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Objectives

  • The student will learn the following:

    Basic Anatomy

    • Identify the cardiac chambers, valves and blood supply to the myocardium
    • Identify the Great Vessels (aorta, superior and inferior vena cava, pulmonary artery)
    • Identify how an impulse is generated in the sinus node and the route it travels to get to the ventricles 
    Excitation Contraction Coupling
    • Describe the constituents of the cardiomyocyte
    • Describe the microcellular steps leading to contraction
    • Define excitation contraction coupling 
    The Cardiac Cycle
    • Define systole and diastole
    • Identify the first and second heart sounds and the mechanism of their genesis
    • Define isovolumic contraction and iso volumic relaxation
    • Define the components of the cardiac cycle on the intracardiac pressure tracing; systole, diastole, isovolumic contraction and relaxation, S1, S2, S3 and S4
    • Describe the initiators of systole and diastole and the coupling between electrical activity and mechanical events in the heart
    • Define the components of atrial activity during the cardiac cycle, the a and v waves, the x and y descent
    • Describe S3 and S4 and their genesis 
    Cardiac Output
    • Define cardiac output and stroke volume
    • Recognize the determinants of cardiac output and stroke volume 
    • Understand what preload is and its relationship with the cardiac output 
    • Understand what inotropy is and how to recognize different inotropies on the Frank-Starling curve and on the pressure-volume loops 
    • Understand what end diastolic and end systolic volumes are and what stroke volume is 
    • Understand what afterload is 
    • Define what left ventricular ejection fraction is 
    • Describe the pressure volume loop 
    • Identify critical points of the cardiac cycle on the pressure volume loop  
    Intra Cardiac Pressures
    • Define the significance of the left ventricular end-diastolic pressure
    • Describe the classical hemodynamic picture in aortic and mitral stenosis 
    Systemic and Pulmonary Pressure and Resistance
    • Calculate mean pulmonary and systemic pressures
    • Define cardiac output and cardiac index
    • Define the determinants of blood pressure
    • Distinguish between different causes of hypotension (shock), cardiogenic, hypovolemic and hypotension secondary to inappropriate vasodilation (anaphylaxis, sepsis, vasodilators) 
    The Genesis and Conduction of Cardiac Rhythm
    • Define automaticity
    • Define resting and threshold potentials
    • Describe impulse conduction from the atrium to the ventricle
    • Define the determinants of resting membrane potential
    • Define the changes that occur across the membrane when an impulse is conducted
    • Define the components of the myocardial monophasic action potential
    • Identify the channels responsible for the genesis of the MAP  
    Coronary Artery Disease 
    Coronary Perfusion
    • Define the determinants of myocardial O2 demand
    • Describe the determinants of coronary perfusion
    • Define the “double product”
    • Identify endothelial vasodilators and vasoconstrictors
    • Define the degree of epicardial narrowing to result in ischemia
    • Define coronary reserve and factors limiting it 
    Atherosclerosis
    • Define the steps towards formation of atherosclerotic plaques
    • Stable vs, unstable plaque
    • Identify risk factors for atherosclerosis
    • Describe consequences of atherosclerosis 
    Coronary Artery Ischemia
    • Identify the factors determining the size of myocardial ischemia
    • Define collateral circulation and ischemic preconditioning
    • Define the consequences of impaired coronary perfusion to the myocardium
    • Distinguish stunned from hibernating myocardium  
    Coronary Syndromes
    • Distinguish between the different types of coronary syndromes, stable vs. acute
    • Distinguish between the different acute coronary syndromes
    • Distinguish acute myocardial infarction from the other coronary syndromes
    • Define the criteria required to diagnose and acute myocardial infarction
    • Define the types of acute myocardial infarction; e.g. silent, ST-segment elevated vs. non ST-segment elevated MI
    • Describe the definitive treatments of myocardial infarction
    • Describe the adjunctive treatment of myocardial infarction
    • Describe the short and long term complications of a myocardial infarction
    • Describe the determinants of prognosis in patients with coronary artery disease and after a myocardial infarction 
    Congenital Heart Disease 
    Introduction
    • Identify the commonest types of congenital heart disease in different age groups
    • Distinguish cyanotic from acyanotic congenital heart disease 
    Consequences of Congenital Heart Disease
    • Identify the main complications of congenital heart disease
    • Describe the EisenmengerÂ’s syndrome and its consequences
    • Identify the risks particular to adults with congenital heart disease 
    Ventricular Septal Defect
    • Describe VSD
    • Describe the pathophysiologic changes
    • Recognize the hemodynamic changes of VSD using hemodynamic data
    • Determine the natural course of VSD and indications for surgical correction 
    Atrial Septal Defect
    • Identify the different types of ASD
    • Describe the pathophsiologic changes
    • Describe the characteristic auscultatory findings
    • Describe the indications for treatment 
    Patent Ductus Arteriosus
    • Describe the connections of PDA and their consequences
    • Describe the classical findings
    • Describe treatment 
    Coarctation of the Aorta
    • Describe coarctation of the aorta
    • Describe the consequences of coarctation
    • Describe the physical findings
    • Identify indications for surgery
    Tetralogy of Fallot
    • Identify the components of TOF
    • Describe the clinical presentation
    • Identify long-term consequences in treated patients 
    Complete (D-TGA) Transposition of the Great Arteries
    • Identify the abnormalities of D-TGA
    • Describe prognosis and management 
    Corrected (L-TGA) Transposition of the Great Arteries

    Introduction to Electrocardiography

    • Describe the different types of electrocardiographic leads.
    • Explain the definition of the P, QRS and T waves, the PR and QT intervals and the ST segment.
    • Correlate the components of the electrocardiogram with the cardiac cycle.
    • Define a normal PR, QRS and QT intervals.
    • Identify abnormalities seen in the PR interval (short in preexcitation, prolonged in first degree AV block)
    • Distinguish 2nd from 3rd degree AV block, Mobitz I (Wenckebach) from Mobitz II 2nd degree AV block.
    • Distinguish sinus node dysfunction, as a cause of bradycardia, from AV block
    • Identify the electrocardiographic features of atrial fibrillation.
    • Identify the electrocardiographic features of atrial flutter.
    • Identify the electrocardiographic features of paroxysmal supraventricular tachycardia.
    • Identify the electrocardiographic features of tachy-brady syndrome (sinus node dysfunction).
    • Identify the electrocardiographic features of preexcitation (short PR interval, delta wave).
    • Identify the electrocardiographic features of ventricular tachycardia (wide complex, regular tachycardia).
    • Identify the electrocardiographic features of ventricular fibrillation (irregular, low amplitude wide complex tachycardia).
    • Describe what an AED (automatic external defibrillator) does and the indication for its use.