CSG

TOPIC SUB TOPIC LEARNING OBJECTIVESRESOURCE

PERSONREFERENCES

BASIC SCIENCE OF EMBRYOLOGY At the end of the chapter, the learner will be able to explain :

CARDIOVASCULAR NORMAL EMBRYOLOGY 1. Formation of the heart tube

SYSTEM 2. Formation of the heart loop

. Truncus arteriosus, bulbus/conus cordis, ventricle, atrium, sinus

venosus

3. Formation of cardiac septum:

. Septum in the atrium-septum primum-septum

secundum, septum in the ventricle, septum in the truncus and

conus, septum in the atrioventricular canal

4. Formation of the valves: bicupid, tricuspid, semilunar valves

5. ASD: Atrial Septal Defect:

. Ostium secundum defect, septum primum resorption, inadequate

development of the septum secundum

6. VSD: Ventricular Septal Defect:

. Partition of truncoconal region, muscular dafect of the septum,

mebranous defect

7. Transposition of the vessels:

. Abnormal truncoconal septum function, defect in membranous part

of inetrventricular septum

8. Patent Ductus Arteriosus:

. Valvular stenosis, valvular atresia, closure of ductus arteriosus

9. Tetralogy Fallot:

. Pulmonary stenosis interrventricular septa defect, hyperthrophy of

the ventricular wall, overriding of the ventricular septum

CARDIOVASCULAR ANATOMY 10. ASD:Atrial Septal Defect:

. Ostium secundum defect, septum primum resorption, inadequate

development of the septum secundum

11. VSD: Ventricular Septal Defect:

. Partition of truncoconal region, muscular defect of the septum,

membranous defect

12. Transpotition of the vessels:

. Abnormal of truncoconal septum functio, defect in membranous

part of interventricular septum

13. Patent Ductus Arteriosus:

. Valvular stenosis, navular atresia, closuere of ductus arteriosus

14. Pulmonary stenosis, interventricular septal defect, hiperthroophy of

the ventricular wall, overriding of the ventricular septum

CARDIOVASCULAR PHYSIOLOGY 15. At the end of the chapter, the learner will be able to rxplain the

pricipies of cardiovascular physiology (C3)

. Illustrate the physilogical characteristic of the heart sa a pump

* explain the physilogy of the heart muscle

* explain the cardiac cycle

* explain the regulation of heart pump

. Explain the mechanism of rhythmical excitation of the heart

* explain the specialized excitatory and conductive system of the

heart

* explain the control of excitation and conduction in the heart

. Sketch the normal ECG Characteristic of the normal Electro Cardio

Grams.

* explain the nethod for recording electrocardiograms.

* explain the flow of current around the heart during the cardiac

cycle.

* explain the electrocardiographic leads.

UNIVERSITAS PEMBANGUNAN NASIONAL "VETERAN" JAKARTAFAKULTAS KEDOKTERAN UMUM

COURSE STUDY GUIDE (CSG)

CARDIOVASCULAR SYSTEM

EMBRYOLOGY OF CONGENITAL HEART DISEASE

. Explain the medical physics of pressure, flow, and resistence

* explain the physical characteristics of the circulation.

* explain the basic theory of the circulation finction.

* explain the interrelationship among pressure, flow, and

resistance.

. Explain the function of the arterial and venous system

* explain the vascular distensibility.

* explain the arterial pressure pulsation.

* explain the veins and their functions

. Explain the micro circulation and lymphatic system.

* explain the structure of the microcirculation and capillary

system

* explain the flow of blood in the capillaries

* explain the exchange of nutrient and other subtance between

the blood and interstitial fluid.

* explain the interstitium and interstitial fluid.

* explain the importance of protein in the plasma and interstitial

fluid are especilly in controling plasma and interstitial fluid

volume

* explain the lymphatic system.

. Explain the mechanism of circulation control

* explain the local control of blood flow in response to tissue

needs

* explain the mechanism of blood flow control.

* explain the mechanism of humorals regulartion of the circulation.

* explain the mechanism of nervous regulation of the circulation.

* explain the role of the nervous system for rapid control of

arterial pressure

* explain thespecial feature of nervous control of arterial

pressure

* explain the function of the renal body fluid system for arterial

perssure explain the effect of the renninangiotensin system

. Illustrate the cardiac output, venous return

* explain the normal value for cardiac output at rest and during

activity

* explain the control of cardiac output by venous return-role of

the Frank-Starling mechanism of the heart.

* explain what are the pathologically high and pathologically low

cardisc output

* explain the quantitative analysis of cardiac output regulation

* explain the method of measuring cardiac output

. Explain the muscle blood flow and coronary circulation

* explain about the blood flow in skeletal muscle an its regulation

during exercise

* explain about the coronary circulation

. Explain yhe heart sound

* explain about the heart sounds and their relationship with valve

functions

* explain the dynamics of the circulation in cardiac failure

* explain about the unilateral left heart failure

* explain what is low-output cardiac failure-cardiogenic shock

* explain the mechanism of edema in patient with cardiac failure

* explain what is the cardiac reserve

* illustrate the physiologic causes of shock

* give some example types of shock

CONGENITAL PREVALENCE OF CONGENITAL HEART DISEASE 16. At the end of the chapter, the learner will be able to describe the

HEART DISEASE prevalence of congenitalheart disease (C3)

FETAL AND PRENATAL CIRCULATION 17. At the end chapter, the learnerwill be able to explain the fetal

and prenatal circulation (C3)

PATHOPHYSIOLOGY 18. patophysiology of left to right shunt lesion (C3)

19. patophysiology of cyanotic congenital heart disease (C3)

PATHOLOGY OF THE HEART 20. At the end of the chapter, the learner will be able to describe :

(VSD,ASD,PDA.TETRALOGY OF pathology of the heart (VSD, ASD,PDA, Tetralogy of Fallot )(C3)

FALLOT) 21. the situs (C2)

NOMENCLATURE OF CONGENITAL HEART 22. AV-VA concordance (C2)

DISEASE

SPECIFIC CONGENITAL HEART DISEASE 23.to categorize the left to right shunt lesions

LEFT TO RIGHT SHUNT: At the end of the chapter, the learner will be able to:

A.ATRIAL SEPTAL DEFECT (ASD) 24. state the definition of ASD (C1)

25. Explain symptoms & signs

· Clinical findings ( symptoms )

· Physical findings ( C2 )

· Radiological finding ( C3 )

· Blood, ECG & echochardigraphy findings ( C2 )

· Catherization & Angiocardigraphy finding ( C1 )

26. Examine the natural history of ( C4 )

· Heart Faiilure ( C3 )

· Eisenmenger/ pulmonary vascular disease ( C3 )

· Endocarditis ( C3 )

· Pulmonary hypention (C 3)

27. explain the management (C2)

The general management (C4)

Management of associated condition (C2)

Management of complications (C2)

28 explain the prognosis (C4)

At the the capter, the learner will be able to:

B.Ventricural Septal Defect 29. state definition of VSD (C1)

( VSD) 30. explain the symptoms & signs

Clinical findings (symptoms)

Physical findings (C2)

radiological findings (C3)

blood,ECG & angio cardiography findings (C1)

31. examine the natural history (C4)

· heart failure (C3)

· Einsenmenger/Pulmonary Vascular disease (C3)

· Pulmonary hypertantion (C3)


The general management (C4)

Managemet of associated conditions (C2)

Management of complications (C4)

Timing of sugery (C2)

33. explainthe prognosis (C4)

At the endof the chapter, the learner will be able to :

c. Persisitent Ductus 34. state definition of PDA (C1)

Arteriousus (PDA) 35. explain the symptoms & signs

· Clinical findings (symptoms)

· Physical findings (C2)

· Radiological findings (C3)

· Blood, ECG & echocardiography findings (C2)

· Catheterization & angiocardiography findings (C1)


Heart failure (C3)

Einsenmenger/pulmunary Vascular disease (C3)

Endocarditis (C3)

Pulmonary hypertension (C3)


The general managemet (C4)

Management of associated conditions (C2)

Managements of complications (C4)

Timing of sugery (C2)

38. explain the prognosis (C4)

At the end ofbteh chapter, the learner will be able to:

Cyanotyc Congenetal Heart 39. state the definition of TF

Disease: 40. expain the clinical presentation and findings in TF

Tetralogy of Fallot (TF) Definition and the cause fo cianosys (C2)

Pathophysiology of cianosis (C2)

41. expalain the methemoglobinemia, the causes of genetic and acquired Methemoglobinemia (C2)

42. explain thesymptoms & sign

· The clinical findings (symptoms)

· Physical findings (C2)

· Radiologal findings (C3)

· Blood, ECG & echocardioghraphy findings (C2)

Catheterization & angiocardiography findings (C1)


· The Hypoxic spell (C3)

· The cardiac arrest and respiratory failure. (C3)

· The brain abscess (C3)

· The cardiovascular accident (C3)

· The rndocarditis (C3)

· The polycithemia (C3)

· The relative iron deficiency (C3)

· The endocarditis (C3)

44. explain the management

. explain the general management (C4)

. management of associated condition (C2)

. the condition of complication (C4)

. performing cardiopulmonary resuscitation timing of surgery (C2)

45. explain the prtognosis

At the end of the Chapter , The learner will be able to :

Congenital heart disease in Adult 46. State the definition of cogengital heart disease in adult (C1)

47. Explain clinical presentation & findings

Symptoms & sign

Physical findings( C2 )

Radiological findings ( C3 )

Lab Examination , ECG & Echocardiography findings ( C1 )

Catheterization & Angiochardiography findings (C1 )

48. Examine the natural history ( C4 )

49. Explain the complication ( C3 )

50. Explain The management ( C3 )

51. Exlain The prognesis ( C4 )

INFECTIVE At the end of the chapter, the learner will be able to :

ENDOCARDITIS Prevalence 52. describe the prevelance of IE ( C3 )

Pathogenesis 53. Explain the Ethiology and Patogenesis of IE ( C3 )

Pathology 54 Explain the pathology of IE ( C3 )

Microbiology 55. Understand the microbiology of IE ( C3 )

Clinical Aspect 56. Explain the definition of IE ( C1 )

57 Explain the physical findings ( C3 )

. History

. Physical Examination

Diagnosis 58. Describe the lab and diagnostic tool findings: lab

Examination, ECG, and Echocardiography.

59.Interpret chest roentgenogram of IE ( C3 )

60. Analize and makea Diagnose of IE ( C4 )

Prognosis 61. Explain the prognosis of IE ( C4 )

Management 62. Explain the principles of management of IE ( C4 )

Prevention 63. Explain the preventation of IE ( C4 )

Rheumatic Disease Acute rheumatic fever At the end of the chapter, the learner will be able to :

64. Describe the epidemyoiogy of streptococcus infections and rheumatic fever ( C2 )

65. Describe the prevaient theories of ways how streptococcal infection causes rheumatic fever ( C2 )

66. Deecribe the pathologyof rheumatic fever ( C2 )

67. Describe extracardiac pathology ( C2 )

68. Categorize the clinical manifestations major criteria by examining :

The carditis ( C4 )

The Arthritis ( C4 )

The Corea ( C4 )

The Erythema marginatum ( C4 )

The Subcutaneous nodule ( C4 )

69. Categorize the clinical manifestations major criteria by examining :

The arthralgia ( C4 )

The fever ( C4 )

The acute phase reactants ( C4 )

70 Describe laboratory findings : ASTO, CRP

71. Categorize the diagnosis and differential diagnosis( C4 )

72. Explain the treatment ofacute rheumatic fever ( C4 )

Treatment of Chorea ( C4 )

Treatment of heart failure ( C4 )

73. Describe the role of steroids (prednisone) used in treatment in rheumatic fever ( C4 )

74. Describe prophylaxis :

The primary prophylaxis ( C4 )

The secondary prophylaxis ( C4 )

75. Solve the prognosis ( C4 )

Recurrences of rheumatic fever 76. Describe the recurrences of rheumatic fever ( C2 )

Mitral Valve Disease 77. At the end of the chapter, the learner will be able to :

A. Mitral Stenosis Sumarize the natural history, etiology, pathology, and pathophisiology ( C2 )

Describe the history ( C2 )

Explain the physical Examination ( C3 )

Describe the ECG, Echocardiography, and Angiography ( C2 )

Interpret the radiological findings ( C3 )

Explain the medical treatment ( C4 )

Describe the valvotom ( bailon mitral valvuplasty ) and surgical ( C2 )

B. Mitral Regurgitation 78. At the end of the chapter, the learner will be able to :

Cronic Mitral regurgigation Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )

Describe the history (C2 )


Describe the ECG, Echocardiography, radio nucide angiography, MRI, and Left ventricular angiography ( C2 )



Describe the surgical treatment ( C 2 )

Acute Mitral regurgigation 79. At the end of the chapter, the learner will be able to :

Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )







Mitral valve prolaps syndrome 80. At the end of the chapter, the learner will be able to :

·Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )



Describe the ECG, Echocardiography, angiography ( C2 )

The diagnoistic criteria (mayor & minor criteria ) (C1)

Explain the management ( C4 )

Aortic valve disease 81. At the end of the chapter, the learner will be able to :

A. Aortic Stenosis Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )







B. Aortic Regurgigation 82. . At the end of the chapter, the learner will be able to :

Chronic Aortic Regurgigation Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )







Acute Aortic Regurgigation 83. At the end of the chapter, the learner will be able to :




Describe the ECG, echocardiography ( C2 )




Tricuspid valve disease 84. At the end of the chapter, the learner will be able to :

VALVULAR HEART DISEASE

A. Tricuspid Stenosis Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )



Describe the ECG, echocardiography ( C2 )




B. Tricuspid regurgigation 85. At the end of the chapter, the learner will be able to :



Eplain the physical examination (C3)

Describe the ECG, echocardiography (C2 )


Explain the management ( C4 )

PULMONARY VALVE DISEASE 86. At the end of the chapter, the learner will be able to :

A. PULMONARY STENOSIS Summarize the etiology, pathology and pathophysiology (C2)

Describe the history (C2)

Explain the physical examination (C3)

Describe the ECG, echocardiography (C2)

Interpret the radiological findings (C3)

Explain the management (c4)

B. PULMONIC REGURGITATION 87. At the end of the chapter, the learner will be able to :

Describe the clinical manifestation (C2)

Explain the physical examination (C3)

Describe the ECG, echocardiography (C2)

Interpret the radiological findings (C3)

Explain the management (c4)

MULTIVALVULAR DISEASE

CORONARY ARTERY DISEASE ATHEROSCLEROSIS 89. At the end of the chapter, the learner will be able to :

● Describe the structure and basic constituents of normal artery (C2)

● Describe the structure and functions of vascular endothelium (C2)

● Describe endothelial dysfunction (C2)

● Illustrate the pathogenesis of atherosclerosis : respone to injury hypotesis; involvement and interaction of endothelial cells, smooth

muscle cells, monocytes, platelets, lipoprotein, and chemical mediators (C3)

● Describe the risk factors for atherosclerosis (C2)

● Illustrate the pathological hallmark : fatty streak, atheromatus plague (C3)

● The pathologic features of atherosclerosis (C2)

RISK FACTOR FOR ATHEROSCLEROTIC DISEASE 90. At the end of the chapter, the learner will be able to :

● illustrate the metabolism of lipoprotein : composition and function of lipoprotein (C3)

● illustrate the biosynthesis, transport and excretion of cholestherol; regulation of cholesterol synthesis (C3)● describe the factors affecting cholesterol balance in the tissue (C2)

● describe dyslipidemia (C2)

● outline risk factors assessment (C4)

● describe laboratorium of lipid profile (C2)

PRIMARY AND SECONDARY PREVENTION 91. At the end of the chapter, the learner will be able to :

● state the definition (C2)

● make a scheme of classification of intervention (C4)

● appraise risk factor management (C4)

● describe the role of aspirin used as a secondary prevation og CAD (C4)

CORONARY BLOOD FLOW AND MYOCARDIAL ISCHEMIA 92. At the end of the chapter, the learner will be able to reviev:

● hypoxia and ischemia (C2)

● determinant of myocardial oxygen consumption (C2)

● regulation of coronary blood flow (C2)

● coronary collateral circulation (C2)

● consequences of myocardial ischemia (C2)

● pathogenesis of myocardial ischemia

STABLE AGINA PECTORIS 93. At the end of the chapter, the learner will be able to :

● define non atherosclerotic causes (C1)

● describe magnitude of the problem (C2)

At the end of the chapter, the learner will be able to describe the prevalence, physical examination, laboratory examination, and

management of MS & AR, MS & AS, AS & MS, AR & MR, and three-valve disease

● inventory clinical manifestations (C4)

● interpret pathophysiology and granding of agina pectoris (C3)

● describe biochemical findings (C2)

● examine resting ECG (C4)

● describe exercise ECG (C2)

● state clinical application of non invasive testing (C1)

● define invasive testing (C1)

● make a scheme of medical management (C4)

● describe the pharmacogolgic properties (mechanism of action, effects, adverse reactions, pharmacokinetics, indication and

contraindications and posology) of organic nitrat used in treatment of stable angina pectoris (C4)● describe the role of beta blocker and calcium antagonis used in the treatment o stable agina pectoris (C4)

● difine percutaneous coronary intervention (C1)

● define coronary artery bypass surgery (C1)

● make a scheme of patient selection (C4)

● calculate the prognosis (C4)

PRINZMETAL (VARIANT) ANGINA 94. At the end of the chapter, the learner will be able to explain :

● The mechanism (C1)

● Clinical manifestations (C1)

● ECG findings (C1)

● The arteriographic studies (C1)

● Explain the management (C1)

● The prognosis (C1)

SYNDROME X (CHEST PAIN WITH NORMAL CORONARY ANGIOGRAM)95. At the end of the chapter, the learner will be able to define :

● Mechanism (C1)

● Clinical features (C1)

● Physical and laboratory examination (C1)

● Management

● Prognosis (C1)

SILENT MYOCARDIAL ISCHAEMIA 96. At the end of the chapter, the learner will be able to explain :

● Categories of silent ischemia (C1)


● Management (C2)

● Prognosis (C1)

UNSTABLE ANGINA 97. At the end of the chapter, the learner will be able to explain :

● Definition and classification (C2)

● Pathophysiology of unstable angina (C3)

● Clinical presentation (C4)


● The examination of cardiac markers (C4)

● Coronary angiography findings (C1)

● The outline of risk stratification (C4)

● Differentiation with non – ST elevation myocardial infarction (C4)

● Conservative treatment (C4)

● Invasive treatment (C1)

● Invasive vs conservative treatment (C1)

ACUTE MYOCARDIAL INFARCTION 98. At the end of the chapter, the learner will be able to :

● Explain the pathology of acute plaque change (C2)

● Explain the gross pathological change (C2)

● Explain pathophysiology of left ventricular function, circulatory regulation, ventricular remodeling and other organ system (C3)

● Examine clinical features (C4)

● Discriminate laboratory examination : cardiac markers (C4)

● Determine ECG finding (C4)

● Examine chest X ray (C4)

● Report echocardiography finding (C2)

● Define nuclear imaging (C1)

● Outline management (C4)

● Outline hemodynamic disturbances, arrhythmias and other complication

● Outline prehospital care (C4)

● Outline general management in the emergency department (C4)

● Define reperfusion on myocardial infarction (C1)

● Explain coronary trombolysis (C2)

● Define catheter based reperfusion (C1)

● Define surgical reperfusion (C1)

● Distinguish antithrombotic antiplatelet therapy (C4)

● Describe the role and the pharmacogolgic propertics (mechanism of action, effects, adverse reactions,

pharmacokinetics, contra indications and posology) of thrombolysis (strepptokinase) used in treatment of acute myocardial

● Review convalescence, discharge, and post myocardial infraction care (C3)

● Review risk stratification (C3)

99. At the end of the chapter, the learner will be able to explain the cardiac rabilitation of coronary artery disease (CAD) after myocardial

infraction :

● ACUTE PHASE (CICU INPATIENT PHASE PROGRAM) PHASE I

o The affect of prolonged bed rest (C2)

o The educational programs as socialization of rehabilitation programs (C2)

o The gradual mobilization (C2)

o The gradual activities of daily living (ADL) or self care (C2)

o Gradual activities acoording to intensity / cardiac capacity (independent in ambulation and ADL (C2)

● SUBACUTE / CONVALESENCE PHASE (In the ward or intermediate care / at home) PHASE II

o The intensive training programs based on the result of stress test in cardiac centre (supervised program) (C2)

o The home training programs independently as preparation before return home (C2)

o Psychiatric and phychological counseling and treatment

o The discharge with daily home programs and regular training in cardiac rehabilitation centre as non supervised

programs (C2)

● CHRONIC STAGE (Post Discharge / in the Community) :

o Phase III : Traning phase / supervised

Phase IV : Maintenance Phase (non Supervised)

o The independent home programs training (C2)

o The regular training in cardiac rehabilitation centre (C2)

o The stress test and new program (C2)

o The program return to previous potition or activities (C2)

HEART DISEASE IN PREGNANCY CARDIOVASKULER PHYSIOLOGY DURING PREGNANCY AND

PUERPERUM101. At the end of the chapter, the learner will be able to :

● Explain the changes in blood volume during normal pregnancy (C2)

● Explain the changes in cardiac output, stroke volume, heart rate, blood pressure and left ventricular ejection fraction and systemic

vascular resistance during normal pregnancy (C2)

● Explain the hemodynamic changes during labor, delivery, cesarean section and the puerperium (C2)

CARDIOVASCULER EVALUATION DURING PREGNANCY 102. At the end of the chapter, the learner will be able to :

● Explain the history and physical findings durings normal pregnancy (C1)

● Explain the ECG and chest radiographic findings (C2)

● Define the Doppler and echocardiographic findings during normal pregnancy (C1)

● Define recommendations related to intrauterine radiation exposure

CONGENITAL HEART DISEASE 103. At the end of the chapter, the learner will be able to explaine the risk of pregnancy and delivery of mother with cyanotic and non –

cyanotic congenital heart disease as well as the risk to the fetus and newborn (C2)

MITRAL STENOSIS 104. At the end of the chapter, the learner will be able to :

● Explain the hemodynamic consequencies of pregnancy in patient with mitral stenosis (C2)

● Explain the treatment of mitral stenosis in pregnancy (C2)

MITRAL REGURGITATION, AORTIC STENOSIS, AORTIC

REGURGITATION105. explain the hemodynamic con sequencies of pregnancy a patients with MR, AS, AR (C2)

PREGNANT PATIENTS WITH PROSTHESTIC VALVES 106. explain the risk associated with pregnancy of patient with prosthetic valves (C2)

107. explain about anticoagulantion in pregnancy (C2)

HEMODYNAMIC CHANGES OF PREGNANCY IN PERIPARTUM

CARDIOMYOPATHY109. explain the pathophyysiologic and pathologic features of PC (C2)

EPIDEMIOLOGY AND RISK FACTORS 110. explain the epidemiology and risk factors of PC (C2)

PRIMARY AND SECONDARY PREVENTION 111. appraise risk factor management (C2)

DIAGNOSIS 112. inventory the clinical manifestations and differential diagnosis of PC

NONINVASIVE TESTING 113. At the end of the chapter, the learner will be able to :

● Describe the biochemical changes as well as the ECG and X ray findings in PC (C2)

● Define the echocardiographic findings in PC (C1)

MANAGEMENT 114. At the end of the chapter, the learner will be able to outline :

● The management during pregnancy, delivery and the postpartum period (C4)

● The complications (C4)

● The Prognosis (C4)

● Secondary prevention (C4)

HEART FAILURE PATHOPHYSIOLOGY OF HEART FAILURE 100. At the end of the chapter, the learner will be able to describe :

● Short term adaptive mechanism (C2)

● Chronic of myocardial remodeling (C2)

● Molecular mechanisms myocardial remodeling and ventricular failure (C2)

● Pathophysiology of diastolic heart failure (C2)

● Neurohormonal, autocrine and paracrine adjustment (C2)

CLINICAL ASPECTS OF HEART FAILURE 101. At the end of the chapter, the learner will be able to :

● State the definition of heart failure (C1)

● Describe the forms of heart failure (C2)

● Explain physical findings (C3)

● Describe the laboratory findings : the lab test, ECG, and echocardiography (C2)

● Interpret the chest roentgenogram of heart failure (C3)

● Categorize the prognosis (C4)

MANAGEMENT OF HEART FAILURE 102. At the end of the chapter, the learner will be able to solve :

● Management of acute, new onset heart failure and chronic heart failure (C4)

● Describe the role and the pharmacogolgic properties (mechanism of action, affects, adverse reactions, pharmacokinetics,

contraindications and posology) of digoxin used in treatment of heart failure (C4)

● Describe the role of diuretics (furosemide and spironolcton) used in treatment of heart failure (C4)

PULMONARY EDEMA & CARDIOGENIC SHOCK 103. At the end of the chapter, the learner will be able to describe :

● The definitition of PE and cardiogenic shock (C2)

● Mechanism of pulmonary edema (C2)

● The imbalance of starling forces (C2)

● The altered alveolar – capillary membrane permeability (ARDS) (C2)

● The lymphatic insufficiency (C2)

● The unknown or incompletely understood mechanism

● The cardiogenic pulmonary edema (C2)

● The pulmonary edema of unknown pathogenesis (C2)

● The difference of pulmonary edema with other diseases (C4)

● Solve the management of pulmonary edema (C4)

● The cardiogenic shock (C2)

● Describe the role and the pharmacogolgic properties (mechanism of action, effects, adverse reaction, pharmacokinetics,

contraindications and posology) of inotropes (dopamine & dobutamine) used in treatment of cardiogenic shock (C4)

ARRHYTHMIA & CARDIAC ARREST ELECTROCARDIOGRAPHY104. At the end of the chapter, the learner will be able to :

● Describe and summarize the basic principle of electrocardiography (C2)

● Illustrate and interpret the normal electrocardiogram (C3)

● Illustrate and interpret abnormal electrocardiograms of coronary artery disease, cardiac arrhythmias, and conduction disturbances

(C3)

CARDIAC ARRYTHMIA 105. At the end of the chapter, the learner will be able to :

● Describe and summarize the basic electrophysiologic principles, mechanism of arrhythmogenesis, and disorders of impulse

conduction (C2)

● Perform a systematic approach to interpret the electrocardiogram of cardiac arryhtmias (C3)

● Identify cardiac arrhythmias by exercise testing, holter monitoring, and invasive electrophysiologic syudies (C1)

● Employ pharmacological therapy (C3)

● Describe of electrotherapy with direct current electrical cardioversion (C2)

● Define implantable electrical devices and ablation therapy (C1)

● Define surgical therapy for cardiac arrhythmia (C1)

● Describe of the clinical features ECG findings and therapy of sinus nodal disturbances (C2)

● Examine the clinical features, ECG findings, and outlining and solving the therapy of atrial rhythm disturbances (C4)

● Describe the clinical featuresi, ECG findings and the therapy of AV junctional rhythm disturbances (C2)

● Examine the clinical features, ECG findings (C3), and outlining and solving the therapy for ventricular disturbances (C4)

● Describe the clinical features, ECG findings and the therapy of atrioventricular block (C2)

● Describe the role and the pharmacogolgic properties (mechanism of action, effects, adverse reaction, pharmacokinetics,

contraindications and posology) of anti arrhythmias (amiodarone) used in treatment of cardiac arrhythmia (C4)

CARDIAC ARREST AND SUDDENT CARDIAC DEATH 106. At the end of the chapter, the learner will be able to describe :

● Definition, epidemiology and causes of cardiac arrest and sudden cardiac death (C2)

● Pathology and pathophysiology of cardiac arrest and sudden cardiac death (C2)

● Examination of clinical characteristics of cardiac arrest and suddent cardiac death (C4)

● Community based intervention for cardiac arrest and sudden cardiac death (C4)

● And summarize the therapy of cardiac arrest, sudden death and post cardiac arrest care (C2)

● Therapy for prevention of cardiac arrest and sudden cardiac death (C2)

VASCULAR DISEASE A. DISEASE OF THE ARTERY 107. At the end of the chapter, the learner will be able to summarize :

BUERGER’S DISEASE ● Epidemiology of this disease (C2)

● Etiology and the pathogenesis concerning the association between heavy tobacco use and this disease (C2)

● Gene associated with this disease (C2)

● Abnormality of hypercoagulability and endothelial function in this disease (C2)

● Inflammatory thrombosis that affects the arteries and veins (C2)

● Clinical features of Buerger’s disease (C2)

● Diagnosticncriteria (C2)

● Characteristic arteriographic findings (C1)

● Pathologic feature of buerger’s disease (C2)

● Differential diagnosis of the disease that mimic buerger’s disease (C2)

● Conservative and operative therapeutic procedures (C2)

TAKAYASU VASCULITIS 111. At the end of the chapter, the learner will be able to summarize :

● Epidemiology of this disease (C2)

● Etiology and the pathogenesis concerning this disease (C2)

● Signs and symptoms (C2)

● Arteriographic findings (C2)

● Conservative and operative treatment procedures (C2)

ARTERIAL THROMBOEMBOLISM 112. At the end of the chapter, the learner will be able to summarize :

● Source of spontaneous embolism (C2)

● The most frequent site if embolic occlusion (C2)

● Clinical presentation (C2)

● Pharmacologic therapy and surgical treatment option (C2)

ARTERIAL THROMBOSIS 113. At the end of the chapter, the learner will be able to summarize :

● The phases of thrombosis and types of thrombi (C2)

● The step, factors involved, and mechanism of platelet activation and aggregation (C2)

● The mechanism and the pathways of blood coagulation (C2)

● The mechanism of fibrinolysis (C2)

● The regulation of thrombisis and fibrinolysis (C2)

ARTERIAL ANEURYSM 114. At the end of the chapter, the learner will be able to describe :

● Etiologic classification (C1)

● Summarizing the primary disorders, mechanical factors in aneurysm formation (C2)

● The signs of aneurysm (C2)

● The indication of surgery (C2) and recalling the surgical treatment procedures (C1)

CHRONIC LOWER EXTREMITY ISCHEMIA 115 At the end of the chapter, the learner will be able to summarize :

● Risk factor (C2)

● Natural history (C2)

● Physical examination (C2)

● Ultrasonographic and arteriographic findings (C1)

● Medical and surgical treatment (C2)

B. DISEASES OF THE VEINS

MICROSCOPIC STRUCTURE OF THE VEINS 116. At the end of the chapter, the learner will be able to explain the general structure of the veins (C2)

ACUTE DEEP VEINS THROMBOSIS 117. At the end of the chapter, the learner will be able to summarize :

● The pathophysiology (C2)

● The signs and symptoms (C2)

● The ultrasounic and phlebographic examinations (C1)

● The use anticoagulants (C2)

● The use of intermittent and graduated leg compression (C2)

● The sclerotherapy of the superficial limb vein (C2)

● The surgical treatment (C2)

CHRONIC VENOUS INSUFFICIENCY 118. At the end of the chapter, the learner will be able to describe :

● The natural history, such as the risk factors and the pathophysiology (C1)

● The signs and symptoms (C2)

● The clinical procedure for diagnosis of venous reflux (C2)

● The pathologic features of varicouse vein (C2)

● The medical treatment (C2)

● The surgical treatment options (C2)

C. DISEASES OF THE LYMPHATIC SYSTEM

MICROSCOPIC STRUCTURE OF THE LYMPH VESSEL 119. At the end of the chapter, the learner will be able to describe the histologic structure of lymphatic vessel wall (C1)

LYMPHEDEMA 120. At the end of the chapter, the learner will be able to explain :

● The lymphatic drainage (C1)

● The pathogenesis of obstruction and the compensatory mechanisms in the development of lymphedema (C2)

● The etiologic classification of lymphedema (C1)

● Signs and symptoms of lymphedema (C2)

● The complications of lymphedematous limb (C2)

● The lymphoscintigraphy and lymphography (C1)

● The pharmacologic and physical therapy (C2)

● The surgical treatment procedures

PERICARDITIS & CARDIAC

TAMPONADE

ACUTE PERICARDITIS121. At the end of the chapter, the learner will be able to :

● Describe the epidemiology and etiology (C2)

● Describe the history, physical findings and the ECG (C3)

● Describe the treatment (C2)

MYOPERICARDITIS 122. At the end of the chapter, the learner will be able to :

● Describe the etiology, pathogenesis and pathology (C2)

● Describe the history and physical findings (C2)

● Describe the biochemical findings (C2), and ECG (C3)

● Describe the echocardiogram, nuclear imaging and MRI findings (C2)

● Describe the management (C2)

PERICARDIAL EFFUSION 123. At the end of the chapter, the learner will be able to :

● Describe the epidemiology, etiology, and natural history (C2)

● Examine the pathogenesis and pathology

● Examine the history and physical findings (C4)

● Examine the laboratory findings (C4)

● Examine the radiological findings (C3) chest x-ray, USG (C2), and ECG (C3)

● Describe the echocardiogram (C2)

● Identify the CT, MRI and nuclear imaging findings (C1)

● Solves the management (C4)

CARDIAC TAMPONADE 124. At the end of the chapter, the learner will be able to :

● Describe the pathophysiology (C2)

● Examine the history and physical findings (C4)

● Analyzenthe ECG (C3)

● Describe the radiological findings (C2)

● Describe the echocardiogram (C2)

● Identify the cardiac catheterization (C1)

● Describe the medical treatment (C2)

● Describe the surgical treatment (C2)

CINSTRICTIVE PERICARDITIS 125. At the end of the chapter, the learner will be able to :

● Describe the etiology, natural history, pathology and pathophysiology

● Describe the history, physical examination and laboratory findings (C2)

● Describe the radiological findings (C2)

● Describe the ECG and echocardiogram (C2)

● Identify the CT, MRI and cardiac catheterization findings (C1)

● Describe the management.

CORPOLMONALE PULMONARY HYPERTENSION 126. At the end of the chapter, the learner will be able to :

● The normal pulmonary circulation (C2)

● The respone to hypoxia, drugs, and neural and environmental factors (C2)

● The diagnostic classification of pulmonary hypertension (C2)

● Secondary pulmonary hypertension (C2)

COR PULMONALE SECONDARY TO LUNG DISEASE 127. At the end of the chapter, the learner will be able to explain :

● History and physical examination (C2)

● Hematological and chemical findings (C2)

● Interpreting the radiological findings (C3)

● Interpreting the electrocardiographic findings (C3)

● Describing the echocardiography (C2)

● Difining the radionuclide ventriculography, CT, and MRI (C1)

CHRONIC OBSTRUCTIVE PULMONARY DISEASE 128. At the end of the chapter, the learner will be able to describe :

● The epidemiology of pulmonary hypertension (C2)

● The hemodynamic changes (C2)

● The treatment (C2)

● The rehabilitation (C2)

● Blood Gas Analysis : metabolic acidosis & alkalosis

● Blood Gas Analysis : respiratory acidosis & alkalosis

A. HEART FAILUREAt the end of the chapter, the learner will be able to :

PATHOPHYSIOLOGY, DRUG METABOLISM, EPIDEMIOLOGY 129. summarize the pathophysiology, drug metabolism and epidemiology (C2)

VALVULAR HEART DISEASE

130. describe the diagnosis and treatment (C2)

CORONARY ARTERY DISEASE

131. summarize the prevalence, incidence, risk factors clinical presentation, diagnosis and management (C2)

B. HYPERTENSION

132. summarize the epidemiology and treatment (C2)

C. CARDIOMYOPATHY & ARRHYTMIAS

133. summarize the most common cardiomyopathy and arrihythmias in elderly

THE CARDIOVASCULAR DISEASE IN

THE ELDERLY

CSG

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