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JAKARTA
FAKULTAS KEDOKTERAN UMUM COURSE STUDY GUIDE (CSG)
CARDIOVASCULAR SYSTEM
RESOURCE
LEARNING OBJECTIVES REFERENCES
PERSON
TOPIC SUB TOPIC
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
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.
. 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
CONGENITAL * explain about the unilateral left heart failure
HEART DISEASE * 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
PREVALENCE OF CONGENITAL HEART DISEASE 16. At the end of the chapter, the learner will be able to describe the
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)
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)
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 )
VALVULAR HEART DISEASE
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 )
Explain the physical Examination ( C3 )
Describe the ECG, Echocardiography, radio nucide angiography, MRI, and Left ventricular angiography ( C2 )
Interpret the radiological findings ( C3 )
Explain the medical treatment ( C4 )
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 )
Describe the history (C2 )
Explain the physical Examination ( C3 )
Describe the ECG, Echocardiography, radio nucide angiography, MRI, and Left ventricular angiography ( C2 )
Interpret the radiological findings ( C3 )
Explain the medical treatment ( C4 )
Describe the surgical treatment ( C 2 )
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 history (C2 )
Explain the physical Examination ( C3 )
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 )
Describe the history (C2 )
Explain the physical Examination ( C3 )
Describe the ECG, Echocardiography, radio nucide angiography, MRI, and Left ventricular angiography ( C2 )
Inte
rpret the radiological findings ( C3 )
Explain the medical treatment ( C4 )
B. Aortic Regurgigation Describe the surgical treatment ( C 2 )
Chronic Aortic Regurgigation 82. . At the end of the chapter, the learner will be able to :
Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )
Describe the history (C2 )
Explain the physical Examination ( C3 )
Describe the ECG, Echocardiography, radio nucide angiography, MRI, and Left ventricular angiography ( C2 )
Interpret the radiological findings ( C3 )
Explain the medical treatment ( C4 )
AcuteAorticRegurgigation Describe the surgical treatment ( C 2 )
83. At the end of the chapter, the learner will be able to :
Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )
Describe the history (C2 )
Explain the physical Examination ( C3 )
Describe the ECG, echocardiography ( C2 )
Interpret the radiological findings ( C3 )
Explain the medical treatment ( C4 )
Tricuspid valve disease Describe the surgical treatment ( C 2 )
84. At the end of the chapter, the learner will be able to :
A. Tricuspid Stenosis
B. Tricuspid regurgigation
Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )
Describe the history (C2 )
Explain the physical Examination ( C3 )
Describe the ECG, echocardiography ( C2 )
Interpret the radiological findings ( C3 )
Explain the medical treatment ( C4 )
PULMONARY VALVE DISEASE
Describe the surgical treatment ( C 2 )
A. PULMONARY STENOSIS
85. At the end of the chapter, the learner will be able to :
Summarize the natural history, etiology, pathology, and pathophsycology ( C2 )
Describe the history (C2 )
Eplain the physical examination (C3)
Describe the ECG, echocardiography (C2 )
Interpret the radiological findings ( C3 )
Explain the management ( C4 )
B. PULMONIC REGURGITATION
86. At the end of the chapter, the learner will be able to :
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)
MULTIVALVULAR DISEASE
Explain the management (c4)
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
92. At the end of the chapter, the learner will be able to reviev:
STABLE AGINA PECTORIS
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
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)
ECG findings (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)
ECG findings (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
HEART DISEASE IN PREGNANCY CARDIOVASKULER PHYSIOLOGY programs (C2)
DURING PREGNANCY AND
PUERPERUM 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)
CARDIOVASCULER EVALUATION DURING o The program return to previous potition or activities (C2)
PREGNANCY
101. 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)
CONGENITAL HEART DISEASE
102. At the end of the chapter, the learner will be able to :
Explain the history and physical findings durings normal pregnancy (C1)
MITRAL STENOSIS
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
MITRAL REGURGITATION, AORTIC STENOSIS, 103. t the end of the chapter, the learner will be able to explaine the risk of pregnancy and delivery of mother with cyanotic and non
AORTIC cyanotic congenital heart disease as well as the risk to the fetus and newborn (C2)
REGURGITATION
104. At the end of the chapter, the learner will be able to :
PREGNANT PATIENTS WITH PROSTHESTIC VALVES Explain the hemodynamic consequencies of pregnancy in patient with mitral stenosis (C2)
Explain the treatment of mitral stenosis in pregnancy (C2)
PRIMARY AND SECONDARY PREVENTION 109. explain the pathophyysiologic and pathologic features of PC (C2)
DIAGNOSIS
110. explain the epidemiology and risk factors of PC (C2)
NONINVASIVE TESTING
111. appraise risk factor management (C2)
TAKAYASU VASCULITIS
ARTERIAL THROMBOEMBOLISM
ARTERIAL THROMBOSIS
procedures (C2)
ARTERIAL ANEURYSM Describe the role and the pharmacogolgic 111. At the end of the chapter, the learner will be able to summarize :
Epidemiology of this disease (C2)
properties (mechanism of action, effects, adverse Etiology and the pathogenesis concerning this disease (C2)
reaction, pharmacokinetics, Signs and symptoms (C2)
contraindications and posology) of anti arrhythmias Arteriographic findings (C2)
(amiodarone) used in treatment of cardiac Conservative and operative treatment procedures (C2)
CHRONIC LOWER EXTREMITY
arrhythmia (C4)
ISCHEMIA 112. At the end of the chapter, the learner will be able to summarize :
Source of spontaneous embolism (C2)
106. At the end of the chapter, the learner will be The most frequent site if embolic occlusion (C2)
able to describe : Clinical presentation (C2)
Definition, epidemiology and causes of cardiac Pharmacologic therapy and surgical treatment option (C2)
arrest and sudden cardiac death (C2)
Pathology and pathophysiology of cardiac 113. At the end of the chapter, the learner will be able to summarize :
arrest and sudden cardiac death (C2) The phases of thrombosis and types of thrombi (C2)
B. DISEASES OF THE VEINS
Examination of clinical characteristics of The step, factors involved, and mechanism of platelet activation and aggregation (C2)
MICROSCOPIC STRUCTURE OF THE
cardiac arrest and suddent cardiac death (C4) The mechanism and the pathways of blood coagulation (C2)
VEINS
Community based intervention for cardiac The mechanism of fibrinolysis (C2)
ACUTE DEEP VEINS THROMBOSIS arrest and sudden cardiac death (C4) The regulation of thrombisis and fibrinolysis (C2)
And summarize the therapy of cardiac arrest,
sudden death and post cardiac arrest care (C2) 114. At the end of the chapter, the learner will be able to describe :
Therapy for prevention of cardiac arrest and Etiologic classification (C1)
sudden cardiac death (C2) Summarizing the primary disorders, mechanical factors in aneurysm formation (C2)
The signs of aneurysm (C2)
107. At the end of the chapter, the learner will be The indication of surgery (C2) and recalling the surgical treatment procedures (C1)
able to summarize : 115 At the end of the chapter, the learner will be able to summarize :
Epidemiology of this disease (C2) Risk factor (C2)
Etiology and the pathogenesis concerning the Natural history (C2)
association between heavy tobacco use and this Physical examination (C2)
disease (C2) Ultrasonographic and arteriographic findings (C1)
Gene associated with this disease (C2) Medical and surgical treatment (C2)
Abnormality of hypercoagulability and
endothelial function in this disease (C2)
Inflammatory thrombosis that affects the 116. At the end of the chapter, the learner will be able to explain the general structure of the veins (C2)
arteries and veins (C2)
Clinical features of Buergers disease (C2) 117. At the end of the chapter, the learner will be able to summarize :
Diagnosticncriteria (C2) The pathophysiology (C2)
Characteristic arteriographic findings (C1) The signs and symptoms (C2)
Pathologic feature of buergers disease (C2) The ultrasounic and phlebographic examinations (C1)
Differential diagnosis of the disease that mimic The use anticoagulants (C2)
buergers disease (C2) The use of intermittent and graduated leg compression (C2)
Conservative and operative therapeutic The sclerotherapy of the superficial limb vein (C2)
CORPOLMONALE
able to :
Describe the etiology, pathogenesis and
CARDIAC TAMPONADE 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)
128. At the end of the chapter, the learner will be able to describe :
CORONARY ARTERY DISEASE
The epidemiology of pulmonary hypertension (C2)
B. HYPERTENSION The hemodynamic changes (C2)
The treatment (C2)
C. CARDIOMYOPATHY & ARRHYTMIAS The rehabilitation (C2)
Blood Gas Analysis : metabolic acidosis & alkalosis
Blood Gas Analysis : respiratory acidosis & alkalosis
131. summarize the prevalence, incidence, risk factors clinical presentation, diagnosis and management (C2)