morphology, outcomes & clinical features of acute rheumatic heart disease (RHD) & chronic valvular deformities.
3. Pathogenesis, morphology & clinical features of calcific aortic stenosis.
4. Epidemiology, pathogenesis, morphology, clinical features & complications of myxomatous cardiac valve.
5. Types & complications of prosthetic cardiac valves.
Student Notes:
King Abdul Aziz University Faculty of Medicine and Allied Sciences72
Phase 2 Cardiovascular Module Year 2
Continue .... Lecture 25: Valvular Heart Diseases
Robbins Basic Pathology, 8th edition.Chapter 11 – The Heart. Pages 400-406 & 409.
You can check more information on the pathology of the cardiovascular system from:www.pathguy.com& see nice gross & microscopic pathology pictures on:http://library.med.utah.edu/WebPath/webpath.html
What is the clinical significance of rheumatic fever?
What is the difference between acute rheumatic heart disease & chronic valvular deformities?
What is the most important complication of deformed & prosthetic valves?
(Insert here handouts and
additional pages for notes if
needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences73
Phase 2 Cardiovascular Module Year 2
Lecture 26: Infective Endocarditis.Department: Pathology
Lecturer:Dr. Taha Moatamad &Dr. Rana Bokhary
At the end of the lecture you should be able to:
Describe the pathogenesis, morphology & clinical features of:4. Infective endocarditis.5. Nan-bacterial thrombotic endocarditis
(NBTE).6. Myocarditis.7. Pericarditis.8. Pericardial effusions.
The lecture will cover the following topics:
3. Clinical classification, pathogenesis, high risk groups, causative organisms, morphology, clinical features & complications of infective endocarditis.
4. Etiology, pathogenesis, complications & clinical features of non-bacterial thrombotic endocarditis (NBTE) & Libman-Sacks endocarditis.
5. Causes, morphology & clinical features of myocarditis.
6. Causes, morphology, clinical features & outcomes of pericarditis & pericardial effusions.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences74
Phase 2 Cardiovascular Module Year 2
Continue Lecture 26: Infective Endocarditis, Myocardial & Pericardial Diseases
Robbins Basic Pathology, 8th edition.Chapter 11 – The Heart. Pages 406-408 & 414-417.
You can check more information on the pathology of the cardiovascular system from:www.pathguy.com& see nice gross & microscopic pathology pictures on:http://library.med.utah.edu/WebPath/webpath.html
What is the difference between acute & subacute infective endocarditis?
What are the different types of valvular vegetations?
What are the causes of myocarditis? What are the causes of different types of
pericarditis & pericardial effusions?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences75
Phase 2 Cardiovascular Module Year 2
Lecture 27: Hypertension and Effects on Blood Vessels and Heart
Department: Pathology.Lecturer: Dr. Taha Moatamad & Dr. Sawsan Jalalah
At the end of this lecture you will be able to:
1) Describe the difference between the types of
systemic hypertension.
2) Explain the pathogenesis of systemic
hypertension.
3) Differentiate between the types of hypertensive
arteriolosclerosis.
4) Describe effects of systemic hypertension on the
heart.
5) Define cor pulmonale and list its causes.
The lecture will cover the following topics:1) definition and classification of hypertension2) pathogenesis of hypertension 3) effect of hypertension on blood vessels4) hypertensive heart disease 5) definition and causesof cor pulmonale.
90% to 95% of hypertension is idiopathic.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences76
Phase 2 Cardiovascular Module Year 2
Continue. Lecture 27: Hypertension and Effects on Blood Vessels and Heart
Robbins Basic Pathology 8 th editionChapter 10; Pages: 353-357 & Chapter 11 Pages 398-400
You can check more information on the pathology of the cardiovascular system from:www.pathguy.com& see nice gross & microscopic pathology pictures on:http://library.med.utah.edu/WebPath/webpath.html
Self-assessment
You have seen a patient in emergency room suffers from severe headaches; his BP was 220/120.
What is your diagnosis? What are the types of arteriolar changes can
be seen in blood vessels due to this type of hypertension.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences77
Phase 2 Cardiovascular Module Year 2
Lecture 28: Vasculitis & Cardiovascular Tumors
Department: Pathology.Lecturer: Dr. Ali Sawan & Dr. Rana Bokhary
At the end of the lecture you should be able to:
1. Classify vasculitis & describe the pathogenesis, morphology & clinical features of giant-cell (temporal) arteritis
2. Classify vascular tumors & describe the morphology & clinical features of hemangioma, glomus tumor, Kaposi sarcoma, epithelioid hemangioendothelioma & angiosarcoma.
3. Classify cardiac tumors, describe the morphology & clinical features of myxoma, as well as enumerate primary origins of metastatic cardiac tumors.
The lecture will cover the following topics:
1. Classification of vasculitis & subclassification of immune-mediated vasculitis.
2. Pathogenesis, morphology & clinical features of giant-cell (temporal) arteritis.
3. Classification of vascular tumors into benign, intermediate & malignant neoplasms.
4. Pathogenesis, morphology & clinical features of different vascular tumors covering the different variants of hemangioma & Kaposi sarcoma.
5. Classification of cardiac tumors with special attention to primary sources of metastatic tumors as well as morphology, & clinical effects of myxoma.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences78
Phase 2 Cardiovascular Module Year 2
Continue Lecture 28:Vasculitis & Cardiovascular Tumors
Robbins Basic Pathology, 8th edition.Chapter 10 – The Blood Vessels. Pages 362-364 & 371-377.Chapter 11 – The Heart. Pages 417-418.
You can check more information on the pathology of the cardiovascular system from:www.pathguy.com& see nice gross & microscopic pathology pictures on:http://library.med.utah.edu/WebPath/webpath.html
Classify vasculitis. Classify immune-mediated vasculitis. Classify vascular tumors. What are the variants of Kaposi sarcoma? Classify cardiac tumors. What is the most common primary origin of
metastatic cardiac tumors & in which layer of the heart it tends to involve more?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences79
Phase 2 Cardiovascular Module Year 2
Lecture 29:Anti-anginal drugs
Department: Pharmacology
Lecturer: Prof. Abdel-Moneim Osman - Dr. Magda Hagras
At the end of this lecture,student will be able to1-Outline antianginal drugs2- Know the mechanism of action of antianginal drugs3- know the Side effects of the antianginal drugs
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences80
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 29:Anti-anginal drugs
D.R. Laurance & P.N. Bennet, Clinical pharmacology. Pages: 205 -216.
You have the opportunity to watch the CD-ROM about the antianginal drugs. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “antianginal drugs –in the search engine google (www.google.com).
http://www . Google.com
Self-assessment
Write short essay on the mechanism of action of the
antianginal drugs .
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences81
Phase 2 Cardiovascular Module Year 2
Lecture 30:Anti-arrhythmic drugs
Department: Pharmacology
Lecturer: Prof. Abdel-Moneim Osman - Dr. Magda Hagras
At the end of the lecture you should be able to:
1) Describe the mechanism of action of the anti-
arrhythmic agents in the Vaughan-William
classification.
2) Explain the pharmacological properties of these
drugs.
3) Relate the type of drug to be used for the type of
arrhythmia.
4) Describe the various effects of digitalis on the
heart.
Anti-arrhythmic drugs are classified according to the
Vaugham-William Classification. The four major
classes (and some subdivisions) will be discussed,
together with their action on the heart muscle. And
examples of typical drugs in each category. In
addition, a few other drugs which are often used in
treating cardiac arrhythmias such as Digoxin will be
discussed.
The aims of antiarrhythmic drugs are: To decrease cell excitability To increase the refractory period To slow conduction or block conduction if
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences82
Phase 2 Cardiovascular Module Year 2already slow.
King Abdul Aziz University Faculty of Medicine and Allied Sciences83
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 30:Anti-arrhythmic drugs
D.R. Laurance & P.N. Bennet, Clinical pharmacology. Pages: 205 -216.
You have the opportunity to watch the CD-ROM about the Anti-arrhythmic drugs. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “anti-arrhythmic drugs –in the search engine google (www.google.com).
http://www . Google.com
Self-assessment
Write short essay on the mechanism of action of the
anti-arrhythmic agents in the Vaughan-William
classification.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences84
Phase 2 Cardiovascular Module Year 2
Lecture 31:Hyperlipoproteinamias and hypolipoproteinaemias
Department: Biochemistry
Lecturer: Prof. Mohd Ali Ajab Noor - Dr. Enayat Hashem
At the end of this lecture you will be able to:
1) Recognise the six different types of hyperlipo-
proteinamia and understand their relationship to
arthrosclerosis and coronary disease.
2) Give examples of both genetic and acquired
factors that lead to hyperlipoproteinaemias
3) Give examples of hypolipoproteinaemias and
their clinical significance.
The WHO (Freidrickson) classification of hyperlipo-
proteinaemias will be described and discussed. The
genetic and/or acquired factors responsible for the
different hyperlipoprotienaemias will be described
and their clinical significance will be discussed.
Some hypolipo-proteinaemias will also be described
and discussed.
Hyperlipidaemia must be remembered as a controllable cause of coronary heart disease, especially in the young.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences85
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 31:Hyperlipoproteinamias and hypolipoproteinaemias
Rubin & Farber, Essential pathology, end edition. Pages 287 -294.
You have the opportunity to watch the CD-ROM about the Hyperlipoproteinamias and hypolipoproteinaemias. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “Hyperlipoproteinamias and hypolipoproteinaemias” –in the search engine google (www.google.com).
http://www . Google.com
Self-assessment
What treatment would you prescribe
to lower plasma cholesterol?
Why is reduced cholesterol intake
important?
Discuss the relation of cholesterol to low-density lipoproteins and high density lipoprotein.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences86
Phase 2 Cardiovascular Module Year 2
Lecture 32:Diagnostic cardiac enzymology
Department: BiochemistryLecturer Prof. Mohd Ajab Noor – Dr. Enayat Hashem
At the end of this lecture you will be able to:
1) Evaluate the diagnostic value of the cardiac
enzymes
2) Determine the use of CK-MB in the diagnosis of
myocardial infarction.
3) Summarise the newer enzymes for the early
diagnosis of MI
4) Outline cardiac injury and the use of cardiac
markers in the diagnosis of the new syndromes
of cardiac injury.
The practical use of the traditional enzymes in the
diagnosis of MI in a clinical setting will be
discussed. The pitfalls of CK-MB as the gold
standard will also be addressed.
Modern understanding of myocardial ischemia has
resulted in new clinical syndromes. How the latest
biochemical markers (CK isoforms, troponins,
Myoglobin) help to make a diagnosis of these
syndromes (which change the treatment and
prognosis of ischemic heart disease) will be outlined.
Testing for the proteins specifically
released from cardiac tissues can be a useful aid in
confirming myocardial infarction.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences87
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 32:Diagnostic cardiac enzymology
Fagan, cardiovascular system, Physiology, 2nd edition, page: 152 - 153
You have the opportunity to watch the CD-ROM about the Diagnostic cardiac enzymology. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “Diagnostic cardiac enzymology” –in the search engine google (www.google.com).
• http://www. Google.com
Self-assessment
Draw a curve to show the levels of classic cardiac
enzymes after myocardial infarction.
King Abdul Aziz University Faculty of Medicine and Allied Sciences88
Phase 2 Cardiovascular Module Year 2
Lecture 33:Drugs used in heart failure
Department: Pharmacology
Lecturer Dr. Osman Hasan – Dr. Mai Abdel Aleim
At the end of this lecture you will be able to:
1) Describe the mode of action of each of the main
groups of drugs used in the treatment of heart
failure.
2) Determine in what type of institution some of
these drugs might be contra-indicated.
3) Have some knowledge of their side effects.
The therapeutic agents that can be used in the
treatment of congestive heart failure include
diuretics, positive inotropic agents, vasodilators,
ACE inhibitors, and sympathomimetic agents.
Students should understand the mechanism of each
of these types of drugs and a typical example of each
group together with some of the major side-effects.
Heart failure is not a diagnosis. You must always
identify the underlying pathology that is responsible.
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences89
Phase 2 Cardiovascular Module Year 2
Continue … Lecture 33:Drugs used in heart failure
D. R. Laurance & P. N. Bennett, Clinical pharmacology, PP. 407 – 433.Katsung, Basic and Clinical Pharmacology, Chapter 11
You have the opportunity to watch the CD-ROM about the treatment of heart failure. You can access the CD-ROM during your spare time.
In the computer cluster also you have the opportunity to see some useful web site about the cardiovascular system. I would recommend you to use the key words – “Drugs & heart failure” –in the search engine google (www.google.com).
• http://www. Google.com
Self-assessment
You have been called to see a 56 year old patient with severe dyspnoea. After history and examination you diagnose heart failure.
What drug treatment would you administer at this time and how would you give it?
What are the indication, contra indications and cautions of such treatment?
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences90
Phase 2 Cardiovascular Module Year 2
Lecture 34:Cardiovascular Investigations
Department: Medicine
Lecturer :Dr. Aisha Siddiqui/ Dr. Layth mimash
Learning Objectives:At the end of the lecture, the student should be able to recognize the investigational note of:
1. ECG at rest.2. Stress ECG.3. CXR.4. MRI / CT.5. Echocardiography.6. Angiograpy (Cardiac cathetarization).7. Nuclear scan (Thalium scan..etc.)Not to over lookthe importance of cardiac enzymes such as Troponin … etc.
Suggested references:1. Davidson's Principles & Practice of Medicine.2. Crush Module of Cardiovascular Diseas
Student Notes: .
(Insert here handouts and additional pages for notes if needed)
King Abdul Aziz University Faculty of Medicine and Allied Sciences91
Phase 2 Cardiovascular Module Year 2
Lecture 35:Cardiovascular causes of chest pain
Department: Medicine
Lecturer :Dr. Aisha Siddiqui/ Dr. Layth mimash
Suggested references:
1. Davidson's Principles & Practice of Medicine.
2. Crush Module of Cardiovascular Disease.
Learning Objectives:
1. Provide a differential diagnosis of acute chest pain.
2. Differentiate chest pain due to cardiac disease.
3. Differentiate ischaemic cardiac pain from non ischaemic cardiac pain.
4. Differentiate pain due to angina from pain due to myocardial infarction.
5. Outline the principals of managment of acute myocardial infarction &
complications.
Student Notes: .
King Abdul Aziz University Faculty of Medicine and Allied Sciences92
Phase 2 Cardiovascular Module Year 2
King Abdul Aziz University Faculty of Medicine and Allied Sciences93
Phase 2 Cardiovascular Module Year 2
Practical
King Abdul Aziz University Faculty of Medicine and Allied Sciences94
Phase 2 Cardiovascular Module Year 2
Department of Anatomy
Practical (1)Middle mediastinum, heart in situ
Demonstrator: The staff members
Learning OBJECTIVES : At the end of this practical lesson, student should be able to:
List the subdivisions of the mediastinum and their components.
Develop clear concept on the anatomy of the pericardium.
Detailed Contents:1- Mediastinum: position, divisions, components and relations.
2- Pericardium: types, layers, sinuses, blood and nerve supply.
READING:
Suggested textbooks and other references:
Richard S. Snell: Clinical Anatomy of Medical Students, 7th edition, Lippincott,
William and Wilkins.
Grant J. C.B.: Grant Anatomy, 10th edition, Lippincott, William and Wilkins.
Practical notes in the department of Anatomy web site and its attached links:
www.kauanatomy.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences95
Phase 2 Cardiovascular Module Year 2
Department: PhysiologyPractical 2:Heart sounds – prediction of timing of uncomplicated murmurs
TUTOR: Dr. Al-hazimi – Dr. Maha Hegazi Department: Physiology
SUMMARY:
The stethoscope has two ends, the bell and the diaphragm. The diaphragm is better for
listening to higher pitched sounds; therefore, it is best for hearing:
first and second heart sounds
systolic murmur
aortic incompetence
The bell of the stethoscope is best for low-pitched sounds e.g third and fourth heart
sounds.
Many sounds can be heard with stethoscope. Try to concentrate on hearing the heart
sounds first.
At the end of this session you will be able to:
Describe the principle that creates the heart sounds
Where on the chest wall can you best hear which sounds and why?
Understand the genesis of murmurs.
Classify the four most important valvular lesions and their corresponding
murmurs.
Draw, on a graph, the classic pattern of murmur in the case of mitral stenosis,
mitral regulation, aortic stenosis, and aortic regulation.
Ganong, Review of Medical Physiology, 20th edition, page: 547 - 549
You have the opportunity to watch the CD-ROM about “heart sounds” you can access the CD-ROM during your spare time. The computer cluster is in the 2nd floor of the medical library, building No. 7.
King Abdul Aziz University Faculty of Medicine and Allied Sciences96
Phase 2 Cardiovascular Module Year 2
Department of Anatomy
Practical (3)External features of the heart and coronary vessels
Demonstrator: The staff members
Learning OBJECTIVES : At the end of this practical lesson, student should be able to:
Recognize and identify the external features of the heart
Identify the coronary arteries and coronary sinus
Detailed Contents:1- Surfaces and borders of the heart
2- Grooves on the surfaces of the heart and their contents
3- Coronary arteries (origin and branches)
4- Coronary sinus (site, termination and tributaries)
READING:
Suggested textbooks and other references:
Richard S. Snell: Clinical Anatomy of Medical Students, 7th edition, Lippincott,
William and Wilkins.
Grant J. C.B.: Grant Anatomy, 10th edition, Lippincott, William and Wilkins.
Eroschenko V.P. Di Fiore’s: Atlas of histology with functional correlations. 9th
edition. Lippincott, William and Wilkins.
Practical notes in the department of Anatomy web site and its attached links:
www.kauanatomy.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences97
Phase 2 Cardiovascular Module Year 2
Department of AnatomyPractical (4)Internal features of the heart
Demonstrator: The staff members
Learning OBJECTIVES : At the end of this practical lesson, student should be able to:
Demonstrate the significance of a knowledge and understanding of the great vessels in the superior mediastinum and their surface marking.
Understand the position of the cardiac chambers and their appearance of the chest radiograph.
Understand the different methods of the cardiovascular imaging (ultrasonography. Computer topography, and Magnetic image resonance
Understand the different radiographic procedures (Plain-X- ray chest, arteriography, venography and Doppler).
Detailed Contents:1- Heart: position, size and appearance.2- Chambers of the heart and their sizes.3- Features of the cavity of different chambers of the heart
READING:
Suggested textbooks and other references:
Richard S. Snell: Clinical Anatomy of Medical Students, 7th edition, Lippincott,
William and Wilkins.
Grant J. C.B.: Grant Anatomy, 10th edition, Lippincott, William and Wilkins.
Stimac,: Diagnosis Imaging.
Practical notes in the department of Anatomy web site and its attached links:
www.kauanatomy.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences98
Phase 2 Cardiovascular Module Year 2Department: PhysiologyPractical 5:ECG Recording
TUTOR: Prof Hosam Awad – Prof. Maha Hegazi
SUMMARY:
In student volunteers, students will locate, and connect the four limb electrodes to the
volunteer. A recording will be made of each student at rest.
The recording will be analysed by the students, and the following values will be
measured: PQ interval, QRS duration, QT-interval, heart rate and the mean QRS vector.
OBJECTIVES:
To be familiar with recording an ECG
To analyse an ECG.
To determine the heart rate, several intervals and mean electrical axis.
READING:
Fagan, cardiovascular system, Physiology, 2nd edition,
page: 143 -154
King Abdul Aziz University Faculty of Medicine and Allied Sciences99
Phase 2 Cardiovascular Module Year 2
Department: BiochemistryPractical 6:
Determination of lipoproteins/plasma lipids
TUTOR: Prof. Mohd Ali Ajab Noor - Dr. Enayat Hashem……
SUMMARY:
An introduction will be given to laboratory methods for the assessment of plasma lipids
and lipoproteins of patients. The following practical tasks will be set: (a) Visual
inspection of normal and pathological (hyperlipoproteinaemic) plasma specimens and
relation of the findings to the Fredrickson Classification. (b) Separation of normal and
pathological lipoproteins by electrophoresis on agarose gel. N.B: staining, destaining and
densitometric scanning of replicate electropherograms will be done for you. The practical
will be concluded with a general discussion of the findings and their clinical importance.
OBJECTIVES:
At the end of this practical session you will be able to:
1) Recognise the role of the biochemistry laboratory in the assessment of the patient’s
plasma lipid and lipoprotein status.
2) Recognise that valid results for patient lipid and lipoprotein status require that fasting
blood samples be tested.
3) Interpret the results of plasma lipid and lipoprotein investigations and to relate them
to the health care needs of the patient.
READING:
Practical Manual of Biochemistry Lab (See the technician in Biochemistry Lab)
King Abdul Aziz University Faculty of Medicine and Allied Sciences100
Phase 2 Cardiovascular Module Year 2
Practical 7:Atherosclerosis
TUTOR: Dr. Ali Sawan & Dr. Sawsan Jalalah… Department: Pathology
SUMMARY:
The gross and microscopic morphology of atherosclerosis will be discussed and
illustrated using gross specimen, digital images and microspic slides.
OBJECTIVES:
At the end of the session you should be able to:
1) Compare and contrast fibrofatty atheromas and fatty streaks.
2) Identify and describe the components of atheromas.
3) Describe the complications that occur in atheromas.
READING:
Robbins Basic Pathology 8 th editionChapter 10; Pages: 348-351
King Abdul Aziz University Faculty of Medicine and Allied Sciences101
Phase 2 Cardiovascular Module Year 2
Department: Biochemistry
Practical 8:
Cardiac enzymes and proteins
TUTOR: Prof. Mohd Ali Ajab Noor – Dr. Enayat Hashem
SUMMARY:
The practical use of the traditional enzymes in the diagnosis of MI in a clinical setting
will be discussed. The pitfalls of CK-MB as the gold standard will also be addressed.
Modern understanding of myocardial ischemia has resulted in new clinical syndromes.
How the latest biochemical markers (CK isoforms, troponins, myoglobin) help to make a
diagnosis of these syndromes will be outlined.
At the end of this session you will be able to:
Evaluate the diagnostic value of the cardiac enzymes.
Determine the use of CK-MB in the diagnosis of myocardial infarction.
Summarize the newer enzymes for the early diagnosis of the new syndromes of
cardiac injury.
Rubin & Farber, Essential Pathology, 2nd edition. Page 249 - 260
King Abdul Aziz University Faculty of Medicine and Allied Sciences102
Phase 2 Cardiovascular Module Year 2
Practical 9:Myocardia Infarction/ Valvular Heart Diseases
Department: Pathology
TUTOR: Dr. Ibrahim Alzahrani, Dr. Sawsan JalalahTaha Moatamad, Dr. Rana Bokhary
SUMMARY:
The morphology of myocardial infarction (gross and microscopic) will be
discussed in different time durations after coronary artery occlusion.
The morphology of rheumatic valvular disease (acute and chronic).
The morphology of valvular changes in cases of infective endocarditis.
At the end of the session you should be able to:
1) Analyse the histological features of myocardial infarction.
2) Explain the chronology of MI pathology.
3) Differentiate between vegetations of rheumatic fever and infective endocarditis.
4) Describe the valvular changes in chronic rheumatic heart disease.
Robbins Basic Pathology 8 th edition Chapter 11; Pages: 391-394 & 403-405
King Abdul Aziz University Faculty of Medicine and Allied Sciences103
Phase 2 Cardiovascular Module Year 2
Department: Pharmacology Practical # 10 :
Effects of Drugs on Isolated Mammalian Heart
Tutor: Prof. Abdel Moneim M. Osman Dr. Hoda Alkarby
Summary:
This session describes different types of drugs affecting heart rate or force of
contraction (either stimulant or depressant).
It will show different types of receptors & the site of action of stimulatory or
inhibitory drugs.
References:
Pharmacological Experimentson Isolated Preparations. By the Staff of the Dep.
of Pharmacology, University of Edinburgh. E& S Livingstone LTD pp 104-111
King Abdul Aziz University Faculty of Medicine and Allied Sciences104
Phase 2 Cardiovascular Module Year 2
Tutorial
Department of AnatomyTutorial (1):Anatomy of the Heart and Coronary vessels.Tutor: Staff members
Learning Objectives:At the end of this practical lesson, student should be able to:
1. Structure of the heart and big vessels.
2. Relations of the heart and big vessels to the surroundings.
3. Development of the Heart and big vessels.
4. Fetal circulation and Common congenital heart diseases.
Detailed Contents: Pericardium (shape, layers, sinuses, nerve and blood supply).
Heart (shape, surfaces, borders, external features, surface anatomy,
chambers, valves, conducting system, blood supply and nerve supply).
Big vessels (Aorta, Pulmonary trunk, Superior and Inferior venae vcavae).
Some important relations of the heart and big vessels to the surrounding
structures.
Development of the heart and big vessels (phases, sinus venosus, cardiac
septa, conducting system, difference between fetal and adult circulations,
Congenital malformations, Histological difference between skeletal and
cardiac muscles).
Suggested Textbooks and Other Reverences: Richard S. Snell. Clinical Anatomy for Medical Students, 7th edition, Lippincott,
Williams and Wilkins.
Grant J.C.B. Grant's Atlas of Anatomy. 10th edition. Lippincott, Williams and
Wilkins.
Stimac, Diagnostic Imaging.
King Abdul Aziz University Faculty of Medicine and Allied Sciences105
Phase 2 Cardiovascular Module Year 2 Practical notes in the Department of Anatomy Web Site and its attached links:
www.kauanatomy.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences106
Phase 2 Cardiovascular Module Year 2
Tutorial:
Atherosclerosis /MyocardiacInfarction/ Valvular Heart Diseases/ Hypertension
Department: Pathology
TUTOR: Dr. Ibrahim Alzahrani, Dr. Sawsan JalalahAli Sawan, Dr. Rana BokharyTaha Moatamad,
SUMMARY:
Discuss problems, questions, or mini cases provided by the tutor or suggested by
the students.
Small group and/or general discussion is encouraged between students.
At the end of the session you should be able to:
1) Discuss topics covered in the module lectures and practical.
2) Analyze the cases in view of the knowledge gained during the course.
Robbins Basic Pathology 8 th edition Chapter 10 & 11
King Abdul Aziz University Faculty of Medicine and Allied Sciences107
Phase 2 Cardiovascular Module Year 2
Independent learning
“Independent learning is a very essential skill for tomorrow’s doctors. We will train you to gain this important skill by asking you to read independently about specific topics in cardiovascular system”
Study Histology of blood vessels and Relate structure to function in the circulation
You may use the following objectives as guidelines:
describe the histological structure of different blood vessels
recognise specific cell types for the different tissues as well as those common to
many tissues.
relate the structure to function in all types of blood vessels.
Ganong, Review of Medical Physiology, 20th edition, page: 556 – 559
Wheather’s Functional Histology (3rd ed) pp. 140 - 152
I would recommend you to use the key word – blood vessels &
histology–in the search engine google (www.google.com).
http://www . Google.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences108
Phase 2 Cardiovascular Module Year 2
Embryology of the heart and great vessels
You may use the following objectives as guidelines:
describe the process of angiogenesis
list the part of the primitive heart
describe the basic plan of early embryonic circulation
describe the process of interatrial septum development
list the embryonic sources of membraneous interventricular septum
describe the development of arch of the aorta, carotid arteries and subclavian
arteries
Sadler T. W. (ed), Langmans Medical Emberyology, 5th ed, 168 - 194
I would recommend you to use the key words – Embryology of the heart –in the
search engine google (www.google.com).
http://www . Google.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences109
Phase 2 Cardiovascular Module Year 2
Congenital heart diseases
You may use the following objectives as guidelines:
Classify congenital heart diseases by incidence.
Describe the hemodynamics involved in common congenital heart diseases
Describe the clinical presentation of the common heart diseases
Explain the embryologic basis of Fallot’s tetralogy
Describe the emberyonic basis of patent ductus arteriosus, coarctation of the aorta,
and transposition of great vessels.
Explain the complications of congenital heart diseases
Ganong, Review of Medical Physiology, 20th edition, page: 664
Rubin & Farber, Essential pathology, 2nd edition. PP. 284-291
I would recommend you to use the key words – Congenital Heart Disease–in the
search engine google (www.google.com).
http://www . Google.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences110
Phase 2 Cardiovascular Module Year 2
Factors affecting tissue perfusion
You may use the following objectives as guidelines:
Define autoregulation and describe its role in physiology
Describe the important factors that affect tissue perfusion.
List the principal vasoregulatory factors secreted by endothelial cells, and describe
the function of each.
Name the main hormones that affect tissue perfusion.
Ganong, Review of Medical Physiology, 20th edition, page: 568 - 573
I would recommend you to use the key word – tissue perfusion, factors–in the
search engine google (www.google.com).
http://www . Google.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences111
Phase 2 Cardiovascular Module Year 2
PBL
PBL process
The clinical scenario
Key information
Explore the problem
What you know
What you need to know
Identify learning issues
Self/group study
Share the knowledge
Solve the problem
King Abdul Aziz University Faculty of Medicine and Allied Sciences112
Phase 2 Cardiovascular Module Year 2 Give feedback & reflect
Introduction
During this week you will work through the case of a patient who has a
history of chest pain.
King Abdul Aziz University Faculty of Medicine and Allied Sciences113
50 year old taxi driver admitted with a two hours history of sever “crushing” central chest pain. He
has 8 children.
He also gives a history of being tired recently and under stress. He has had “indigestion” for some
weeks especially if walking after a heavy meal. His father died of a heart attack aged 48. He takes
no exercise and spends his time at work behind the wheel of his taxi. He smokes 40 cigarettes a day.
He is still in pain. Physical examination shows that he is pale clammy and sweating profusely. He
has tachycardia of 100/min. Blood pressure is 100/70 mmHG. The jugular venous pressure is
elevated to 6 cm. There are no other signs of cardiac failure. The heart sounds are normal.
ECG shows ST elevation in leads II, III, and aVF. The changes are consistent with an acute inferior
myocardial infarction.
The first CK is normal. The cardiothoracic ratio on chest X-ray is normal and the lung field is clear.
The following day the CK has risen to 1800 U/L.
After making good progress, the patient suddenly becomes breathless. On examination, the pulse is
irregularly irregular, the blood pressure is 80/40 mmHg and there is a new pansystolic murmur at
the apex radiating to the axilla. There are wide spread cripitations over both lung fields. The chest
X-ray now shows cardiomegaly with pulmonary congestion most marked around the hila.
Echocardiography shows normal left ventricular function with turbulent Doppler flow in systole
from the left ventricle into the left atrium. ECG shows atrial fibrillation.
The patient makes good progress and has no further complications during his convalescence. He is
due to go home shortly.
He wishes to know what treatment he has received, what he will receive in the weeks a head and
what rehabilitation program he should follow.
Despite an advice to the contrary you find out that he has returned to work a taxi driver six weeks
following his MI.
Phase 2 Cardiovascular Module Year 2
Aims of the PBL sessions
Provide differential diagnosis of acute chest pain
Differentiate chest pain due to cardiac disease from non-cardiac
causes
Differentiate pain due to angina from pain due to myocardial
infarction
Describe the principles of management of acute myocardial
infarction
Describe the principles of management of an acute myocardial
infarction and its complications
Appreciate the importance of primary and secondary prevention,
including cardiac rehabilitation, of acute myocardial infarction.
Prerequisite
You should be able to describe the gross anatomy of the heart with
special reference to the area supplied by each coronary artery.
You should be able to take a full cardiovascular history including a
risk factor profile
King Abdul Aziz University Faculty of Medicine and Allied Sciences114
Phase 2 Cardiovascular Module Year 2 You should understand the clinical events which are responsible
for each part of the ECG waveform
You should be familiar with the biochemical markers of
myocardial cell damage.
Learning opportunity
Fagan, cardiovascular system, Physiology, 2nd edition,
page: 121 -140
Ganong, Review of Medical Physiology, 20th edition
Try to access CD-ROM series about the CVS. The computer cluster is in the 2nd floor of the medical library, building No. 7.
I would recommend you to use the key words – chest pain & case study –in the search engine google (www.google.com). The aim is to recognize the rich resources in the web.
o http://www . Google.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences115
Phase 2 Cardiovascular Module Year 2
Learning issues
At the end of the first session you will be able identify the learning issues which related to the above clinical problem. Try to summarize these learning issues in the table below. We recommend you to learn about these issues. This will help you to solve the problem in the next session.
Learning issues Notes …………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
…………
……………………………………………………………
King Abdul Aziz University Faculty of Medicine and Allied Sciences116
Phase 2 Cardiovascular Module Year 2
Key Facts
Causes of chest pain include:
Myocardial infarction Pulmonary embolus Aortic dissection Peumothorax Herps Zoster Pericarditis
Emergency Care of acute myocardial infarction:
IV access Asprin Analgesia with opiates Oxygen if breathless Thrombolysis if indicated
Indications for thrombolysis
Unequivocal acute myocardial infarction in the absence of contra-indications i.e. chest pain for more than 12 hours with ECG showing ST elevation or a new LBBB.
Contraindications to thrombolysis:
Suspected aortic dissection Recent haemorrhage Major surgery or trauma within
previous two weeks
Active peptic ulceration CVA in previous six months Uncontrolled hypertension Aggressive CPR Warfrin therapy Proliferative diabetic retinopathy
Arrhythmic complications of myocardial infarction:
Ventricular fibrillation Ventricular tachycardia Atrial fibrillation Atrial flutter First second or third (complete)
degree heart block Asystole Electromechanical dissociation
Secondary prevention of myocardial infarction:
Risk factors can be divided into those which are modifiable such as smoking, hypertension and hypercholesterolaemia and those which are not modifiable such as age, sex, ethnic origin, family history, and past medical history.
Secondary preventive treatment is targeted on the modifiable risk factors.
King Abdul Aziz University Faculty of Medicine and Allied Sciences117
Phase 2 Cardiovascular Module Year 2
Introduction
During this week you will work through the case of a patient who has a
history of heart failure.
King Abdul Aziz University Faculty of Medicine and Allied Sciences118
A 62-year-old man is transferred to your hospital because of recurrent dyspnoea 5 days
after suffering a large myocardial infarction. On the day of arrival he is free of chest pain
but is still breathing with moderate difficulty.
You obtain a chest radiograph, which confirms increased distended pulmonary vasculature,
septal lines, and an enlarged heart. An echocardiogram shows an enlarged heart and an
ejection fraction of 30% with minimal systolic motion of the anterior and apical portions of
the heart.
The patient is in normal sinus rhythm, with a heart rate of 110. Arterial blood pressure is
96/68, mean 82, respiratory rate 25/min.
On cardiac auscultation you hear a S3 gallop, a S4 gallop, a normal S1 and S2, and a soft
murmur that encompasses systole (holosystolic), and has uniform intensity that is heard at
the apex and radiates to the left axilla. There are fine, late-inspiratory crackles (crepitations)
heard about a third of the way up both lung fields.
Arterial blood gases reveal a PaO2 of 60 mmHg, PaCO2 of 30 mmHg and pH of 7.37
Phase 2 Cardiovascular Module Year 2
Aims of the PBL sessions
Provide differential diagnoses of heart failure
Differentiate dysnoea due to cardiac disease from non-cardiac
causes
Describe the principles of management of acute heart failure
Describe the principles of management of an acute myocardial
infarction and its complications
Appreciate the importance of primary and secondary prevention,
including cardiac rehabilitation, of heart failure.
Prerequisite
You should be able to describe the gross anatomy of the heart with
special reference to the area supplied by each coronary artery.
You should be able to take a full cardiovascular history including a
risk factor profile
You should be familiar with the nurohumoral regulation of the
cardiovascular system.
Learning opportunity
Fagan, cardiovascular system, Physiology, 2nd edition,
page: 121 -140 Ganong, Review of Medical
Physiology, 20th edition
Try to access CD-ROM series about the CVS. The computer cluster is in the 2nd floor of the medical library, building No. 7.
I would recommend you to use the key words – heart failure & case study –in the search engine google (www.google.com). The aim is to recognize the rich resources in the web.
http://www. Google.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences119
Phase 2 Cardiovascular Module Year 2
Learning issues
At the end of the first session you will be able identify the learning issues which related to the above clinical problem. Try to summarize these learning issues in the table below. We recommend you to learn about these issues. This will help you to solve the problem in the next session.
Learning issues Notes …………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
……
…
King Abdul Aziz University Faculty of Medicine and Allied Sciences120
Phase 2 Cardiovascular Module Year 2
Key Facts
Mechanical complications of myocardial infarctions include:
Actute left ventricular failure Cardiogenic shock Cardiac rupture Pericardial tamponade Ventricular aneurysm Ventricular septal defect Mitral regulation
Causes of heart failure:
Myocardial dysfunction Volume overload Pressure overload Impaired filling Arrythmias High output
King Abdul Aziz University Faculty of Medicine and Allied Sciences121
Phase 2 Cardiovascular Module Year 2
Introduction
During this week you will work through the case of a patient who has a
history of valvular disease.
King Abdul Aziz University Faculty of Medicine and Allied Sciences122
You are asked to supervise an exercise stress test on a 65-year-old man. He saw his doctor
last week for exertional chest pain and mild dysnoea. He has had chest discomfort for about
a year, but the increased frequency of angina promoted him to see his doctor. He has chest
pain when he walks more than one block, and if he continues he becomes breathless.
He never has chest pain or dyspnea at rest. He has no ankle swelling, orthopnoea, or
paroxysmal nocrtornal dysnoea. When you examine him before the stress test, his blood
pressure is 120/86, heart rate 82 and regular, jagular venous pressure is 120/86. Heart rate
82 and regular, jugular venous pressure 5 cmH2O, and lungs are clear. His apex beat is
slightly lateral to the midclavicular line and mildly sustained. He has a soft crescendo-
decrescendo systolic murmur, best heard at the upper right sternal border, radiating to the
carotids and the apex. The carotid pulses are delayed and diminished.
You call the refereeing doctor to discuss the signs and symptoms, cancel the stress test, and
perform an echocardiogram instead.
Phase 2 Cardiovascular Module Year 2
Aims of the PBL sessions
Provide a differential diagnosis of dysnoea
Differentiate dysnoea due to cardiac disease from non-cardiac
causes
Describe the principles of stress test
Describe the principles of management valvular dieases
Appreciate the importance of primary and secondary prevention,
including cardiac rehabilitation, of valvular dieases.
Prerequisite
You should be able to describe the gross anatomy of the heart with
special reference to the area supplied by each coronary artery.
You should be able to take a full cardiovascular history including a
risk factor profile
You should be familiar with the neurohumoral regulation of the
cardiovascular system.
Learning opportunity
Fagan, cardiovascular system, Physiology, 2nd edition,
page: 121 -140 Ganong, Review of Medical
Physiology, 20th edition
Try to access CD-ROM series about the CVS. The computer cluster is in the 2nd floor of the medical library, building No. 7.
I would recommend you to use the key words – heart failure & case study –in the search engine google (www.google.com). The aim is to recognize the rich resources in the web.
http://www. Google.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences123
Phase 2 Cardiovascular Module Year 2
Learning issues
At the end of the first session you will be able identify the learning issues which related to the above clinical problem. Try to summarize these learning issues in the table below. We recommend you to learn about these issues. This will help you to solve the problem in the next session.
Learning issues Notes …………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
…………
……………………………………………………………
King Abdul Aziz University Faculty of Medicine and Allied Sciences124
Phase 2 Cardiovascular Module Year 2
Key Facts
Mechanical complications of myocardial infarctions include:
Actute left ventricular failure Cardiogenic shock Cardiac rupture Pericardial tamponade Ventricular aneurysm Ventricular septal defect Mitral regulation
Causes of heart failure:
Myocardial dysfunction Volume overload Pressure overload Impaired filling Arrythmias High output
King Abdul Aziz University Faculty of Medicine and Allied Sciences125
Phase 2 Cardiovascular Module Year 2
Introduction
During this week you will work
through the case of a patient who
has a history of shock.
King Abdul Aziz University Faculty of Medicine and Allied Sciences126
A 27 year old male is involved in a road traffic accident (RTA). He has multiple wounds
and fractures in his leg. He has been transferred to the ER in your hospital. You have been
called to see the patients. You found the patient comatose. On examination his blood
pressure is 80/40 and his heart rate is 120 bpm.
How would you classify this patients' haemodynamic status?
How would you manage this patient?
What is the role of primary and secondary prevention in this case?
Phase 2 Cardiovascular Module Year 2
Aims of the PBL sessions
Provide a differential diagnosis of shock
Differentiate shock due to cardiac disease from non-cardiac causes
Describe the effect of shock on the cardiovascular system
Describe the principles of management shock
Appreciate the importance of primary and secondary prevention of
shock.
Prerequisite
You should be able to describe the gross anatomy of the heart with
special reference to the area supplied by each coronary artery.
You should be able to take a full cardiovascular history including a
risk factor profile
You should be familiar with the types and causes of shock.
Learning opportunity
Fagan, cardiovascular system, Physiology, 2nd edition,
page: 121 -140 Ganong, Review of Medical
Physiology, 20th edition
Try to access CD-ROM series about the CVS. The computer cluster is in the 2nd floor of the medical library, building No. 7.
I would recommend you to use the key words – shock & case study –in the search engine google (www.google.com). The aim is to recognize the rich resources in the web.
http://www. Google.com
King Abdul Aziz University Faculty of Medicine and Allied Sciences127
Learning issues
At the end of the first session you will be able identify the learning issues which related to the above clinical problem. Try to summarize these learning issues in the table below. We recommend you to learn about these issues. This will help you to solve the problem in the next session.
Learning issues Notes …………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
………………………………………………………………………
…………
……………………………………………………………
Phase II Cardiovascular Module Faculty of Medicine
Key facts
Cardiogenic shock
Acute myocardial infarction
Acute aortic incompetence
Ischaemic mitral regurgitation
LV aneurysm
Myocardial contusion
~ 40% of myocardium damaged leading to Shock
Obstructive shock
Outflow obstruction ->pulmonary embolus
Inflow obstruction -> Cardiac tamponade
Hypovolaemic shock
Exogenous loss from haemorrhage
Endogenous loss -> third space loss & capillary leak syndrome
Distributive shock
A state of relative hypovolaemia (eg. loss blood oncotic pressure).
Impaired distribution and oxygen utilisation.
129