MED 364 — الجهاز القلبي الوعائي
السنة 3 · 40 محاضرة · 6 ساعة معتمدة
العناوين والأهداف منقولة من خطة كلية الطب الرسمية.
1. Introductory lecture
Multidisciplinary
- Understand the general outline of the CVS module.
- Be familiar with the teaching modalities.
- Be familiar with the grading system and passing requirements.
- Understand the current status of cardiovascular disease in Jordan.
2. The mediastinum and heart coverings (pericardium)
Anatomy
- Describe the divisions of the mediastinum.
- Describe the outline and normal position of the heart.
- Identify the relations of the parts of the heart in the middle mediastinum.
- List the contents and relations of the mediastinum.
- Define the pericardium and its layers.
- Describe its attachments to the diaphragm and the great vessels.
3. Pericardial spaces and external features of the heart
Anatomy
- Discuss the pericardial space and its recesses.
- Describe the innervation of the fibrous pericardium.
- Describe the external features of the heart.
- Identify the surface anatomy of the heart.
4. Heart chambers, valves, conductive system, and innervation of the heart
Anatomy
- Describe the four chambers and the interior of each.
- Identify the papillary muscles, their locations, and importance.
- Describe the atrioventricular valves, cusp attachments to papillary muscles, and their function.
- Describe the aortic and pulmonary semilunar valves.
- Describe the parts of the conductive system and their distribution in the myocardium.
5. Histology of the heart and blood vessels
Anatomy
- Describe the microscopic structure of cardiac muscle.
- Describe the ultrastructure of the cardiac muscle fiber.
- Describe the histology of endocardium and epicardium.
- Describe the histology of arteries and veins and their differences.
- List the types of capillaries and their distribution.
6. Organization of the CVS
Physiology
- Describe the systemic and pulmonary circulations and their differences.
- Explain the functional parts of the CVS.
- Discuss blood velocity, volumes, and pressures in the parts of the CVS.
- Discuss the basic functions of the CVS.
7. Physiology of cardiac muscle
Physiology
- Describe the cardiac conductive system and its function.
- Describe the cardiac action potential and its components.
- Define the refractory period and excitation-contraction coupling.
8. Cardiac cycle
Physiology
- Define the durations of systole and diastole.
- Discuss the pressure and volume changes in the left ventricle, left atrium, and aorta during the cycle.
- Identify the periods of the cycle: atrial systole, isovolumetric contraction, ejection, isovolumetric relaxation.
- Discuss the left ventricular volume-pressure relationship.
9. Pumping of the heart and regulation of cardiac output
Physiology
- Discuss the intrinsic and extrinsic control of cardiac output.
- Explain the Frank-Starling mechanism.
- Describe the effect of high K+ and Ca++ on heart function.
- Define cardiac index.
- Discuss venous return and cardiac reserve and their effects on cardiac output.
- Explain the effect of sympathetic activity and blood volume on cardiac output.
- Study the methods of measuring cardiac output.
10. Endocarditis, valvular diseases, and myocarditis
Pathology
- Know the types of endocarditis.
- Classify infective endocarditis.
- Discuss the pathogenesis and list the causative organisms.
- Compare acute and subacute bacterial endocarditis.
- List the complications of bacterial endocarditis.
- Describe marantic and Libman-Sacks endocarditis.
- Classify valvular heart diseases and their pathological consequences.
- List the etiological factors and clinical presentations of myocarditis.
11. ECG
Physiology
- Identify the ECG waves and the cause of each.
- Define the normal intervals and segments.
- Discuss the bipolar and unipolar limb and chest leads.
- Discuss the bipolar limb leads and the cardiac axis.
12. Coronary circulation and venous drainage of the heart
Anatomy
- Describe the origin, course, branches, and distribution of the coronary arteries.
- Describe the sites of anastomosis between coronary branches.
- Describe the cardiac veins: names, location, drainage areas.
- Describe the coronary sinus, its location, termination, and tributaries.
13. Blood vessels I: arterial system
Anatomy
- List the parts of the aorta.
- List the branches of the arch of the aorta.
- Describe the blood supply of the head and neck.
- Describe the blood supply of the upper limb.
- Describe the branches of the thoracic aorta.
- Describe the branches of the abdominal aorta.
- Describe the blood supply of the pelvis.
- Describe the blood supply of the lower limb.
14. Blood vessels II: venous system
Anatomy
- Describe the caval system: course and relations of the superior and inferior vena cava.
- Describe the SVC tributaries draining head, neck, and upper limbs.
- Describe the IVC tributaries draining abdomen, pelvis, and lower limbs.
- Describe the azygos system and its drainage.
- Describe the portal venous system.
- Describe the portocaval anastomoses.
15. Cardiac arrhythmias
Physiology
- Define ectopic foci and the mechanism of re-entry.
- Describe the types of arrhythmia and the ECG changes in each.
- Discuss the types of conduction block.
16. Antiarrhythmic drugs
Pharmacology
- Describe the distinguishing features of the five major groups of antiarrhythmics.
- Describe the mechanism of action of each group.
- Understand the pharmacokinetics, clinical uses, and major toxic effects of antiarrhythmic drugs.
17. Rheumatic heart disease
Pathology
- Know the main features of rheumatic fever.
- Discuss its etiology and pathogenesis.
- Be familiar with the pathognomonic lesions of RF and RHD.
- Describe the changes in the heart and other organs in RF.
- Describe the chronic sequelae of RHD.
18. Blood flow to tissues
Physiology
- Describe the local mechanisms of tissue blood flow control, acute and long-term.
- Discuss the metabolic and myogenic theories.
- Discuss humoral regulation by vasoconstrictors and vasodilators.
- Describe capillary flow and the precapillary sphincter.
- Discuss exchange between blood and interstitial fluid and its determinants.
- Identify the primary forces controlling fluid movement across the capillary membrane.
- Explain coronary blood flow during systole and diastole to the parts of the myocardium.
- Discuss local control of coronary flow: metabolism and oxygen demand.
- Describe the autonomic effects on the coronary arteries and the role of alpha and beta receptors.
19. Cardiomyopathy, tumors of the heart, and pathology of the pericardium
Pathology
- Discuss the main features and effects of the main types of cardiomyopathy.
- Classify pericarditis by type of exudate.
- Describe the pathology of the common heart tumors.
20. Hemodynamics
Physiology
- Explain the relationship between pressure, flow, and resistance.
- Discuss laminar and turbulent flow.
- Understand the methods of measuring blood flow.
- Understand Laplace's law.
- Describe arterial pressure pulsation and its transmission to the peripheral arteries.
- Discuss the function of the veins, venous pressure, venous resistance, valves, and the venous pump.
21. Regulation of blood pressure
Physiology
- Define systolic, diastolic, and pulse pressure.
- Define mean arterial pressure, circulatory filling pressure, and central venous pressure.
- Explain the effect of gravity on blood pressure in different positions.
- Discuss the methods of blood pressure measurement.
- Describe the fast reflex mechanisms: baroreceptors, chemoreceptors, low-pressure receptors.
- Discuss the CNS ischemic response.
- Discuss the long-term mechanisms: renin-angiotensin system, aldosterone, ADH.
22. Development of the vascular system
Anatomy
- Describe the formation of the dorsal aorta.
- Describe the formation and fate of the aortic arches.
- Revise the transformation of fetal into adult circulation.
- Describe the major congenital malformations of these stages and their clinical implications.
23. Vasculitis
Pathology
- Define vasculitis and list its possible causes.
- Discuss the mechanism of vasculitis.
- Understand the relation between ANCA and vasculitis.
- Classify vasculitis.
- Describe the main features of the types of vasculitis.
24. Antihypertensive drugs I
Pharmacology
- List the major groups of antihypertensives with an example of each.
- Describe the mechanism and value of diuretics in hypertension.
- List the sites of action of sympathoplegic drugs with examples.
- List the indications, contraindications, pharmacokinetics, and adverse effects of each drug.
- Understand the role of vasodilators in hypertension.
- Understand the mechanisms, pharmacokinetics, indications, contraindications, and adverse effects of common vasodilators.
25. Antihypertensive drugs II
Pharmacology
- Continuation of antihypertensive drugs I: diuretics, sympathoplegics, vasodilators, and their clinical use.
26. Surgical aspects of CAD and valvular heart disease
Surgery
- Understand the surgical complications and consequences of CAD and valvular heart disease.
- Outline the surgical interventions used in their management.
27. Cholesterol synthesis and degradation
Biochemistry
- Discuss the sources of the hepatic cholesterol pool and its input and output routes.
- Discuss the cholesterol biosynthetic pathway, key enzymes, and regulation.
- Discuss cholesterol degradation including bile acid synthesis and its regulation.
- Describe the enterohepatic circulation of bile acids and its control of the cholesterol pool.
28. Arteriosclerosis and atherosclerosis
Pathology
- Define arteriosclerosis and atherosclerosis.
- List the three patterns and two morphologic variants of arteriosclerosis.
- Describe medial calcification, hyaline and hyperplastic arteriolosclerosis, and the histology of atherosclerosis.
- List the risk factors of atherosclerosis.
- Outline the theories of pathogenesis with emphasis on the response-to-injury hypothesis.
- Define aneurysm and list its types.
- Discuss syphilitic aortitis and its effects.
- Discuss the etiology, mechanism, and outcome of dissecting hematoma.
29. Plasma lipoproteins and familial hypercholesterolemia
Biochemistry
- Describe the structure, components, and types of lipoproteins and the functions of the apoproteins.
- Describe the metabolic pathways of chylomicrons, VLDL, LDL, and HDL.
- Describe the biochemical basis of familial hypercholesterolemia.
30. Lipid-lowering drugs
Pharmacology
- Understand the therapeutic strategies to lower blood lipids.
- Classify lipid-lowering drugs.
- Understand the indications, mechanisms, toxic effects, pharmacokinetics, and pharmacodynamics of each class.
31. Cardiac enzymes and other protein markers
Biochemistry
- Discuss the clinical relevance of creatine kinase, LDH, troponins, myoglobin, and other peptide markers in cardiac diagnosis.
32. Ischemic and hypertensive heart diseases
Pathology
- Define ischemic heart disease.
- Understand its pathogenesis and list its syndromes.
- Correlate the type of angina with coronary pathology.
- Describe myocardial infarction: types, gross, histology, sites.
- Describe chronic ischemic heart disease.
- List the causes and mechanism of sudden cardiac death.
- List the criteria of hypertensive heart disease and its gross and histological features.
33. Antianginal drugs
Pharmacology
- Define the therapeutic strategies in angina.
- List the drug groups used in angina.
- Classify nitrates and describe their pharmacokinetics, mechanism, uses, administration, and toxic effects.
- Understand the role of calcium channel blockers in angina.
- List the common calcium channel blockers with their pharmacokinetics, indications, contraindications, and adverse effects.
- Understand the role of beta-blockers in angina.
34. Clinical aspects of ischemic heart disease
Medicine
- Describe the clinical presentation of the types of IHD.
- Understand the complications and consequences of IHD.
- Describe the major investigations in IHD.
- Outline a general management plan.
35. Epidemiology of cardiovascular disease
Community Medicine
- Appreciate the magnitude of CVD as a public health problem.
- Understand the epidemiology of CVD by person, time, and place.
- List CVD risk factors with emphasis on modifiable ones.
- Be familiar with the Framingham study.
36. Surgical aspects of peripheral vascular diseases
Surgery
- Describe the clinical presentation of peripheral vascular disease.
- Understand its complications and consequences.
- Outline the surgical interventions used in its management.
37. Circulatory shock and heart failure
Physiology
- Define circulatory shock and distinguish cardiogenic from hypovolemic shock.
- Discuss the non-progressive and progressive stages of shock.
- Describe sympathetic reflex compensation in shock.
- Discuss the effects of shock on the body.
38. Varicose veins, lymphatic pathology, and tumors of blood vessels
Pathology
- Discuss the pathogenesis of varicose veins.
- Know the sites where varicose veins occur.
- List the sequelae of varicose veins and other lymphatic disorders.
- Know the criteria distinguishing benign, borderline, and malignant vascular tumors.
- Give examples of the types of vascular tumors.
39. Drugs used in the treatment of heart failure
Pharmacology
- Understand the therapeutic strategies in congestive heart failure.
- Classify the digitalis glycosides with examples.
- Describe the pharmacokinetics of digitalis.
- Understand the mechanism and effects of digitalis.
- List the toxic effects of digitalis and their treatment.
- Describe the role of diuretics, ACE inhibitors, vasodilators, and beta-1 agonists in heart failure.
40. Prevention and control of CVD
Community Medicine
- Distinguish the high-risk-group from the population-based approach.
- List the levels of control of CVD.
- Case study: the North Karelia program, Finland.