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Cardiovascular Course WEEK 1, CARDIO 5-WEEK OVERVIEW - Coggle Diagram
Cardiovascular Course WEEK 1
ANATOMY
Normal & Abnormal Cavity Development
Describe the tube-within-a-tube body plan. Describe derivatives of the mesodermal germ layer.
Describe how folding creates foregut, midgut, and hindgut.
Define the development of the somatic and splanchnic mesoderm and their role in the formation of the intraembryonic coelomic cavities.
Understand the pathological abnormalities of ectopic cordis, congenital umbilical hernia, gastroschisis, and exstrophy of the bladder.
Recognize the developmental events involved in the formation of the embryonic body cavities.
Describe the development of the structures contributing to the formation of the respiratory diaphragm, and the sensory and motor innervation of the diaphragm.
Recognize the developmental abnormalities occurring with congenital diaphragmatic hernia, eventration of the diaphragm, congenital esophageal hiatal hernia, and retrosternal (parasternal) hernia.
Anterior Thoracic Wall (Lecture & Lab)
Define the boundaries of the four subdivisions of the mediastinum and identify the structures found in each.
Describe the normal position of the heart within the thorax.
Describe the relationship of the pericardial sac to the heart, the great vessels, the diaphragm and lungs.
Familiarize yourself with cross sectional, X-ray and CT images of the mediastinum.
Locate the approximate topographic site on the anterior thoracic wall where each valve sound is best auscultated in a normal individual.
Heart & Pericardial Sac (Lecture & Lab)
Describe the positional relationships of each heart chamber.
Identify the anatomic features of each chamber.
Trace blood flow through the heart. Integrate your knowledge of this pathway with the timing of electrical conduction through the heart, opening and closing of the heart valves, and the heart sounds.
Describe the structure and features of the atrioventricular and arterial valves of the heart
Name the components of the extrinsic nerve supply to the heart. Describe their origins and pathways to the heart muscle. How do these systems affect heart contractility and rate?
Describe the intrinsic conduction system of the heart, including approximate location of nodal tissues and major bundles of conducting fibers. Relate these features to normal function.
Describe the normal origin and distribution of the coronary vasculature. Relate variations in distribution to clinical problems.
Differentiate between systemic and pulmonary circulation
Describe the arterial supply and venous drainage of the heart
Identify the major structures in the heart, the blood vessels and other structures located in the mediastinum and lower neck as shown in different types of imaging
Identify the major structures in the heart, the blood vessels and other structures located in the mediastinum and lower neck as shown in different types of imaging
Physiology, Biochemistry, Genetics
Cardiac Structures / Intro to CV Physiology
Describe the structure and functional roles of the impulse conducting system, the cardiac skeleton and the cardiac valves. (Histo/Path)
Explain the function of the cardiovascular system as a fluid delivery system for nutrients, O2, CO2 and wastes.
Origin of the Heartbeat (action potentials and ions at a cellular level)
Explain the process by which a myocyte maintains a resting membrane potential, depolarizes and repolarizes
Discuss the ion gradients across myocytes that lead to the ion flux responsible for depolarization and repolarization.
Electrical Activity of the Heart (conduction pathways and electrical activity at the organ level)
Explain how the pulse travels along a vessel and the implications of pulse characteristics in different areas of the body.
Explain the role of gap junctions and desmosome for the formation of the cardiac function syncytium (cells working together to be a pump)
Describe the electrical properties of the ventricular conducting pathway and explain its role in the coordination of ventricular depolarization.
Explain how pacemaker cells in the SA node regulates the rate of depolarization in the heart.
Explain the importance of gap junctions to the electrical coordination of the heart.
Predict the effect areas of high electrical resistance (scar tissue, loss of gap junctions) on conduction of depolarization throughout the heart.
Describe the innervation of the sympathetic and parasympathetic nervous system in cardiovascular regulation. PNS (Decreases HR and blood pressure) SNS (increases HR, contractility, vasoconstriction and blood pressure)
DESCRIBE THE FUNCTIONING OF THE AUTONOMIC NERVOUS SYSTEM
DESCRIBE PHYSIOLOGIC CHANGES ASSOCIATED WITH AUTONOMIC INSTABILITY
LIST COMMON CAUSES OF AUTONOMIC INSTABILITY AND ASSOCIATED PATTERNS OF AUTONOMIC DYSFUNCTION
EXPLAIN HOW THE heart rate ADJUSTS in response to exercise
The Electrocardiogram
Synthesize understanding of electrical pathways within cardiac tissue and electrical vectors, to understand appearance of different conditions on EKG
Compare the differences in the ECG with sinus rhythm, a RHYTHM ORIGINATING FROM A junctional pacemaker and an ectopic focus.
Lipid Synthesis
Based on an understanding of the cholesterol (lipid) synthesis pathway, describe the clinical significance of the major lipoproteins.
Compare and contrast the mechanisms of therapeutic metabolic pathway targets for common medications used to treat hyperlipidemia.
Describe the relationship between lipoprotein metabolism and angiogenesis.
Give examples of lipid and amino acid pathway disorders that lead to early myocardial infarction.
Summarize the major familial dyslipidemias, as they relate to lipid metabolism.
Identify when to seek out a genetic cause for high cholesterol
Describe the process of lipid deposition and oxidation in the wall of vessel (atherosclerosis)
Describe the impact of familial hyperlipidemia on cardiovascular functioning
Cardiovascular Genetics
Define how epigenetic changes contributes to cardiovascular disease
Describe important familial heart disease caused by single gene mutations
Identify common cardiac abnormalities associated with many genetic conditions
Identify classic cardiac conditions associated with specific genetic conditions and the clinical presentation of these cardiac anomalies
Identify appropriate genetic testing for common cardiac diseases.
Discuss potential future options for genetic testing for common cardiac diseases
Describe inheritance patterns for congenital malformations
Discuss variants of unknown significance and how to interpret them.
Describe a VUS and how to interpret this in a population that is not represented in the reference genomes
Pharmacology
Clinical Applications: Electrophysiology of the Cell (pharmacology of ion channels and action potentials as applied to cells - not looking at the entire heart or dysrhythmias yet!)
Given that myocytes and smooth muscle cells are excitable cells, explain the importance for maintaining extracellular Ca2+, K+, Mg2+, O2, H+ and glucose levels for appropriate myocyte function. (Physiology)
Identify hyperkalemia and hypomagnesemia on an EKG (Physiology)
Describe inheritance patterns for genetic arrhythmias (Genetics)
Dyslipidemia Pharmacology
Medications to treat dyslipidemias (PCSK-9 inhibitors, statins, fibrates, ezetimibe, niacin, and bile acid sequestrants
Differentiate how the processes of absorption, distribution, metabolism, and elimination (ADME) influence drug dosing and disposition
Describe how the processes of ADME work independently and collectively to influence drug dosing and disposition.
Associate specific drugs with principle molecular targets, desired vs undesired effects,physiological influences, and medical settings
Recognize the clinical applications of treating dyslipidemia and be familiar with the primary dose-limiting adverse effect for each class of lipid-lowering drugs
Contrast and compare how drugs are used in disease prevention vs progression and in the treatment of acute vs chronic medical problems.
Understand the techniques for delivery of pharmacologic treatment for cardiovascular and peripheral vascular conditions (Clinical Skills)
Oral
IV/IM, continuous infusions
Catheter-deployed (thrombolytics, DES)
Topical/Patch (nitro)
Histo/Path
Blood Vessel Histology
Atherosclerosis
Describe the role of hyperlipidemia and other risk factors in the development of atherosclerotic plaques, endothelial damage, and plaque rupture including the clinical consequences for both cardiovascular and peripheral vasculature
Describe the role of chronic inflammation in atherosclerosis and of stress as a risk factor in endothelial activation (as a link to DEI)
Describe the process and manifestations of inflammation and the associated cardiovascular effects
Identify how dietary patterns and specific foods impact inflammation, in cardiovascular disease.
DESCRIBE OTHER TYPES OF EXPOSURES THAT LEAD TO INFLAMMATION (TOXIC STRESS, ENVIRONMENTAL, ETC.)
Describe the predisposing factors, clinical, radiographic, and pathological features of pulmonary embolism distinguishing single versus multiple, and large versus small emboli.
Define clinical descriptors/terminology used to describe peripheral vascular conditions
e.g. pulse, bruit, claudication, insufficiency, limb ischemia, vascular ulcers, VTE/DVT/SVT/PE, proximal vs distal DVT
Peripheral (dependent) edema conditions vs anasarca vs lymphedema (distinguish hydrostatic vs oncotic edema) (Clinical Skills)
Define clinical descriptors/terminology used to describe vascular risk factors
Dyslipidemia/hyperlipidemia
Blood Pressure measurement and significance (e.g. systolic, diastolic, pulse pressure, korotkoff, hypertension, hypotension) (Clinical Skills)
Ischemic Heart Disease & Cardiac Tumors
Describe the macroscopic and microscopic features of acute myocardial infarction including the progression of changes over time from initial ischemia through healing and scar formation
Describe how laboratory values of cardiac muscle enzymes/proteins are utilized in diagnosis of acute myocardial infarction including the changes over time and correlation with underlying histology.
Explain reperfusion injury, the repercussions of reperfusion injury and any factors that can limit it
Define clinical descriptors/terminology used to describe central cardiovascular conditions
Vascular: Ischemic Disease: STEMI/NSTEMI/OMI
Patient Symptoms: angina, palpitations, angina equivalent, PND, orthopnea, pleuritic, claudication
Describe the most common cardiac tumors - metastatic cancer to the heart, atrial myxoma, rhabdomyoma
Vasculitis
Compare and contrast the predisposing etiologies, typical locations, patient populations, and clinical consequences of aortic aneurysm and aortic dissection.
Compare and contrast the etiology and underlying mechanisms as well as clinical consequences of the vasculitides which occur in small, medium, and large vessels.
Understand how microbial tiggers can lead to vascular leakage, hypotension and DIC (Micro/Infectious Disease)
Clinical Skills, Delivery of Care, Life Stages
Imaging of the Chest, CT Scans, MRIs, X-Ray,
USE echocardiogram for systolic, diastolic, and valvular functioning, and for determination of intravascular volume (IVC) (Physiology)
INTERPRET THE RESULTS FROM A LEFT HEART CATHETERIZATION FOCUSED ON RECOGNITION OF CORONARY DISEASE, PERIPHERAL VASCULAR DISEASE, CARDIAC DYSFUNCTION Angiography (Physiology)
Recognize terminology as used in imaging techniques
Ultrasound windows: axial ….
Hypertrophy, akinesis, hypokinesis, systolic/diastolic dysfunction
Stenosis, sclerosis, regurgitation
Recognize the purpose, indications for use, risks/benefits and diagnostic utility of cardiovascular/peripheral vascular testing
Blood pressure and SpO2 measurement
EKG and ambulatory monitoring
X-ray
CT, CTA, CAC measurement
MRI
Echocardiography
Vascular ultrasound (venous and arterial)
ABI
EP testing
Stress testing
Exercise vs pharmacologic
ECG vs echo vs nuclear perfusion
Coronary angiography (LHC, RHC)
Peripheral angiography
Lab testing
Troponins
BNP/proBNP
Lipids and related
D-dimer
V/Q Scan
Peripheral Vascular Disease (?) Case
DISCUSS the three dimensional aspect of cardiovascular and peripheral vascular system function and how that impacts the following:
Growth and development across the lifespan
Impact of disease states on function
Impact of injury, infection, cancer
Impact of cardiovascular disease as it interacts with the pulmonary system
DISCUSS the exam findings that help to prioritize the differential diagnosis
Cardiovascular
Electrical: pulse, dyspnea, BP
Structural: heart failure - diaphoresis, hypotension
Vascular: ischemia, cyanosis etc
Peripheral vascular system
ex: Dissection, Clots, Valvular insufficiency, edema, skin changes c/w ischemia, pulses/waveforms
Demonstrate safe techniques in exam, e.g. BP/occlusion, carotid massage, positional exam comfort/safety
Understand how to develop an effective strategy in approaching use of reference sources
Books
Research literature
Online sources (Google / Google search)
Apps
DEI, Public Health
Race-Based Medicine in Cardiovascular
Students will understand the history of the utilization of race in cardiovascular risk calculators - and how race is a surrogate marker for how racism impacts cardiovascular health
Students will learn the history of Bidil at the University of Minnesota, and how “racialized medicines” were discovered and now have been disproven in their efficacy
Recognize some reasons for resistance to genetic testing in some populations
Demonstrate professionalism by holding one another accountable and respecting diverse views. (Delivery of Care)
CARDIO 5-WEEK OVERVIEW
WEEK 1- Vascular Disease / Intro to Structures, Electrical Cardiac Function
WEEK 2- CV development/Hypertension/Endocarditis/ Electrical & Mechanical Cardiac Function
WEEK 3- Congestive Heart Failure / Mechanical Cardiac Function
WEEK 4- Vascular Control / Advanced Electrical & Mechanical Cardiac Function
WEEK 5- Shock / Advanced Functions of the CardioVascular System