Outcome of the undergraduate Curriculum -...

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.


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.


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.


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.



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)


Second Year Courses


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


STRUCTURE OF THE MODULE

mailto:[email protected]


mailto:Abdelrahman.fahmy@hotmail

mailto:Abdelrahman.fahmy@hotmail





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.



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


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.



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



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.



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



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



Topic Outlines


LECTURES


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)



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: .


http://www/


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: .



Continue … Lecture 2:Cellular events in the heart



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



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: .





Continue … Lecture 3:The Heart as a pump


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: .



Lecture 4: Anatomy of the Mediastinum and Pericardium Department: AnatomyLecturer: Prof. Dr. Said Zaghloul Prof. Dr. Amira El-haggagy


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.



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



Lecture 5: External Features of the Heart and coronary vessels

Department: AnatomyLecturer: Prof. Dr. Said ZaghloulProf. Dr. Amira El-haggagy


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.



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



Lecture 6:The control of the cardiac output


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)



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.


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.


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: .


http://www/


Lecture 7Cardiac Cycle


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: .






Continue … Lecture 7Cardiac Cycle


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: .



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: .



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: .



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).


Self-assessment

Answer MCQs (4 and 8) in Ganong, Review of Medical Physiology, 20th edition, page: 745


http://www/


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



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.



Lecture 10: Normal development of the heart

Department: Anatomy

Lecturer: Prof. Dr. Said Zaghloul Dr. Eman Abd El-aal


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.




- 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.



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: .




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.


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: .


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).


Lecture 12:Cardiac arrhythmias

Department: PhysiologyLecturer : & Prof. Hossam Prof. Maha Hegazi & Dr. Azra


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: .




Continue … Lecture 12:Cardiac arrhythmias


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


Describe the pathophysiological

principal of the cardiac arrhythmias.

Classify cardiac arrhythmias using a

simple concept map.

Student Notes: .



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.




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.



Lecture 14:The autonomic nervous system and the cardiovascular system


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: .




Continue … Lecture 14:The autonomic nervous system and the cardiovascular system


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.


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: .



Lecture 15:Relationship between pressure, flow and resistance


Lecturer: Prof. Hosam Awad – Prof. Maha Hegazi


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: .




Continue … Lecture 15:Relationship between pressure, flow and resistance


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.


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: .



Lecture 16:Cholesterol and triglycerides transport pathways

Department: Biochemistry

Lecturer Prof. Mohd Ali Ajab Noor - Dr. Enayat Hashem


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: .



Phase 2 Cardiovascular Module Year 2density and low density lipoproteins.



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).


Self-assessment

How defects in lipoprotein metabolism result in

hyperlipoproteinaemias?

Student Notes: .


http://www/


Lecture 17: Myocardial & Pericardial Diseases

Department: Pathology

Lecturer:Dr. Taha Moatamad &Dr. Rana Bokhary


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: .




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: .


http://library.med.utah.edu/WebPath/webpath.html

http://www.pathguy.com/


Lecture 18:Pressure and flow in systemic circulation


Lecturer: Prof. Hosam Awad Prof. Maha Hegazi


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: .




Continue … Lecture 18:Pressure and flow in systemic circulation


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.


http://www.cvphysiology.com/Blood%20Pressure/BP002.htm

Self-assessment


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: .



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: .



Continue … Lecture 19: Predict how CVS will react in common situations: eating a meal, exercise and changes in posture


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.


Self-assessment


Describe the main changes in cardiovascular system during exercise.

Why do people faint when rise from supine to standing position?

Student Notes: .



http://www/

Phase 2 Cardiovascular Module Year 2pages for notes if needed)



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: .



Continue Lecture 20: Special circulations: Coronary , Pulmonary , Cerebral and Skeletal circulation.


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


What is reactive hyperaemia? Where dose it occur?


Student Notes: .


http://www/


Lecture 21: Atherosclerosis and Aneurysm

Department: PathologyLecturer: Dr. Ali Sawan & Dr. Sawsan Jalalah


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.


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: .




Continue … Lecture 21: Atherosclerosis and Aneurysm

.

Robbins Basic Pathology 8 th editionChapter 10; Pages: 343-352


Self-assessment

Describe the acute plaque changes.

Describe the complications that may occur as a

result of these changes.

Student Notes: .





Lecture 22: Ischemic heart Disease

Department: PathologyLecturer : Dr. Ibrahim Alzahrani & Sawsan Jalalah


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.


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: .



Continue … Lecture 22: Ischemic heart Disease



Robbins Basic Pathology 8 th editionChapter 11; Pages: 388-398.


Self-assessment

What are the complications of myocardial

infarction?

Which of these is considered a late complication?

Lecture 23:Antihypertensive drugs

Student Notes: .




Phase 2 Cardiovascular Module Year 2Department: PharmacologyLecturer:Prof. Abdel- Moneim Osman - Dr. Magda Hagras


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




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.


Self-assessment


Write short essay about anti-hypertensive drugs

Write short account about the treatment of heart failure

Student Notes: .


http://www/


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: .



Continue Lecture 24: Tissue fluid formation and Edema


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


Define edema, describe its causes.


Student Notes: .


http://www/


Lecture 25: Valvular Heart DiseasesDepartment: Pathology

Lecturer: Dr. Taha Moatamad & Dr. Rana Bokhary


Describe the pathogenesis, morphology & clinical features of:

1. Rheumatic valvular disease.2. Calcific aortic stenosis.3. Myxomatous mitral valve.4. Prosthetic cardiac valves.


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:



Continue .... Lecture 25: Valvular Heart Diseases

Robbins Basic Pathology, 8th edition.Chapter 11 – The Heart. Pages 400-406 & 409.


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)





Lecture 26: Infective Endocarditis.Department: Pathology

Lecturer:Dr. Taha Moatamad &Dr. Rana Bokhary


Describe the pathogenesis, morphology & clinical features of:4. Infective endocarditis.5. Nan-bacterial thrombotic endocarditis

(NBTE).6. Myocarditis.7. Pericarditis.8. Pericardial effusions.


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: .




Continue Lecture 26: Infective Endocarditis, Myocardial & Pericardial Diseases

Robbins Basic Pathology, 8th edition.Chapter 11 – The Heart. Pages 406-408 & 414-417.


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: .





Lecture 27: Hypertension and Effects on Blood Vessels and Heart

Department: Pathology.Lecturer: Dr. Taha Moatamad & Dr. Sawsan Jalalah


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: .




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


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: .





Lecture 28: Vasculitis & Cardiovascular Tumors

Department: Pathology.Lecturer: Dr. Ali Sawan & Dr. Rana Bokhary


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.


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: .




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.


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: .





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: .




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).


Self-assessment

Write short essay on the mechanism of action of the

antianginal drugs .

Student Notes: .


http://www/


Lecture 30:Anti-arrhythmic drugs


Lecturer: Prof. Abdel-Moneim Osman - Dr. Magda Hagras


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: .



Phase 2 Cardiovascular Module Year 2already slow.



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).


Self-assessment

Write short essay on the mechanism of action of the

anti-arrhythmic agents in the Vaughan-William

classification.

Student Notes: .


http://www/


Lecture 31:Hyperlipoproteinamias and hypolipoproteinaemias


Lecturer: Prof. Mohd Ali Ajab Noor - Dr. Enayat Hashem


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: .




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).


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: .


http://www/


Lecture 32:Diagnostic cardiac enzymology

Department: BiochemistryLecturer Prof. Mohd Ajab Noor – Dr. Enayat Hashem


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: .




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.



Lecture 33:Drugs used in heart failure


Lecturer Dr. Osman Hasan – Dr. Mai Abdel Aleim


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: .




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: .



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: .




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: .





Practical



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



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.



Department of Anatomy

Practical (3)External features of the heart and coronary vessels



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:





Eroschenko V.P. Di Fiore’s: Atlas of histology with functional correlations. 9th

edition. Lippincott, William and Wilkins.


www.kauanatomy.com



Department of AnatomyPractical (4)Internal features of the heart



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:





Stimac,: Diagnosis Imaging.


www.kauanatomy.com


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



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)



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




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



Practical 9:Myocardia Infarction/ Valvular Heart Diseases


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.


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



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



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.


Phase 2 Cardiovascular Module Year 2 Practical notes in the Department of Anatomy Web Site and its attached links:

www.kauanatomy.com


http://www.kauanatomy.com/


Tutorial:

Atherosclerosis /MyocardiacInfarction/ Valvular Heart Diseases/ Hypertension


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.


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



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/


Embryology of the heart and great vessels


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/


Congenital heart diseases


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




http://www/


Factors affecting tissue perfusion


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




http://www/


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


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.


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.


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


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


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


http://www/


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 …………………………………………………………………………

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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.



Introduction


history of heart failure.


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



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


including cardiac rehabilitation, of heart failure.

Prerequisite




risk factor profile

You should be familiar with the nurohumoral regulation of the

cardiovascular system.



page: 121 -140 Ganong, Review of Medical

Physiology, 20th edition


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


http://www/


Learning issues



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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



Introduction


history of valvular disease.


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.



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


including cardiac rehabilitation, of valvular dieases.

Prerequisite




risk factor profile

You should be familiar with the neurohumoral regulation of the

cardiovascular system.






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/


Learning issues



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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



Introduction

During this week you will work

through the case of a patient who

has a history of shock.


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?



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




risk factor profile

You should be familiar with the types and causes of shock.






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/

Learning issues



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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.

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Date post:	23-Apr-2018
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