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CuRe PreClerkship Presentation

CARDIOVASCULAR COURSE Anita Soni MD FRCP (C)

January 23, 2014

Human Biology and Health wks.days ( w. 2 days eval ) Y1

M1

Y2

Health and Disease

• FOUNDATION 1.Blood & Immunology I (+ Skin I) 2.CV I & Resp (+ ET) I 3.NeuroScience I(Psych, Neuro + Opth) 4.Musculoskeletal I 5.Endocrine I & Woman’s Reproduction I 6.GI/ Nutrition I & Urinary system I

M2

M3 2 Consolidation 10-------------Mar 24 - May 27

2--------------Mar 23 - April 2 ( Friday April 4 )

7--------------April 7 - May 22 (Easter Monday April 6)

----------------May 25 - 29 …………. Rural week

4--------------Aug 24 - Sept 18

7--------------Sept 21 - Nov 6 3……………. Nov 9- Nov 27 3-----------Nov 30 —Dec 18 Dec break 3 -----2016 Jan 4 - Jan 22 3--------------Jan 25 - Feb 12 4---------------Feb 16 – Mar 11 ----------------Mar 14 - 18 Reading

4 ---- 2014 Aug 25 - Sept 19 3------------ Sept 22 - Oct 11

6 ------------ Oct 14 - Nov 21 4 --------- Nov 24 - Dec 19… Dec break 2------2015 Jan 5 - Jan 16 4------------- Jan 19 - Feb 13

4------------- Feb 17 - Mar 13 TOTAL 27 …….Mar 16 - 20 …………..Reading week

CuRe Preclerkship M0, 1/2: Human Biology , Health and Disease

DRAFT 5 Nov 1, 2013

1. Intro to Infectious Disease and Therapeutics 2. CV II 3. Resp (+ ET) II

4. Introduction to Oncology 5. Blood & Immunology (+ autoimmune diseases) II 6. NeuroScience II (Psych, Neuro, Opth) 7. WRP II 8. Endocrine II 9. GI & Nutrition II 10. Urinary system II 11. Musculoskeletal II & Skin II

CV Course Objectives- Module I 1. Describe the scope and burden of cardiovascular disease in our community 2. Describe the normal anatomy of the heart and great vessels 3. Describe the normal development and embryology of the cardiac system 4. Describe normal cardiovascular physiology including: (1) properties of the

vascular system, (1) the cardiac cycle, (3) the autonomic nervous system, (4) blood pressure regulation, (5) hemodynamics, (5) cardiac indices and (6) cardiac performance. Contrast normal physiology to abnormal.

5. Describe basic cardiac electrophysiology including normal and abnormal 6. Understand the basis of the electrocardiogram (ECG). Have an approach to

ECG interpretation. 7. Understand the physiologic basis and pharmacology of cardiovascular drugs

including (1) inotropic drugs & vasopressors, (2) vasodilator drugs (3) diuretics(4) antiadrenergic drugs, and (5) antiarrhythmic drugs.

8. Have a basic introduction to cardiac imaging including (1) cardiac radiography (2) echocardiography (3) cardiac catheterization (4) nuclear imaging and (5) computed tomography & magnetic resonance imaging.

9. Have an introductory approach to the cardiovascular patient- basic history skills, and physical exam skills including (1) blood pressure, (2) JVP, (3) precordial exam and (4) peripheral exam.

M CuRe 90% Available Surplus Allocated FLEX 1st Iteration

HOURS HOURS Avail-90% HOURS HOURS HOURS

MO MO 57 63 6 57 6M1 B/I1 52 46 -6 43 3

CV1 48 47 -1 44 3RESP1 39 38 -1 35 3ET 9 9 0 7 2COMBO 96 94 -2 86 8

47 5665 5

NS1 58 56 -2 50 6MS 1 34 29 -5 29 0EM1/ 28 30 2 26 4WRP1 30 33 3 29 4COMBO 58 63 5 55 8GI1/ 37 34 -3 32 2UT1 33 29 -4 26 3COMBO 70 63 -7 58 5

M0 and M1 Course Hour Allocation June 25, 2013

Module 1- 45 hours • Introduction to Cardiovascular • Anatomy • Development of the heart • Physiology

– Cardiovascular Physiology – The Cardiac Cycle (include heart/valves background) – Autonomic Nervous System – CV Hemodynamics

• BP Regulation- ANS/RAAS • Pressure Volume Loops • Cardiac Performance • Cardiac Indices • Introduction to Shock

– Pathology: abnormal hemodynamics – Pharmacology:

• Vascular and Autonomic Drugs (inotropic, vasopressors, antiadrenergic) • Vasodilators, Diuretics

• Electrophysiology – Basic Cardiac Electrophysiology – Mechanism of Arrhythmia – Pharmacology: Antiarrhythmic drugs – ECG

• Cardiac Imaging- CXR, echo, catheterization, nuclear, CT, MRI – Introduction to investigations, incorporating anatomy/physiology.

• Review – Mid Instructional test – Anatomy Review – Course Review

CV Module 1

• See Excel Spreadsheet

CV Course Objectives- Module 2 1. Know the following learned previously:

Objectives from CV Module 1 Antithrombotic drugs- covered in the Blood Course Lipids- covered in the Endocrinology Course.

2. Describe the pathophysiology and clinical approach (diagnosis, investigations and management (both non-pharmacologic and pharmacologic) for various cardiovascular diseases including: (1) valvular heart disease, (2) atherosclerosis & ischemic heart disease, (3) heart failure, (4) cardiomyopathies, (5) arrhythmias, (6) pericardial disease, (7) hypertension, (8) diseases of the peripheral vasculature, (9) acquired pediatric heart disease, and (10) congenital heart disease.

3. Describe primary prevention, risk factors and risk factor modification for cardiovascular diseases.

4. Describe physiologic and pathologic changes of the cardiovascular system that occur with aging.

5. Be aware of genetic and molecular aspects of cardiac disease 6. Evaluate the clinical presentations of cardiovascular diseases including the work-

up of chest pain syndromes, shortness of breath, palpitations, and syncope. 7. Have an approach to the cardiovascular patient- be able to perform a pertinent

history and physical examination.

M CuRe 90% Available Surplus Allocated FLEX 1st Iteration

HOURS HOURS Avail-90% HOURS HOURS HOURS

M2 IDONC

25 32 28 4

BI2 45 48 42 6COMBO 70 80 10 70 10CV2 50 63 13 55 8

YEAR 2 RS2 46 63ET 8RS2 54 63 9 54 9EM2 38 39 1 36 3WRP2 44 46 2 42 4GI2 50 46 -4 46 0UT2 38 46 8 36 10NS2 116 114 -2 105 9MSK2 56 56 52 4skin 7 7 6 1MSK2 63 63 0 58 5

M2 Course Hour Allocation June 25, 2013

•Decrease by 3 hours

Module 2 – ~61 hours • Introduction to Cardiovascular- • Valvular heart disease-

– Includes review of the cardiac cycle, valvular disease, diagnostics, treatment – Pathology – ID and surgery

• Atherosclerosis/Ischemic heart disease- – Pathophysiology: atherosclerosis (including risk factors), chronic IHD, and ACS. – Diagnostics: exercise physiology, stress testing, ECG (tutorial), treatment/drugs – Pathology

• Instructional and Mid-Term Exam- CV/RS • Hypertension • Heart Failure and Cardiomyopathies

– Pathophysiology of heart failure, including review of hemodynamics – Diagnostics, treatment/drugs – Pathology

• Arrhythmias- – Bradyarrhythmia and tachyarrhythmia – Includes review of mechanism, treatment/drugs, and ECG

• Pericardial Diseases • Diseases of the Peripheral Vasculature

– Diseases of the aorta – Peripheral artery disease

• Congenital and Pediatric Heart Disease – Includes acquired conditions (ie. rheumatic fever, Kawasaki) and congenital disease

• Genetics/Molecular Aspects • Aging • Course Review • Unknown Patient Cases CV/RS- 3 hours combined with RS • Exam

CV Module 2

• See Excel Spreadsheet

Common Topics • Lipids- moved to Endocrine course • Antithrombotic drugs- moved to Blood course • Volume Regulation/RAAS/Diuretics/ARB/ACE- overlap

with Urinary Course • HTN exclusive to CV

• Not to Forget: – pulmonary HTN/ path- consider integrate in unknown patient

cases) – Ensure pregnancy and cardiac issues covered (not in CV course

right now)

Clinical Skills • INTRO SESSION

– CV- 2 hours (students rotate through 5 demonstration stations) – RS- 2 hours (WGS)

• SMALL GROUP SESSIONS

– 5-6 students per group – Run by Cardiologists/Respirologists – Real patients – Total of 6 hours exposure to CV (3 sessions of 2 hours each) – Total of 6 hours exposure to RS (3 sessions of 2 hours each)

Clinical Skills small group sessions

• 110 students

• Divide class into ¼ (A, B, C, D) • A subdivides into 5 small groups, each with 5-6 students

– A1, A2, A3, A4, A5 • B subdivides into 5 small groups, each with 5-6 students

– B1, B2, B3, B4, B5 • C subdivides into 5 small groups, each with 5-6 students

– C1, C2, C3, C4, C5 • D subdivides into 5 small groups, each with 5-6 students


• For CV and RS: each group gets 3 sessions of 2 hours each

SESSION 1: • Group A- CV • Group B- RS • Group C- free time or other CS activity • Group D- free time or other CS activity

SESSION 2: • Group A- RS • Group B- CV • Group C- free time or other CS activity • Group D- free time or other CS activity etc………


• For CV and RS: each group gets 3 sessions of 2 hours each

Total: 12 sessions needed to accommodate all students to get: • 3 CV sessions • 3 RS sessions • & 6 free time/other CS activities.

TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY

8 - 9 CV INTRO LECTURE

9 -10 CV INTRO PATIENT ILLUS.

10-11 RS INTRO LECTURE

CV VHD LECTURE REVIEW CARDIAC CYCLE/MURMURS

CV VHD LECTURE AORTIC VALVE

11-12 RS INTRO PATIENT ILLUS

CV VHD LECTURE MITRAL VALVE

CV VHD CSA (T1) CASES

12-13 BREAK

BREAK

BREAK

BREAK

13-14 Clinical Reasoning

Clinical Reasoning

Longitudinal courses

14-15 Longitudinal courses

Clinical Reasoning



CV VHD ASSIGNEDSTUDY

CV/ID VHD LECT. ENDOCARDITIS


Week 1 April 7- 10, 2015


8 - 9 CLINICAL SKILLS CV INTRO

CLINICAL SKILLS RS INTRO

CLINICALSKILLS 1/2 CLASS

9 -10 STATION DEMO SESSIONS

SESSION CLINICALSKILLS 1/2 CLASS

CV LECTURE IHD

10-11 CV VHD TUTORIAL

CV LECTURE

CV LECTURE IHD

11-12 CV VHD TUTORIAL

ATHEROSCLEROSIS AND RISK FACTORS

12-13 BREAK BREAK

BREAK

BREAK

BREAK


CV PATHOLOGY ATHEROSCLEROSIS

Clinical Reasoning



CV PATHOLOGY IHD TUTORIAL

Clinical Reasoning




Week 2 April 13- 17, 2015


8 - 9 CV ACS ASSIGNED STUDY




CV TUTORIAL IHD

9 -10 CV LECTURE ACS




CV TUTORIAL IHD

10-11 CV LECTURE ACS

CV LECTURE

11-12 1° & 2 ° PREVENTION

12-13 BREAK BREAK

BREAK

BREAK

BREAK

13-14 CV TUTORIAL ECG IN IHD

Clinical Reasoning

Clinical Reasoning Longitudinal courses


Clinical Reasoning Longitudinal courses


CV HTN ASSIGNED STUDY


Week 3 April 20- 24, 2015


8 - 9 CV/ RESP/ENT INSTRUCTIONAL



CV TUTORIAL HF/CM

9 -10 CV/ RESP/ENT INSTRUCTIONAL



CV TUTORIAL HF/CM

10-11 CV LECTURE HTN

CV LECTURE

CV LECTURE HEART FAILURE

11-12 CV LECTURE HTN

REVIEW HEMODYNAMICS/HEART FAILURE

CV LECTURE HEART FAILURE

12-13 BREAK BREAK

BREAK

BREAK

BREAK

13-14 CV CSA HTN CASES

Clinical Reasoning

CV LECTURE CARDIOMYPATHIES

Clinical Reasoning



CV LECTURE CARDIOMYOPATHIES

Clinical Reasoning



PATHOLOGY TUTORIALHF/CM


Week 4 April 27- 30, 2015


8 - 9 CV PERICARDIUM ASSIGNED STUDY



CV TUTORIAL ARRHYTHMIA

9 -10 CV PERICARDIUM CSA (T1) CASES



CV TUTORIAL ARRHYTHMIA

10-11 CV LECTURE

CV ASSIGNED STUDY

ARRHYTHMIA

11-12 BRADYARRHYTHMIA CV TUTORIAL ECG ARRHYTHMIA

12-13 BREAK BREAK

BREAK

BREAK

BREAK

13-14 CV LECTURE REVIEW EP

Clinical Reasoning

Clinical Reasoning


14-15 CV LECTURE TACHYARRHYTHMIA


Clinical Reasoning


15-16 CV LECTURE TACHYARRHYTHMIA



Week 5 May 4- May 8, 2015


8 - 9 CV LECTURE THORACIC AORTA



CV TUTORIAL PEDS CARDIO

9 -10 CV LECTURE



CV TUTORIAL PEDS CARDIO

10-11 PERIPHERAL VASCULAR

CV TUTORIAL AGING

CV REVIEW

11-12 CV TUTORIAL PVD

CV LECTURE ACQUIRED PEDS

RESP REVIEW

12-13 BREAK BREAK

BREAK

BREAK

BREAK


CV LECTURE CONGENITAL

Clinical Reasoning



CV LECTURE CONGENITAL

Clinical Reasoning



CV -GENETICS & MOLECULAR

?ASSIGNED STUDY


Week 6 May 11- May 15, 2015


8 - 9 CLINICALSKILLS 1/2 CLASS

CLINICAL SKILLS 1/2 CLASS E

9 -10 CLINICALSKILLS 1/2 CLASS

CLINICAL SKILLS 1/2 CLASS X

10-11 CV/ RESP

CV/ RESP A

11-12 UNKNOWN PATIENT CASES

UNKNOWN PATIENT CASES M

12-13 BREAK

BREAK

BREAK


Clinical Reasoning


Clinical Reasoning


Week 7 May 18- May 22, 2015

Community Health • Community Health topics- moved to Longitudinal

courses – Epidemiology of Heart Disease – Prevention of Vascular Disease – Community Health Concepts (CV/Resp)

Indiginous Health

• Need to coordinate sessions to CV topics

Other Themes to consider:

• Professionalism/ethics • Multidisciplinary care- ie post MI rehab

Clinical Reasoning

• Meeting next week (CR/CV/RS)

CP4 topics

SYMPTOMS & SIGNS 9- cardiac murmurs 10- chest pain 13- cyanosis 22- edema 23- extremity pain- acute and chronic 45- palpitations 56- syncope

CP4 topics

– ABNORMAL LABS 70- cardiac markers and ECG 74- lipid abnormalities (with endo) – FACTORS AFFECTING HEALTH 83- chronic disease

CP4 topics

– HEALTH CONDITIONS 102-CVD 110-hypertension 120- palliative care 125- shock/ rescucitation

Consolidation Topics (M3)

• To be considered - Chest pain, dyspnea, palpitations, syncope

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