MED 364 · الجهاز القلبي الوعائي

السنة 3 · 40 محاضرة · 6 ساعات معتمدة

العناوين والأهداف منقولة من خطة كلية الطب الرسمية.

موقعها في الخطة الاسترشادية 2023: السنة الثالثة، الفصل الثاني

الخطة التفصيلية للمساق على موقع الجامعة · صادرة الفصل الثاني 2022/2023

المحاضرات وأهدافها

1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 25. Antihypertensive drugs II

    Pharmacology

    • Continuation of antihypertensive drugs I: diuretics, sympathoplegics, vasodilators, and their clinical use.

26. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.