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.