Download Effects of Drugs on Isolated Mammalian Heart

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Faculty of Medicine
King Abdulaziz University
Cardiovascular System Module
Phase 2, MBBS
1429/1430 H (2008/ 2009)
Phase 2
2003/2004
Year 2
TABLE OF CONTENTS
TOPIC
Page
THE OUTCOMES OF THE UNDERGRADUATE
CURRICULUM
CURRICULUM MAP
PHASE 2
STRUCTURE OF THE MODULE
INTRODUCTION
AIMS & OBJECTIVES
TEACHERS CONTACTS
ASSESSMENT
ICONS
TOPIC OUTLINES
NO.
LECTURES (NAMES)
1
Introduction to the cardiovascular system:
2
Cellular events in the heart
The Heart as a pump//
3
4
Anatomy of the Mediastinum and Pericardium .
5
External Features of the Heart and coronary vessels
6
The control of the cardiac output
7
Cardiac Cycle
8
Plasma lipoprotein-composition, structure and function
9
internal Features of the Heart.
10
Normal development of the heart
11
The Electrical activity of the heart and the ECG
12
Cardiac arrhythmias
13
Congenital anomalies of heart
14
The autonomic nervous system and the cardiovascular system
15
Relationship between pressure, flow and resistance
16
Cholesterol and triglycerides transport pathways
17
Myocardial & Pericardial Diseases
18
Pressure and flow in systemic circulation
Predict how CVS will react in common situations: eating a
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meal, exercise and changes in posture
Special circulations: Coronary , Pulmonary , Cerebral and
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Skeletal circulation
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Atherosclerosis and Aneurysm
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Phase 2
Cardiovascular Module
Year 2
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NO.
Ischemic heart Disease
Antihypertensive drugs
Tissue fluid formation and Edema
Valvular Heart Diseases
Infective Endocarditis.
Hypertension and Effects on Blood Vessels and Heart
Vasculitis & Cardiovascular Tumors
Anti-anginal drugs
Anti-arrhythmic drugs
Hyperlipoproteinamias and hypolipoproteinaemias
Diagnostic cardiac enzymology
Drugs used in heart failure
Cardiovascular Investigations
Cardiovascular causes of chest pain
PRACTICAL (Names)
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5
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Middle mediastinum, heart in situ
Heart sounds – prediction of timing of uncomplicated murmurs
External features of the heart and coronary vessels
Internal features of the heart
ECG Recording
Determination of lipoproteins/plasma lipids
Atherosclerosis
Cardiac enzymes and proteins
Myocardia Infarction/ Valvular Heart Diseases
Effects of Drugs on Isolated Mammalian Hear
TUTORIALS
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1
Anatomy of the Heart and coronary vessels
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2
Atherosclerosis /MyocardiacInfarction/ Valvular Heart
Diseases/ Hypertension
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INDEPENDENT LEARNING
1
2
3
4
1
2
3
4
Study Histology of blood vessels and relate structure to function
in the circulation
Embryology of the heart and great vessels
Study of common congenital defects
Factors affecting tissue perfusion
PROBLEM BASED LEARNING (PBL)
Case studies of patients with chest pain
Case studies of heart failure
Case studies of valvular disease
Case studies of circulatory shock
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Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Undergraduate Program Learning Outcomes
Learning Outcomes
Code
Knowledge
By the end of the program the graduate will be able to:
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
A11
A12
A13
A14
A15
A16
A17
A18
Describe normal human development across the life-span and how these
affect normal structure and function.
Describe normal structure and function of the major systems and how they
interrelate.
Describe the molecular, biochemical and cellular basis essential for
maintaining homoestasis.
Demonstrate knowledge of the basic medical sciences that explain causes
and mechanisms of disease.
Describe the alterations in structure and function of major body systems as
a result of illness or injury.
Demonstrate knowledge and understanding of the pharmacological
principles of treatment using drugs, their efficacy in the management and
symptomatic relief of diseases, as well as their side effects.
Discuss the implications of basic ethical principles, including
confidentiality, informed consent, truth telling, and justice, for the care of
patients.
recognize the legal background of medical practice
Explain the causes and mechanisms of intoxication.
Describe the role of family, community, and culture as factors influencing
patient presentations, interpretations of illness episodes and adherence to
treatment episodes.
Demonstrate knowledge and understanding of the natural history of disease
and relationships with risk factors and disease prevention.
Recognize and discuss the principles of disease surveillance and screening,
disease prevention, communicable disease control, health promotion, and
health needs assessment.
Describe strategies to support life-long learning via print and electronic
sources to assist in making diagnostic and treatment decisions and to remain
current with advances in medical knowledge and practice.
Demonstrate knowledge of how to use the basic medical sciences and
clinical skills for clinical decision making and problem solving in the care of
patients.
Recognize the scientific basis of health, disease, and medicine in the
management of common and high impact conditions in the society.
Demonstrate knowledge of the functional approach to managing chronic
conditions, including knowledge of the impact of chronic illness on
function.
demonstrate basic knowledge of the global health care delivery system in the
community including physicians, hospitals, outpatient centres, health
agencies and the role of community agencies in that system.
Recognize the management of common emergencies and the initial and the
life saving management steps for other emergencies.
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Phase 2
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Cardiovascular Module
Year 2
Identify the "Red flags" indicating seriousness in the different clinical
presentations.
Cognitive Skills
By the end of the program the graduate will be able to:
B1
Recognize, define and prioritize problems.
B2
Demonstrate the ability to acquire new information and data.
B3
Critically appraise validity and applicability of acquired information to one’s
professional decisions.
B4
Organize, record, research, present, critique, and manage clinical
information.
B5
Recognize the limitations of knowledge in medicine and the importance of
triangulation of evidence before reaching a decision.
B6
Evaluate the patient’s medical problems.
B7
Formulate accurate hypotheses to serve as the basis for making diagnostic
and treatment decisions.
B8
Reflect on one’s thinking process and decisions and apply rational
processes.
B9
Use appropriate intellectual strategies to deal with uncertainties when they
arise.
B10
Demonstrate an understanding of research methodology.
B11
Formulate research questions.
B12
Draw research hypotheses.
B13
Choose appropriate research methodologies and designs.
B14
Select appropriate methods of data collection.
B15
Analyse and interpret collected data.
Interpersonal Skills & Responsibility
By the end of the program the graduate will be able to:
C1
Display the personal attributes of compassion, honesty, and integrity in
relationships with patients, families, communities and the medical
profession.
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Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
C2
Exhibit appropriate value for the sensitive nature of the doctor/patient
relationship and the importance of active listening, with attention to the
patient’s familial, cultural, and spiritual circumstances.
C3
Demonstrate professionalism and high ethical standards in all aspects of
medical practice, specifically competence, honesty, integrity, respect for
others, professional responsibility and social responsibility.
C4
Exhibit a capacity for self-evaluation, moral reflection and ethical reasoning
to form the basis for a self-directed, lifelong engagement in the responsible,
committed, compassionate practice of medicine.
C5
Apply the four principles of ethical and legal knowledge, namely respect for
autonomy, beneficience, non-maleficience and justice.
C6
Demonstrate awareness and understanding of the legal and professional
responsibilities; and report inappropriate medical practice.
Year 2
Communication, Information Technology & Numerical Skills
By the end of the program the graduate will be able to:
D1
work effectively as part of a health care team
D2
communicate effectively with patients, their families and colleagues, both
verbally and in writing
D3
retrieve information by all means including electronically
D4
present information clearly in written, electronic and oral forms
D5
work within a changing, multi-task environment
Psychomotor Skills
By the end of the program the graduate will be able to:
E1
Elicit accurate comprehensive and focused medical history by employing
techniques that facilitate the patient’s sharing of information.
E2
Conduct a both effective and accurate comprehensive and focused physical
examination.
E3
Formulate a differential diagnosis.
E4
Select the appropriate laboratory tests and radiographic studies and interpret
their results and use them in making diagnostic and treatment decisions.
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Phase 2
Cardiovascular Module
Year 2
E5
Formulate and implement a plan of care for both the prevention and
treatment of disease.
E6
Educate patients about their health problems and to motivate them to adopt
health promoting behaviors.
E7
Use pharmacotherapeutic
effectively.
E8
Demonstrate appropriate technique for performing Basic Life Support and
Advanced Life Support.
E9
Undertake tasks to initiate and be involved in the care of acutely ill patients.
King Abdul Aziz University
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and
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other
therapeutic
modalities
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
CURRICULUM MAP
YOU ARE HERE…
Year 1
Year 2
Phase I
Phase II
Year 3
Year 4
Year 5
Year 6
Internship
Phase III
Phase 2, is the first stage towards achieving the objectives specified in the curriculum.
The aim is to lay down a solid foundation for the subsequent full-time clinical study in
phase 3 of the MBBS program. This foundation will include knowledge, skills and
attitudes, particularly attitudes toward the learning process. The curriculum philosophy in
Phase 2 is enforcing the development of a mixture of teaching approaches including
“student-directed learning”. By the end of Phase 2, you should be ready to be much more
involved in the control of the learning process
Second Year Courses
SECOND YEAR
3RD SEMESTER
4TH SEMESTER
Cells and Tissues
General Anatomy (2)
Biochemical Basis of Medicine (1)
Biochemical Basis of Medicine (2)
General Anatomy (1)
Basic Emergency Care
Embryology
Cardiovascular System
Pathology (1)
Respiratory System
Communication Skills (1)
Immune, Blood lymphatic System
Musculoskeletal System
Islamic Studies (4) and Medical Ethics
Islamic Studies (3)
Arabic Language (2)
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Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
STRUCTURE OF THE MODULE
TIMETABLED HOURS:
35 Lectures + 2 Tutorials + 10 Practicals presentations
+ 4 PBL seminars
STUDENT DIRECTED
LEARNING:
4 Topics
TEACHING DEPARTMENTS:
e.g.Anatomy, Physiology, Pharmacology, pathology,
Clinical Biochemistry, Medicine, Radiology, paediatric
MODULE COORDINATOR:
Dr. Mohamed Ajab Noor
MODULE MEMBER CONTACTS CONTACTS
Name
Post
Dept.
prof. Mohameed
Ali Ajab noor
Head
Clinical
biochemistry
Dr. Aish mukarrm
siddiqui
coordinator
Internal
medicine
Pager
Mobil
Ext
E-mail
0555649250 22100 [email protected]
1516
0505536108 18243 [email protected]
prof. Ashraf
Member
youssef nasr
naeem
prof.Abdelmoneim Member
mohamoud osman
anatomy
0500959327
pharmacology
0501834576 20218 [email protected]
Prof.Abdelrahman
fahmy
Member
physiology
0507620596 22111 Abdelrahman.fahmy@hotmail
Dr.Taha motamad
hassan
Member
pathology
Dr.Layth Ahmad
mimish
Dr.Reema Bader
Member
medicine
Member
Paediatrics
Prof. Sawsan
Raheem.
Moataz Alshafei
Member
physiology
Administrative
Coordinator
King Abdul Aziz University
3426
2513
0562394317 21077 [email protected]
21035
0505471257
[email protected]
0500116571
[email protected]
0506638532
[email protected]
21177 0509383573
21197
9
[email protected]
[email protected]
Faculty of Medicine and Allied Sciences
Phase 2
Hanan Alghassal
Cardiovascular Module
Administrative
Coordinator
23075
Year 2
0503696581
INTRODUCTION:
Welcome to the Cardiovascular System Module. Our objective over the next four weeks
is not to teach you to be a cardiologist, or even to teach you all you need to know about
Cardiology to qualify in medicine. Our objective is to lay down the foundations on which
you can build, for yourselves, the knowledge of Cardiovascular medicine that you will
require in whatever branch of medicine you choose to follow.
The Cardiovascular system is of particular significance for the following reasons:

Cardiovascular disease account for the biggest single group of disorders
presenting to the primary care physician.

The heart is intimately associated with respiratory function due to the pulmonary
circulation.

Integrity of the cardiovascular system is central to the proper functioning of other
major systems such as the Central Nervous System and Respiratory System.
Therefore, treatment of cardiovascular failure is central to resuscitation in lifethreatening conditions e.g., trauma, drug over dose and shock.
The cardiovascular system, like the heart itself, is at the very centre of medicine. We hope
you enjoy the next four weeks. There will be other modules ahead, but a good grounding
in Cardiovascular module will be an important stage of your journey through this systembased course.
Revision:
Before you start the cardiovascular module, we recommend you to revise the
following subjects:
 The histological structure of the major tissues of the body, such as epithelia, endothelia
and smooth muscle
 The composition of blood and the cell types it contains, and the principles of
haemostasis.
 The process of formation of tissue fluid and oedema.
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Phase 2
Cardiovascular Module
Year 2
Aims:
The aims of this module are to:
 Study the structure and function of the human cardiovascular system and compare it
with abnormal structure and function.
 Study the assessment of the cardiovascular system and how its function is altered in
common disease states.
 Acquire skills and working knowledge and understanding of the principles and
concepts applicable to the cardiovascular system in general provide the basis for the
study of common clinical conditions and disorders, and for the clinical examination
together with performing simple clinical procedures related to the cardiovascular
system and its management.
Objectives
By the end of this module you should be able to:
 Describe the structure and relations of the heart and major blood vessels of the body
and relate their structure to function in the circulation
 Describe the operation of the heart as a pump, including the function of the heart
valves, and be able to use your understanding of the cardiac cycle as a basis for
physical examination of the heart.
 Describe the development of the heart, some common congenital defects, and the
pathology of valvular problems.
 Describe the factors influencing blood flow to individual tissues and the mechanisms
of control of vascular resistance.
 Describe in general terms the role of the autonomic nervous system in the control of
cardiovascular function, including the concepts of local and central control.
 Describe the mechanisms controlling cardiac output in the normal individual, and how
they operate in common situations such as exercise.
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Cardiovascular Module
Year 2
 Describe the special features of the pulmonary, cerebral, coronary, skin and skeletal
muscle circulations
 Describe the features of the normal electrocardiogram and their relation to electrical
events in the heart, and be able to interpret changes in the ECG produced by common
clinical conditions.
 Describe the molecular and cellular events underlying the cardiac cycle, the principles
of altering heart rhythm and contractility by drugs
 Describe the structure and properties of the coronary circulation, and the pathology and
effects of ischemic heart disease.
 Describe basic material relevant to the assessment, diagnosis and treatment of a patient
presenting with acute chest pain
 Describe some common reasons for and the major effects of chronic heart failure.
 Describe the possible reasons for, effect of, and principles of treatment of
hypertensions.
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Cardiovascular Module
Year 2
Transferable Skills:
By the end of this module, you will demonstrate the ability to:
 Assimilate and integrate information from lectures, practical sessions, tutorials, clinical
presentation sessions and independent learning activities
 Gain practical skills associated with the dissection of the cadaver and the examination
of the living
 Interpret two-dimensional images of the cardiovascular system radiographic techniques
 Explain the pathology of cardiovascular system and drug action in relation to the
underlying processes.
Cross modular themes
1) Concurrent modules:
 The work on the overall structure of the circulation will relate closely to the
musculoskeletal module, where students study the circulation of the limbs.
 The work on the autonomic nervous system and cellular and molecular events in the
heart will closely relate to the material in other core courses of the second year.
 Physical examination of the cardiovascular system will be learned within the clinical
stream and practical of the module
 The study of myocardial infarction and other aspects of ischemic heart disease will be
reinforced by material discussed in clinical presentations.
2) Future modules:
 The respiratory system module will pick up on the properties of the pulmonary
circulation
 Both renal-urinary system and gastrointestinal system modules will deal with their
respective special circulations.
 The renal urinary system module will deal with the control of blood volume, and pick
up again the them of hypertension
 The reproductive system module will deal again with the foetal circulation
King Abdul Aziz University
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Phase 2
Cardiovascular Module
Year 2
Assessment: (EXAMPLE)
1. Formative:
This form of assessment is designed to give you feedback to help you to identify areas
for improvement. It includes a mixture of MCQs, short answer-questions (SAQs),
extended matching questions (EMQs), problems-solving exercises and independent
learning activities in all subjects. These will be given during tutorial sessions and
practicals. The Answers are presented and discussed immediately with you after the
assessment. The results will be made available to you.
2. Summative
This type of assessment is used for judgment or decisions to be made about your
performance. It serves as:
a. Verification of achievement for the student satisfying requirement
b. Motivation of the student to maintain or improve performance
c. Certification of performance
d. Grades
In this Course your performance will be assessed according to the following:
1. Continuous Assessment
40 Marks
2. Final End of Semester Exam (Two Hours)
50 Marks
3. Final OSPE (Practical)
10 Marks
Total = 100 Marks
Write short description about assessment tools for example………….
Exams: Written Exams will include short answer and multiple choice questions (MCQs).
They will cover material presented in lecture, readings, and discussion. All exams must be
taken on the date scheduled. In case of an emergency, the coordinator must be notified.
No make-up exams will be provided if you fail to notify and discuss your situation with
the coordinator. Practical Exam will be in an OSPE (Objective Structured Practical Exam)
format, where you will pass through several stations representing all the subjects.
King Abdul Aziz University
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Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Assignment paper: The purpose of the work is to provide you with the opportunity to
explore an area of basic medical sciences or medical education in depth. The paper is to be
a 10-15 page literature review of the topic will constitute 20% of your final grade. Policy:
Topics must be approved in writing by the coordinator. Directions for topic submission
will be discussed during the first week of class. Topics that have not been approved will
not be accepted.
All papers must reference a minimum of eight references from refereed journals. All
papers must be typed, double-spaced, have 1 inch margins.
Note: We will be making the journey from "womb to tomb" in 15 weeks. Therefore, this
course requires an intensive coursework load. Class attendance and participation are
extremely important to your learning and as such are considered in the evaluation of your
course grade. This course is recommended for students that can make the required time
and energy commitment. If there is anything that the coordinator can do to assist you
during the course, please feel free to contact him.
Course work:
You are required to complete satisfactorily one piece of work during the course. This may
involve a variety of activities, from essays to problem-solving papers and short answerquestions to posters and presentation.
King Abdul Aziz University
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Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Icons (standards)
The following icons have been used to help you identify the various
experiences you will be exposed to.
Learning objectives
Content of the lecture
Independent learning from textbooks
Independent learning from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library,
building No. 7.
Independent learning from the Internet
Problem-Based Learning
Self- Assessment (the answer to self-assessment exercises will
be discussed in tutorial sessions)
The main concepts
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Year 2
Topic Outlines
LECTURES
King Abdul Aziz University
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Cardiovascular Module
Year 2
Lecture 1:
Introduction to the cardiovascular system
Student Notes:
.
Department: Physiology
Lecturer: Prof. Hossam Awad
Prof. Maha Hegazi
By the end of this lecture the student will study the
functional structure parts of the heart and circulatory
system
1. Outline the different functional structure of
the heart
2. Describe the component of the circulatory
system
3. Match the specific vascular structure with its
particular function
4. Describe how the arterioles are responsible
for the peripheral resistance
5. Define the capacitance vessels
6. Describe the importance of the cardiac valves
1. Distinguish between the contractile,
conductive and pace maker tissues of the
cardiac muscle
2. Summarize the conduction pathway of
impulse over the heart
3. Identify how the impulse is auto-generated
in the cardiac muscle
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
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Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 1:
Introduction to the cardiovascular system
Student Notes:
See the Study guide of CV module
Try to access CD-ROM series about the CVS, just
look to the main topics in each CD-ROM and be
sure you know how to run it for future independent
learning.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key word – Cardiovascular System –in the
search engine google (www.google.com). The aim is
to be able to use the search engine and also to
recognize the rich resources in the web. Don’t read
any details at this stage. Later in the course, we will
direct you to specific useful sites.

http://www. Google.com
King Abdul Aziz University
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Faculty of Medicine and Allied Sciences
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Phase 2
Cardiovascular Module
Year 2
Lecture 2:
Cellular events in the heart
Student Notes:
Department: Physiology
Lecturer
:Prof. Hossam Awad
Prof. Maha Hegazi
By the end of this lecture you should be able to
describe the following:
understand
the cardiac property (Automaticity)
understand the cardiac property (Excitability)
Apply his information on a different situations
1.
Explain cardiac automaticity
2. distinguish between slow and fast action
potential
3. predict the effects of ionic, chemical and
neural changes on cardiac automaticity
4. Summarize myocardial excitability phases
5. Explain the significance of plateau phases in
prolongation of ARP
6. Related the phases of cardiac action potential
to excitability and contractility
King Abdul Aziz University
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Faculty of Medicine and Allied Sciences
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Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 2:
Cellular events in the heart
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 528 - 532
You have the opportunity to watch the CD-ROM
about the electrical activity of the heart. You can
access the CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web sites about the
cardiovascular system but these should not used in
isolation. I would recommend you look at the
following web site:
http://www.cvphysiology.com/Arrhythmias/A007.htm
Self-assessment
Draw the action potential of ventricular cell and
compare it with the action potential of a single
sinatorial cell.
Answer MCQs (8) in Ganong, Review of Medical
Physiology, 20th edition, page: 761
King Abdul Aziz University
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Faculty of Medicine and Allied Sciences
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Phase 2
Cardiovascular Module
Year 2
Lecture 3:
The Heart as a pump
Student Notes:
Department: Physiology
Lecturer: Prof. Hossam Awad
Prof. Maha Hegazi.
At the end of the lecture you should be able to:

Understand the cardiac property (Conductivity ).

Understand the cardiac property (Contractility).
Apply
his information on a different situations
1. Explain how the excitation wave is conducted to
the contractile muscle fibers
2. Explain the excitation contraction coupling in
cardiac muscle.
3. Predict the importance of Ca++ om cardiac
contraction
4. List factors affecting contractility
5. Define Frank-Starling law, and explain its
mechanism.
6. Discuss the effect of sympathetic stimulation on
cardiac contractility and explain its mechanism.
7. Compare between the increased cardiac
contraction force and stroke volume by the
increased preload and the sympathetic
stimulation (as regard the mechanism, the O2
consumption, the limitation, and the benefits).
.
Think of the heart as an elastic band – the more
you stretch it initially, the further you can fire it.
This will help you understand Starling Law.
Remember, however, that the force of contraction
can also be affected by other extrinsic factors, e.g.
sympathetic stimulation. Starling’s law is not the
only factor that affects Stroke volume.
King Abdul Aziz University
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(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 3:
The Heart as a pump
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 545 and page 552- 553
You have the opportunity to watch the CD-ROM
about the Cardiac contractility. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.elon.edu/shouse/physiology/physiol22/Lectur
e14.html
Self-assessment
Briefly answer the following short question:

It takes several months for nerves to grow
into transplanted hearts. However, before the
nerves grow in patients with transplanted
hearts, exercise increases their cardiac
output. What is the mechanism involved,
and how does it operate?
King Abdul Aziz University
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Phase 2
Cardiovascular Module
Year 2
Lecture 4: Anatomy of the Mediastinum and Pericardium
Department: Anatomy
Lecturer:
Prof. Dr. Said Zaghloul
Prof. Dr. Amira El-haggagy
At the end of the lecture you should be able to:
1) List the subdivision of the mediastinum and
their components.
2) Boundaries and contents of different mediastina
3) Describe the types of the pericardium
4) Identify the pericardial sinuses
5) Describe the innervation and arterial supply of
pericardium
* Mediastinum: Definition, Boundaries and parts.
* Describe the boundaries, contents and relations of
each part.
* Pericardium: types, cavity, sinuses, blood and
nerve supply and clinical importance.
King Abdul Aziz University
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Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture4:
Richard S. S
nell. Clinical Anatomy for Medical students, 7th
edition, Lippincott, Williams
and Wilkins.
* Lectures notes in the Department of Anatomy Web
Sites and its attached links:
WWW.kauanatomy.com
Self Assessment
* Prepare a simple presentation about one of the
following topics:
- Middle mediastinum (boundaries and contents).
- Fibrous pericardium
- Pericardial sinuses
King Abdul Aziz University
25
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 5: External Features of the Heart and coronary vessels
Department: Anatomy
Lecturer:
Prof. Dr. Said Zaghloul
Prof. Dr. Amira El-haggagy
At the end of the lecture you should be able to:
1- Shape, surfaces, and borders of the heart
2- Chambers forming base & apex of the heart
3- Chambers forming sternocostal and diaphragmatic
surfaces of the heart
4- Chambers forming upper, lower, left and right
borders of the heart
5- Grooves on the external surface of the heart and their
content.
6- Coronary arteries (origin and branches of each artery)
7- Venous drainage of the heart
- External features of the heart: shape, surfaces, borders,
apex, base and grooves.
- Arterial supply of the heart
- Coronary sinus (position, termination and tributaries)
- Cardiac plexuses (superficial and deep)
Richard S. Snell. Clinical Anatomy for Medical
students, 7th edition, Lippincott, Williams and Wilkins.
King Abdul Aziz University
26
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 5 :
* Lectures notes in the Department of Anatomy Web
Sites and its attached links:
WWW.kauanatomy.com
Self Assessment
* Prepare a simple presentation about one of the
following topics:
- Surface anatomy of heart borders
- Surface anatomy of heart valves & best sites of their
auscultation
King Abdul Aziz University
27
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 6:
The control of the cardiac output
Student Notes:
Department: Physiology
Lecturer: Prof. Hossam Awad
Prof. Maha Hegazi
By the end of this lecture you will be able to:
1- Know the factors that affect the cardiac output,
2- Know the relation of cardiac output to the body
surface area.
3- How the cardiac output is influenced by the heart
rate and stroke volume.
4- Know the effect of increased arterial blood
pressure on the cardiac output.
1. Define cardiac output, cardiac index & ejection
fraction.
2. Explain the effects of heart rate changes on CO.
3. Explain how the stroke volume is influenced by
the venous return(preload) which in turn affects
the cardiac output
4. Explain & describe how the cardiac output is
regulated.
5. List what the factors that affect venous return.
6. Explain the effect of changes in arterial blood
pressure (after-load) on cardiac output.
7. Compare between the effects of starling law &
the sympathetic stimulation on the CO.
8. Explain why trained athletes can achieve higher
cardiac output than non athletes.
9. Define the O2 consumption by the heart &
explain why it is more in the left ventricle than
the right.
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
28
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 6:
The control of the cardiac output
Student Notes:
Remember that cardiac output is limited by venous
return; without integrated regulation of the
cardiovascular system, an increased heart rate will
be compensated by reduced stroke volume.
Ganong, Review of Medical
Physiology, 20th edition,
page: 550 - 555
You have the opportunity to watch the CD-ROM
about the Cardiac output. You can access the CDROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web sites about the
cardiovascular system. I would recommend you to
use the key words – Cardiac, output, control –in the
search engine google (www.google.com). The aim is
to be able to use the search engine and also to
recognize the rich resources in the web.

http://www. Google.com
Self-assessment
Briefly answer the following in a short essay:

Which methods are commonly used to
measure cardiac output?
Answer MCQs (1- 5) in Ganong, Review of
Medical Physiology, 20th edition, page: 761
King Abdul Aziz University
29
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 7
Cardiac Cycle
Student Notes:
Department: Physiology
Lecturer :
& Prof. Hossam
Prof. Maha Hegazi &
Dr.Azra
Kiramani
At the end of the lecture you should be able to:
1-Understand the mechanical events (phases) of the
cardiac cycle.
2-Understand the changes in the venous pressures,
arterial pressures, heart sounds, and ECG that take
place during each cardiac beat.
1. analyze the changes in ventricular
volume and or pressure and the
opening and closing of valves during
the cycle
2. Relate the mechanical events of the
cardiac cycle to the ECG.
3. Predict the causes of first and second
heart sounds
4. Describe & draw the jugular pulse
curve & relate its waves to the phases
of cardiac cycle.
5. Analyze the arterial pulse curve, and
explain the causes of diacrotic notch
& wave
The cardiac cycle is the sequence of pressure and
volume changes that takes place during cardiac
activity. A cycle time of 0.8 s is taken at rest
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
30
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 7
Cardiac Cycle
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 545 - 558
You have the opportunity to watch the CD-ROM
about the Cardiac Cycle. You can access the CDROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system but these should not used in
isolation. I would recommend you look at the
following web site:
http://www.elon.edu/shouse/physiology/physiol22/Lect
ure13.html
Self-assessment
Which of the following is incorrect?
1.
The action potential is longer in cardiac muscle than
in skeletal muscle
2.
Cardiac muscle can not undergo tetany because
cardiac muscle uses external Ca++
3.
The AP of cardiac muscle lasts almost as long as the
muscle contraction
4. Muscle contraction in cardiac muscle lasts 100 msec.
Which of the following is incorrect? Under normal
conditions, the pressure in the
1.
Vena cava is 8 mm Hg and the pressure in the right
ventricle is 4 mm Hg.
2.
Right atrium is 4 and the pressure in the right ventricle
is 20/4 mm Hg (this is a systolic pressure of 20 and a
diastolic pressure of 4).
3.
Right ventricle in 20/4 mm Hg and the pressure in the
left ventricle is 120/8 mm Hg.
4.
Pulmonary artery is 120/8 mm Hg and the pressure in
the left atrium in is 8 mm Hg.
King Abdul Aziz University
31
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 8 :
Plasma lipoprotein-composition, structure and function
Student Notes:
Department: Biochemistry.
Lecturer Prof. Mohd Ali Ajab Noor – Dr. Enayat
Hashem
At the end of this lecture you will be able to:
1) Describe the general structure and composition
of a typical plasma lipoprotein.
2) Classify human plasma lipoproteins on the basis
of their particle size, physical properties,
composition and transport function.
3) Discuss the clinically important methods for
analysis of plasma lipoproteins.
In general nature of lipoprotein systems will be
described and discussed before looking in detail at
the lipoproteins found in the human plasma. The
structure, composition, and physical properties of
chylomicrons, very low density, low density and
high density lipoproteins will be reviewed and
methods of clinical importance for the analysis of
plasma lipoproteins will be described.
Lipoprotein A is a prothrombotic lipoprotein that is
particularly involved in coronary disease, while high
(Insert here handouts and additional
pages for notes if needed)
levels of high-density lipoprotein are protective
King Abdul Aziz University
32
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 8 :
Plasma lipoprotein-composition, structure and function
Student Notes:
Rubin & Farber, Essential Pathology,
2nd edition. PP 249 - 260
You have the opportunity to watch the CD-ROM
about the Hyperlipidemias” You can access the CDROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “Hyperlipidemias” –in the
search engine google (www.google.com).

http://www. Google.com
Self-assessment
Answer MCQs (4 and 8) in Ganong, Review of
Medical Physiology, 20th edition, page: 745
King Abdul Aziz University
33
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 9: internal Features of the Heart.
Department: Anatomy
Lecturer: Prof. Dr. Said Zaghloul
Prof. Dr. Amira El-haggagy
At the end of the lecture you should be able to:
1) Identify the chambers of the heart
2) Identify the internal features of the chambers
of the heart
3) Describe the smooth and rough parts of each
cardiac chamber
4) Describe the anatomy of heart valves
(tricuspid, mitral, aortic, and pulmonary
valves)
5) Papillary muscles in the right and left
ventricles
Chambers of the heart
* Features of the cavities of right atrium, ventricle,
left atrium and ventricle and the valves.
* Papillary muscles
* Cusps of the heart valves
King Abdul Aziz University
34
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture9
Richard S. Snell. Clinical Anatomy for Medical
students, 7th edition, Lippincott, Williams and
Wilkins.
* Lectures notes in the Department of Anatomy Web
Sites and its attached links:
WWW.kauanatomy.com
Self Assessment
* Prepare a simple presentation about one of the
following topics:
- Surface anatomy of the heart and its valves
- Anatomy and mechanisms of action of the heart
valves
- Anatomy of the conducting system of the heart.
King Abdul Aziz University
35
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 10: Normal development of the heart
Department: Anatomy
Lecturer: Prof. Dr. Said Zaghloul
Dr. Eman Abd El-aal
At the end of the lecture you should be able to:
1- Describe the process of angiogenesis.
2- List the parts of primitive heart tube
3- Describe the process of the interatrial septum
development
4- Describe the development of the
interventricular septum
5- Embryological origin of smooth and rough
part of each cardiac chamber
6- Development of cardiac valves (tricuspid,
mitral, aortic, and pulmonary valves)







Angiogenesis.
Establishment of the cardiogenic field.
Formation and position of the heart tube.
Folding of the heart tube.
Formation of the cardiac loop.
Formation of the cardiac septa.
Development of the heart valves.
Sadler TW. Langman’s Medical Embryology, 10th
edition. Lippincott, William and Wilkins.
King Abdul Aziz University
36
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 10 :
-
Lecture note in the department of Anatomy
web site and its attached links:
www.kauanatomy.com
Self-Assessment
* Prepare a simple presentation about one of the
following topics:
- Angiogenesis
- Development of the atria
- Development of the heart septa.
King Abdul Aziz University
37
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 11:
The Electrical activity of the heart and the ECG
Student Notes:
Department: Physiology Department
Lecturer
: Prof. Hossam Awad
Prof. Maha Hegazi & Dr.Azra
By the end of this lecture you should be able to
Know the normal ECG waves, segments, and
intervals, understand their significances, and
know the significance of ECG recordings in
diagnosis of diseases and follow up patients.
Understand the following General rouls:
 Spread of the depolarization wave toward
the +ve electrode records
a +ve wave. And vice versa.
 Spread of the repolarization wave toward the
+ve electrode records
a – ve wave. And vice versa.
 T wave is +ve because the spread of
repolarization wave of the ventricles occurs
from epicardium to the endocardium (due to
relative ischemia of endocardium during
ventricular systole). So, it spreads away from
the recording electrode +ve wave.
1. list the relationship between the ECG waves,
segments, and intervals and the cardiac
depolarization and repolarization.
2. describe the normal origin and spread of the
cardiac action potential.
3. list the information you can get from an ECG
recording
4. define the normal sinus rhythm, sinus
tachycardia, and sinus bradycardia.
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
38
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 11:
The Electrical activity of the heart and the ECG
Student Notes:
The various parts of the conduction system and,
under abnormal conditions, parts of the myocardium
are capable of spontaneous discharge.
Ganong, Review of Medical
Physiology, 20th edition,
page: 528 - 534
You have the opportunity to watch
the CD-ROM about the ECG you can access the
CD-ROM during your spare time.
A nice tutorial on the normal ECG. In
particular, section 3 "Parts of the EKG"
and section 4 "The Sequence of
Cardiac Depolarization and
Repolarization" are useful (and brief).
http://endeavor.med.nyu.edu/courses/physiology/cour
seware/ekg_pt1/ekgmenu.html
Self-assessment
Briefly answer the following in a short essay:
 Describe how the action potential is conducted
through the heart and how the ECG helps to
identify conduction abnormalities
Indicate whether each statement is true or false:
In the Electrocardiogram:
a) The Q wave is caused by atrial repolarization.
b) The PR interval is prolonged in atrial
hypertrophy.
c) The QT interval will give you the duration of
ventricular systole.
d) The first heart sound occurs at the same time as
the P wave.
e) The R wave coincides with the depolarization of
the apex.
Answer MCQs (1-4) in Ganong, Review of
Medical Physiology, 20th edition, page: 760
King Abdul Aziz University
39
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 12:
Cardiac arrhythmias
Student Notes:
Department: Physiology
Lecturer :
& Prof. Hossam
Prof. Maha Hegazi & Dr. Azra
At the end of the lecture you should be able to:
1) Understand the types of rhythm and conduction
abnormalities, their possible causes and, their
ECG changes.
2) Describe the basic mechanisms of cardiac
arrhythmias.
3) Identify the common cardiac arrhythmias on an
ECG rhythm strip and explain the mechanism of
its production.
1-List the types of sinus arrhythmias and explain
their ECG changes.
2-List the types of atrial
arrhythmias (atrial extrasystole, flutter, and
fibrillation) show the ECG changes in each. 3Define reentry and link it to the mechanism of
arrhythmis. 4-List the ventricular arrhythmias,
discuss their ECG changes.
5-Compare the ECG
changes between atrial and ventricular extrasystole.
6-Explain the compensatory pause in ventricular
extrasystole and the rhythm shift in atrial
extrasystole.
7-List the types of conduction abnormalities, and
show the ECG changes in each.
Arrhythmias are usually classified clinically as
supraventricular and ventricular.

Supraventricular – originating in the atrium
or atrioventricular node.

Ventricular – originating in the ventricle.
King Abdul Aziz University
40
(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 12:
Cardiac arrhythmias
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 535 - 539
You have the opportunity to watch the CD-ROM
about the Cardiac arrhythmias. You can access the
CD-ROM during your spare time.
ECG tutorial site. A bit more than we need to
know, but the quizzes are useful. Try them!

http://medlib.med.utah.edu/kw/ecg
Self-assessment
Briefly answer the following in a short essay:

Describe the pathophysiological
principal of the cardiac arrhythmias.

Classify cardiac arrhythmias using a
simple concept map.
King Abdul Aziz University
41
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 13: Congenital anomalies of heart
Department: Anatomy
Lecturer: Prof. Dr. Said Zaghloul
Dr. Iman Abd El-aal
At the end of the lecture you should be able to: 1- Describe the common congenital heart diseases
with their clinical presentation and sings.
2- Explain the components of the Fallot’s
tetralogy.
3- Explain the complication of the congenital heart
diseases.








General local causes of the heart defects.
Anomalies of the cardiac loop.
Dextrocardia.
Situs inversus.
Atrial and ventricular septal defects.
Transposition of the great vessels.
Tetralogy of Fallot.
Valvular stenosis and atresia.
King Abdul Aziz University
42
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 13 :


Sadler TW. Langman’s Medical
Embryology, 10th edition. Lippincott,
William and Wilkins.
Rubin and Farber, Essential Pathology, 2nd
edition.
-
Lecture note in the department of Anatomy
web site and its attached links:
www.kauanatomy.com
Self-Assessment
* Prepare a simple presentation about one of the
following topics:
- Fallot tetralogy.
- Ventricular septal defect
- Types of interatrial septal defects.
King Abdul Aziz University
43
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 14:
The autonomic nervous system and the cardiovascular system
Student Notes:
Department: Physiology
Lecturer: Dr. Al-hazimi
–Dr. Zeinab Al Refaei
By the end of this lecture you will be able to:
Outline the neural mechanisms that control arterial
blood pressure and heart rate, including the
receptors, afferent and efferent pathways, central
integrating pathways, and effector’s mechanisms
involved.
1. Define and list central control of the heart
2.
3.
4.
5.
and blood vessels.
Discuss the autonomic control of the heart
and blood vessels.
Discuss the Baroreceptors reflex & gravity
Discuss volume receptors &Bainbridge
reflex chemoreceptors reflex.
Discuss central “reflexes” vasovagel syncopy
& temperature.
.
There are several very important humoral mechanisms
including circulating catecholamines, the reninangiotensin system, vasopressin (antidiuretic hormone),
atrial natriuretic peptide, and endothelin. Each of these
humoral systems directly or indirectly alter cardiac
function and vascular function.
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
44
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 14:
The autonomic nervous system and the
cardiovascular system
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 579 - 583
You have the opportunity to watch the CD-ROM
about the nervous regulation of cardiovascular
system. You can access the CD-ROM during your
spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.cvphysiology.com/Blood%20Pressure/B
P007.htm
Self-assessment
Briefly answer the following short essay:


Compare the function of the carotid and
aortic baroreceptors with the function of
baroreceptors in the atria and great veins.
What are the effects of baroreceptor
denervation?
King Abdul Aziz University
45
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 15:
Relationship between pressure, flow and resistance
Student Notes:
Department: Physiology
Lecturer: Prof. Hosam Awad – Prof. Maha
Hegazi
By the end of this lecture you will be able to:
1) Describe the relationship between flow, pressure,
and resistance in the vascular system.
2) Define laminar flow and critical closing pressure.
3) Explain why the radius of a vessel is such an
important determinant of flow.
4) Define the law of Laplace, and list three example
of its operation in the body.
Physical principles and equations that are applicable
to the description of the behaviour of perfect fluids
in rigid tubes have often been used to explain the
behaviour of blood vessels. However, blood vessels
are not rigid tubes, and the blood is not a perfect
fluid but a two-phase system of liquid and cells.
Therefore, the behaviour of the circulation deviates,
sometimes markedly, from that predicted by these
principles.
The physical principles are of value when used as an
aid to understand what goes on the body rather than
as an end in themselves or as a test of memorizing
ability.
King Abdul Aziz University
(Insert here handouts and additional
pages for notes if needed)
46
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 15:
Relationship between pressure, flow and resistance
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 560 -564
You have the opportunity to watch the CD-ROM
about the blood flow. You can access the CD-ROM
during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.cvphysiology.com/Hemodynamics/H001
.htm
Self-assessment
Briefly answer the following short essay:
Where in cardiovascular system is turbulent flow
normally found? What produces them?
King Abdul Aziz University
47
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 16:
Cholesterol and triglycerides transport pathways
Student Notes:
Department: Biochemistry
Lecturer Prof. Mohd Ali Ajab Noor - Dr.
Enayat Hashem
At the end of this lecture you will be able to:
1) Describe the transport, functions and
metabolism of chylomicrons and chylomicron
remnants.
2) Describe the transport, functions and metabolism
of VLDL and VLDL remnants (IDL).
3) Describe the transport functions and metabolism
of LDL.
4) Give examples of defects in lipoprotein
metabolism which result in
hyperlipoproteinaemias
Two lipoprotein transport pathways will be
described in detail:

The transport of dietary triaglycrol and
cholesterol by very low density and low
density lipoproteins.

The transport of endogenous
triacylglycerole and cholesterol by very low
density and low density lipoproteins.
King Abdul Aziz University
48
(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 16:
Cholesterol and triglycerides transport pathways
Student Notes:
Fagan, cardiovascular system,
Physiology, 2nd edition,
page: 80 - 82
You have the opportunity to watch the CD-ROM
about the Cholesterol and triglycerides transport.
You can access the CD-ROM during your spare
time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “Cholesterol and triglycerides
transport” –in the search engine google
(www.google.com).

http://www. Google.com
Self-assessment
How defects in lipoprotein metabolism result in
hyperlipoproteinaemias?
King Abdul Aziz University
49
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 17: Myocardial & Pericardial Diseases
Student Notes:
Department: Pathology
Lecturer:Dr. Taha Moatamad &Dr. Rana
Bokhary
At the end of the lecture you should be able to:
Describe the pathogenesis, morphology &
clinical features of:
1. Myocarditis.
2. Pericarditis.
3. Pericardial effusions.
The lecture will cover the following topics:
1. Causes, morphology & clinical features of
myocarditis.
2. Causes, morphology, clinical features &
outcomes of pericarditis & pericardial
effusions.
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
50
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue .... Lecture 17: Myocardial & Pericardial Diseases
Student Notes:
Robbins Basic Pathology, 8th edition.
Chapter 11 – The Heart. Pages 414-417.
You can check more information on the pathology of
the cardiovascular system from:
www.pathguy.com
& see nice gross & microscopic pathology pictures
on:
http://library.med.utah.edu/WebPath/webpath.html


What are the causes of myocarditis?
What are the causes of different types of
pericarditis & pericardial effusions?
King Abdul Aziz University
51
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 18:
Pressure and flow in systemic circulation
Student Notes:
Department: Physiology
Lecturer:
Prof. Hosam Awad
Prof. Maha Hegazi
By the end of this lecture you will be able to:
1) Describe the factors that affecting arterial blood
pressure
2) Know the mechanism of arterial blood pressure
regulation.
1- List physiologic factors that affect BP e.g.
age, sex, etc…).
2- Describe different regulatory mechanisms for
ABP:
3- Describe Role of kidney in blood volume
regulation: renin-angiotensin system.
As the pressure pulse moves away from the heart,
the systolic pressure rises and the diastolic pressure
fall. There is also a small decline in mean arterial
pressure as the pressure pulse travels down
distributing arteries due to the resistance of the
arteries. Therefore, when arterial pressure is
measured using a sphygmomanometer (i.e., blood
pressure cuff) on the upper arm, the pressure
measurements represent the pressure within the
brachial artery, which will be slightly different than
the pressure measured in the aorta or the pressure
measure in other distributing arteries.
Systemic vascular resistance (SVR) refers to the
resistance to blood flow offered by all of the
systemic vasculature, excluding the pulmonary
vasculature. This is sometimes referred as total
peripheral resistance (TPR).
King Abdul Aziz University
52
(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 18:
Pressure and flow in systemic circulation
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 565 - 568
You have the opportunity to watch the CD-ROM
about the arterial blood pressure. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system but these should not used in
isolation. I would recommend you look at the
following web sites:
http://www.cvphysiology.com/Blood%20Pressure
/BP002.htm
Self-assessment
Briefly answer the following short essay:


What are Korotkoff’s sounds and what
produces them?
What are the main factors that affect the
arterial blood pressure in a normal person?
King Abdul Aziz University
53
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 19:
Predict how CVS will react in common situations: eating a meal,
exercise and changes in posture
Student Notes:
Department: Physiology
Lecturer: Dr. Atef Abood
Dr. Azra keramani
At the end of this lecture you should be able to:
1- Outline the compensatory mechanisms that
maintain blood pressure on rising from the supine to
the standing position.
2- Describe and explain the circulatory changes that
occur during exercise.
3- Outline the main beneficial effects of athletic
training on the cardiovascular system in the body.
4- Describe the cardiovascular changes that accurse
after a heavy meal.
5-Understand the meaning of cardiac reserve, wok
metabolism and the O2 consumption by the heart.
1. Define cardiac reserve, and discuss its
parameters and limitations.
2. Discuss cardiac metabolism, and compare it
to the skeletal muscle metabolism.
3. Define mechanical efficiency of the heart.
4. Define cardiac work and discuss O2
consumption by the heart.
5. Discuss the changes in the heart rate, stroke
volume, peripheral vascular resistance and
arterial blood pressure that take place during
eating, exercise, and postural changes
.
Exercise is associated with very extensive alterations
in the circulatory and respiratory systems. For
convenience the circulatory adjustments are
considered in this lecture. However, It should be
emphasized that they occur together in integrated
fashion as part of the homeostatic responses that
make moderate to severe exercise possible.
King Abdul Aziz University
54
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 19:
Predict how CVS will react in common situations: eating a meal,
exercise and changes in posture
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 609 - 611
You have the opportunity to watch the CD-ROM
about the Cardiovascular response to exercise. You
can access the CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – Cardiovascular system, exercise
–in the search engine google (www.google.com).
The aim is to be able to use the search engine and
also to recognize the rich resources in the web.

http://www. Google.com
Self-assessment
Briefly answer the following short essay:


Describe the main changes in cardiovascular
system during exercise.
Why do people faint when rise from supine
to standing position?
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
55
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 20:Special circulations:
Coronary , Pulmonary , Cerebral and Skeletal circulation.
Department: Physiology
Lecturer : Dr. Atef Abood
Dr. Azra
Student Notes:
By the end of this lecture you will be able to:
1- Describe the basic principals of coronary
regulation.
2- Know the regulation of the pulmonary circulation.
3- Know the regulation of the cerebral circulation.
4- Know the regulation of the skeletal muscle blood
flow at rest and during exercise.
In this lecture we will describe:
1. The nervous and the mechanical factors
affecting the coronary blood flow.
2. The role of the metabolic factor affecting the
coronary blood flow.
3. The auto-regulation of the cerebral blood
flow.
4. The nerve supply of the skeletal blood
vessels and the skeletal blood flow during
muscular exercise.
5. Compare and contrast between systemic and
pulmonary circulation.
The body is good at diverting blood to where it is
needed. However, some circulations (e.g. cerebral
and renal) are special in that their blood flow is
usually preserved at the expense of others.
King Abdul Aziz University
56
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue Lecture 20: Special circulations:
Coronary , Pulmonary , Cerebral and Skeletal circulation.
Student Notes:
.
Ganong, Review of Medical
Physiology, 20th edition,
page: 588 - 606
You have the opportunity to watch the CD-ROM
about the Coronary, cerebral, skeletal and
pulmonary circulation You can access the CD-ROM
during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “Circulation for special
regions” –in the search engine google
(www.google.com).

http://www.Google.com
Self-assessment
Briefly answer the following in a short essay:

What is reactive hyperaemia? Where dose it
occur?
Answer MCQs (1- 16) in Ganong, Review of
Medical Physiology, 20th edition, page: 765
King Abdul Aziz University
57
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 21:
Atherosclerosis and Aneurysm
Student Notes:
Department: Pathology
Lecturer: Dr. Ali Sawan & Dr. Sawsan Jalalah
At the end of this lecture you will be able to:
1) Outline the epidemiology, major and minor risk
factors implicated in atherosclerosis.
2) Describe the hypothesis to explain the
pathogenesis of atherosclerosis.
3) Outline the morphology of atherosclerosis.
4) Describe the complications of atherosclerosis.
5) Describe the clinical problems of atherosclerosis
as related to the pathological findings.
6) Describe causes of aneurysms.
7) Explain pathogenesis of AAAs.
The lecture will cover the following topics:
1) The importance of atherosclerosis is obvious
from knowledge of its epidemiology of
atherosclerosis and incidence in various
countries.
2) The role of risk factors (major and minor) in
the pathogenesis of atherosclerosis.
3) The detailed pathogenesis of atheroma
formation.
4) The morphology of atheroma.
5) Definition of aneurysm and mechanism of its
most common causes.
Hyperlipidemia (LDL) must be remembered as
controllable causes of coronary heart disease,
especially in the young.
King Abdul Aziz University
58
(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 21: Atherosclerosis and Aneurysm
Student Notes:
.
Robbins Basic Pathology 8 th edition
Chapter 10; Pages: 343-352
You can check more information on the pathology of
the cardiovascular system from:
www.pathguy.com
& see nice gross & microscopic pathology pictures
on:
http://library.med.utah.edu/WebPath/webpath.html
Self-assessment
Describe the acute plaque changes.
Describe the complications that may occur as a
result of these changes.
King Abdul Aziz University
59
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 22:
Ischemic heart Disease
Student Notes:
Department: Pathology
Lecturer : Dr. Ibrahim Alzahrani & Sawsan Jalalah
.
At the end of this lecture you will be able to:
1) Evaluate the epidemiology and pathogenesis of the
ischemic heart diseases.
2) Differentiate between the various types of angina.
3) Explain the pathogenesis of myocardial infarction.
4) Explain the morphology of myocardial infarction.
5) Correlate the complications of MI with the tissue
pathology.
6) Explain chronic ischemic heart diseases and sudden
cardiac death.
The lecture will cover the following topics:
1) types of Ischemic heart disease (IHD)
2) causes and pathogenesis of IHD
3) types of angina pectoris
4) myocardial infarction: pathogensis, location,
size, morphology and complications.
5) pathogensis of chronic ischemic heart diseases.
6) Causes of sudden cardiac death.
Unstable angina should be considered a medical
emergency since it has a high mortality and it may
rapidly lead to myocardial infarction. Rapid access to
treatment will prevent this.
King Abdul Aziz University
60
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 22:
Ischemic heart Disease
Robbins Basic Pathology 8 th edition
Chapter 11; Pages: 388-398.
You can check more information on the pathology of
the cardiovascular system from:
www.pathguy.com
& see nice gross & microscopic pathology pictures
on:
http://library.med.utah.edu/WebPath/webpath.html
Self-assessment
What are the complications of myocardial
infarction?
Which of these is considered a late complication?
King Abdul Aziz University
61
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 23:
Antihypertensive drugs
Student Notes:
Department: Pharmacology
Lecturer:Prof. Abdel- Moneim Osman
Magda Hagras
- Dr.
At the end of this lecture you will be able to:
1) Outline antihypertensive drugs
2)
Outline drugs which can be used for treatment
of angina
3) Describe drugs used in treatment of heart failure
 Beta-blockers - decrease HR, contraction & renin;
bradycardia, increased lipids, (bronchoconstriction)
 ACE inhibitors - suppress formation of angiotensin II,
vasodilatations; cough, dysguesia, depress renal
function
 Ca2+antagonists - block Ca channels of the heart,
dilate arterioles & veins modestly; oedema &
constipation
 alpha1-antagonists - vasodilatations; ortho
hypotension, syncope, tachycardia, syncope
 vasodilators - decrease peripheral resistance
against which the heart must pump; arteriolar,
veno-, combined acting vasodilators, +diuretic
(ACE inhibitors)
 diuretics - removal of retained salt & water,
reduce blood volume, diminished venous
congestion (thiazides & loop), rapid relief, Ksparing to protect against digitalis-induced
arrhythmias
 inotropic agents (digoxin) - increase contractility
of failing heart (without elevating oxygen
requirement), reverses all CHF manifestations,
inhibition of Na-K activated ATP pump, increase
intracellular calcium = increase force of
contraction, electrical effects, aglycone+sugars,
from foxglove, nursing implications
King Abdul Aziz University
62
(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 23:
Antihypertensive drugs
Student Notes:
D. R. Laurance & P. N. Bennett, Clinical
pharmacology, PP. 407 – 433.
Katsung, Basic and Clinical
Pharmacology, Chapter 11
You have the opportunity to watch the CD-ROM
about the treatment of hypertension. You can access
the CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – Cardiovascular system, drugs –
in the search engine google (www.google.com). The
aim is to be able to use the search engine and also to
recognize the rich resources in the web.

http://www. Google.com
Self-assessment
Briefly answer the following short essay:


Write short essay about anti-hypertensive
drugs
Write short account about the treatment of
heart failure
King Abdul Aziz University
63
Faculty of Medicine and Allied Sciences
.
Phase 2
Lecture 24:
Cardiovascular Module
Year 2
Tissue fluid formation and Edema
Department: Physiology
Lecturer : Dr. Atef Abood
Dr. Azra
Student Notes:
By the end of this lecture you will be able to:
1- Understand the forces that cause tissue fluid
formation.
2- Describe the factors affecting lymph flow.
3- Describe the disturbances that cause tissue fluid
accumulation and edema.
In this lecture we will describe:
1- The starling forces that cause tissue fluid
formation.
2- The role of the capillary pressure and the
colloidal osmotic pressure of plasma
proteins in the formation of the tissue fluid.
3- The role of the lymphatic obstruction as a
cause of edema
4- The role of increased venous pressure in
formation of edema.
5- Edema, its types, and its mechanism.
Hypo-proteinemia as in liver and renal diseases,
increased venous pressure as in heart failure and the
lymphatic obstruction as in Filariasis are causes of
edema.
King Abdul Aziz University
64
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Continue Lecture 24:
Year 2
Tissue fluid formation and Edema
Student Notes:
Ganong, Review of Medical
Physiology, 20th edition,
page: 588 - 606
You have the opportunity to watch the CD-ROM
about the lymphatic circulation You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “Lymph, Tissue fluid formation,
and Edema” –in the search engine google
(www.google.com).

http://www.Google.com
Self-assessment
Briefly answer the following in a short essay:

Define edema, describe its causes.
Answer MCQs (1- 16) in Ganong, Review of
Medical Physiology, 20th edition, page: 765
King Abdul Aziz University
65
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 25:
Valvular Heart Diseases
Department: Pathology
Student Notes:
Lecturer: Dr. Taha Moatamad & Dr. Rana Bokhary
At the end of the lecture you should be able to:
Describe the pathogenesis, morphology & clinical
features of:
1.
2.
3.
4.
Rheumatic valvular disease.
Calcific aortic stenosis.
Myxomatous mitral valve.
Prosthetic cardiac valves.
The lecture will cover the following topics:

1.
2.
3.
4.
5.
Major causes of valvular heart disease
"congenital & acquired" with special attention
to:
Definition, epidemiology, & pathogenesis of
rheumatic fever.
Morphology, outcomes & clinical features of
acute rheumatic heart disease (RHD) & chronic
valvular deformities.
Pathogenesis, morphology & clinical features of
calcific aortic stenosis.
Epidemiology, pathogenesis, morphology,
clinical features & complications of myxomatous
cardiac valve.
Types & complications of prosthetic cardiac
valves.
King Abdul Aziz University
66
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Continue .... Lecture 25:
Valvular Heart Diseases
Robbins Basic Pathology, 8th edition.
Chapter 11 – The Heart. Pages 400-406 & 409.
You can check more information on the pathology of the
cardiovascular system from:
www.pathguy.com
& see nice gross & microscopic pathology pictures on:
http://library.med.utah.edu/WebPath/webpath.html



What is the clinical significance of rheumatic
fever?
What is the difference between acute rheumatic
heart disease & chronic valvular deformities?
What is the most important complication of
deformed & prosthetic valves?
(Insert here handouts and
additional pages for notes if
needed)
King Abdul Aziz University
67
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 26:
Infective Endocarditis.
Department: Pathology
Student Notes:
Lecturer:Dr. Taha Moatamad &Dr. Rana
Bokhary
At the end of the lecture you should be able to:
Describe the pathogenesis, morphology &
clinical features of:
4. Infective endocarditis.
5. Nan-bacterial thrombotic endocarditis
(NBTE).
6. Myocarditis.
7. Pericarditis.
8. Pericardial effusions.
The lecture will cover the following topics:
3. Clinical classification, pathogenesis, high
risk groups, causative organisms,
morphology, clinical features &
complications of infective endocarditis.
4. Etiology, pathogenesis, complications &
clinical features of non-bacterial thrombotic
endocarditis (NBTE) & Libman-Sacks
endocarditis.
5. Causes, morphology & clinical features of
myocarditis.
6. Causes, morphology, clinical features &
outcomes of pericarditis & pericardial
effusions.
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
68
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue Lecture 26: Infective Endocarditis, Myocardial &
Pericardial Diseases
Student Notes:
Robbins Basic Pathology, 8th edition.
Chapter 11 – The Heart. Pages 406-408 & 414-417.
You can check more information on the pathology of
the cardiovascular system from:
www.pathguy.com
& see nice gross & microscopic pathology pictures
on:
http://library.med.utah.edu/WebPath/webpath.html




What is the difference between acute &
subacute infective endocarditis?
What are the different types of valvular
vegetations?
What are the causes of myocarditis?
What are the causes of different types of
pericarditis & pericardial effusions?
King Abdul Aziz University
69
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 27:
Hypertension and Effects on Blood Vessels and Heart
Student Notes:
Department: Pathology.
Lecturer: Dr. Taha Moatamad & Dr. Sawsan Jalalah
At the end of this lecture you will be able to:
1) Describe the difference between the types of
systemic hypertension.
2) Explain the pathogenesis of systemic
hypertension.
3) Differentiate between the types of hypertensive
arteriolosclerosis.
4) Describe effects of systemic hypertension on the
heart.
5) Define cor pulmonale and list its causes.
The lecture will cover the following topics:
1) definition and classification of hypertension
2) pathogenesis of hypertension
3) effect of hypertension on blood vessels
4) hypertensive heart disease
5) definition and causesof cor pulmonale.
90% to 95% of hypertension is idiopathic.
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
70
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue. Lecture 27: Hypertension and Effects on Blood Vessels and Heart
Student Notes:
Robbins Basic Pathology 8 th edition
Chapter 10; Pages: 353-357 & Chapter 11 Pages
398-400
You can check more information on the pathology of
the cardiovascular system from:
www.pathguy.com
& see nice gross & microscopic pathology pictures
on:
http://library.med.utah.edu/WebPath/webpath.html
Self-assessment
You have seen a patient in emergency room
suffers from severe headaches; his BP was
220/120.


What is your diagnosis?
What are the types of arteriolar changes can
be seen in blood vessels due to this type of
hypertension.
King Abdul Aziz University
71
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 28: Vasculitis & Cardiovascular Tumors
Student Notes:
Department: Pathology.
Lecturer: Dr. Ali Sawan & Dr. Rana Bokhary
At the end of the lecture you should be able to:
1. Classify vasculitis & describe the
pathogenesis, morphology & clinical
features of giant-cell (temporal) arteritis
2. Classify vascular tumors & describe the
morphology & clinical features of
hemangioma, glomus tumor, Kaposi
sarcoma, epithelioid hemangioendothelioma
& angiosarcoma.
3. Classify cardiac tumors, describe the
morphology & clinical features of myxoma,
as well as enumerate primary origins of
metastatic cardiac tumors.
The lecture will cover the following topics:
1. Classification of vasculitis &
subclassification of immune-mediated
vasculitis.
2. Pathogenesis, morphology & clinical
features of giant-cell (temporal) arteritis.
3. Classification of vascular tumors into
benign, intermediate & malignant
neoplasms.
4. Pathogenesis, morphology & clinical
features of different vascular tumors
covering the different variants of
hemangioma & Kaposi sarcoma.
5. Classification of cardiac tumors with special
attention to primary sources of metastatic
tumors as well as morphology, & clinical
effects of myxoma.
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
72
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue Lecture 28:Vasculitis & Cardiovascular Tumors
Student Notes:
Robbins Basic Pathology, 8th edition.
Chapter 10 – The Blood Vessels. Pages 362-364 &
371-377.
Chapter 11 – The Heart. Pages 417-418.
You can check more information on the pathology of
the cardiovascular system from:
www.pathguy.com
& see nice gross & microscopic pathology pictures
on:
http://library.med.utah.edu/WebPath/webpath.html






Classify vasculitis.
Classify immune-mediated vasculitis.
Classify vascular tumors.
What are the variants of Kaposi sarcoma?
Classify cardiac tumors.
What is the most common primary origin of
metastatic cardiac tumors & in which layer of
the heart it tends to involve more?
King Abdul Aziz University
73
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 29:
Anti-anginal drugs
Student Notes:
Department: Pharmacology
Lecturer: Prof. Abdel-Moneim Osman Dr. Magda Hagras
At the end of this lecture,student will be able to
1-Outline antianginal drugs
2- Know the mechanism of action of antianginal
drugs
3- know the Side effects of the antianginal drugs
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
74
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 29:
Anti-anginal drugs
Student Notes:
D.R. Laurance & P.N. Bennet, Clinical
pharmacology. Pages: 205 -216.
You have the opportunity to watch the CD-ROM
about the antianginal drugs. You can access the CDROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “antianginal drugs –in the
search engine google (www.google.com).

http://www. Google.com
Self-assessment
Write short essay on the mechanism of action of the
antianginal drugs .
King Abdul Aziz University
75
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 30:
Anti-arrhythmic drugs
Student Notes:
Department: Pharmacology
Lecturer: Prof. Abdel-Moneim Osman - Dr.
Magda Hagras
At the end of the lecture you should be able to:
1) Describe the mechanism of action of the antiarrhythmic agents in the Vaughan-William
classification.
2) Explain the pharmacological properties of these
drugs.
3) Relate the type of drug to be used for the type of
arrhythmia.
4) Describe the various effects of digitalis on the
heart.
Anti-arrhythmic drugs are classified according to the
Vaugham-William Classification. The four major
classes (and some subdivisions) will be discussed,
together with their action on the heart muscle. And
examples of typical drugs in each category. In
addition, a few other drugs which are often used in
treating cardiac arrhythmias such as Digoxin will be
discussed.
The aims of antiarrhythmic drugs are:
 To decrease cell excitability
 To increase the refractory period

To slow conduction or block conduction if
already slow.
King Abdul Aziz University
76
(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 30:
Anti-arrhythmic drugs
Student Notes:
D.R. Laurance & P.N. Bennet, Clinical
pharmacology. Pages: 205 -216.
You have the opportunity to watch the CD-ROM
about the Anti-arrhythmic drugs. You can access the
CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “anti-arrhythmic drugs –in the
search engine google (www.google.com).

http://www. Google.com
Self-assessment
Write short essay on the mechanism of action of the
anti-arrhythmic agents in the Vaughan-William
classification.
King Abdul Aziz University
77
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 31:
Hyperlipoproteinamias and hypolipoproteinaemias
Student Notes:
Department: Biochemistry
Lecturer: Prof. Mohd Ali Ajab Noor - Dr.
Enayat Hashem
At the end of this lecture you will be able to:
1) Recognise the six different types of hyperlipoproteinamia and understand their relationship to
arthrosclerosis and coronary disease.
2) Give examples of both genetic and acquired
factors that lead to hyperlipoproteinaemias
3) Give examples of hypolipoproteinaemias and
their clinical significance.
The WHO (Freidrickson) classification of hyperlipoproteinaemias will be described and discussed. The
genetic and/or acquired factors responsible for the
different hyperlipoprotienaemias will be described
and their clinical significance will be discussed.
Some hypolipo-proteinaemias will also be described
and discussed.
Hyperlipidaemia must be remembered as a
controllable cause of coronary heart disease,
especially in the young.
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
78
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 31:
Hyperlipoproteinamias and hypolipoproteinaemias
Student Notes:
Rubin & Farber, Essential pathology,
end edition. Pages 287 -294.
You have the opportunity to watch the CD-ROM
about the Hyperlipoproteinamias and
hypolipoproteinaemias. You can access the CDROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “Hyperlipoproteinamias and
hypolipoproteinaemias” –in the search engine google
(www.google.com).

http://www. Google.com
Self-assessment
What treatment would you prescribe
to lower plasma cholesterol?
Why is reduced cholesterol intake
important?
Discuss the relation of cholesterol to
low-density lipoproteins and high
density lipoprotein.
King Abdul Aziz University
79
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 32:
Diagnostic cardiac enzymology
Student Notes:
Department: Biochemistry
Lecturer Prof. Mohd Ajab Noor – Dr. Enayat
Hashem
At the end of this lecture you will be able to:
1) Evaluate the diagnostic value of the cardiac
enzymes
2) Determine the use of CK-MB in the diagnosis of
myocardial infarction.
3) Summarise the newer enzymes for the early
diagnosis of MI
4) Outline cardiac injury and the use of cardiac
markers in the diagnosis of the new syndromes
of cardiac injury.
The practical use of the traditional enzymes in the
diagnosis of MI in a clinical setting will be
discussed. The pitfalls of CK-MB as the gold
standard will also be addressed.
Modern understanding of myocardial ischemia has
resulted in new clinical syndromes. How the latest
biochemical markers (CK isoforms, troponins,
Myoglobin) help to make a diagnosis of these
syndromes (which change the treatment and
prognosis of ischemic heart disease) will be outlined.
Testing for the proteins specifically
released from cardiac tissues can be a useful aid in
confirming myocardial infarction.
King Abdul Aziz University
80
(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 32:
Diagnostic cardiac enzymology
Fagan, cardiovascular system,
Physiology, 2nd edition,
page: 152 - 153
You have the opportunity to watch the CD-ROM
about the Diagnostic cardiac enzymology. You can
access the CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “Diagnostic cardiac
enzymology” –in the search engine google
(www.google.com).
• http://www. Google.com
Self-assessment
Draw a curve to show the levels of classic cardiac
enzymes after myocardial infarction.
King Abdul Aziz University
81
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Lecture 33:
Drugs used in heart failure
Student Notes:
Department: Pharmacology
Lecturer Dr. Osman Hasan – Dr. Mai Abdel
Aleim
At the end of this lecture you will be able to:
1) Describe the mode of action of each of the main
groups of drugs used in the treatment of heart
failure.
2) Determine in what type of institution some of
these drugs might be contra-indicated.
3) Have some knowledge of their side effects.
The therapeutic agents that can be used in the
treatment of congestive heart failure include
diuretics, positive inotropic agents, vasodilators,
ACE inhibitors, and sympathomimetic agents.
Students should understand the mechanism of each
of these types of drugs and a typical example of each
group together with some of the major side-effects.
Heart failure is not a diagnosis. You must always
identify the underlying pathology that is responsible.
King Abdul Aziz University
82
(Insert here handouts and additional
pages for notes if needed)
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Continue … Lecture 33:
Drugs used in heart failure
Student Notes:
D. R. Laurance & P. N. Bennett,
Clinical pharmacology, PP. 407 –
433.
Katsung, Basic and Clinical
Pharmacology, Chapter 11
You have the opportunity to watch the CD-ROM
about the treatment of heart failure. You can access
the CD-ROM during your spare time.
In the computer cluster also you have the
opportunity to see some useful web site about the
cardiovascular system. I would recommend you to
use the key words – “Drugs & heart failure” –in the
search engine google (www.google.com).
• http://www. Google.com
Self-assessment
You have been called to see a 56 year old
patient with severe dyspnoea. After history and
examination you diagnose heart failure.


What drug treatment would you administer
at this time and how would you give it?
What are the indication, contra indications
and cautions of such treatment?
King Abdul Aziz University
83
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 34:
Cardiovascular Investigations
Student Notes:
Department: Medicine
Lecturer :Dr. Aisha Siddiqui/ Dr. Layth
mimash
Learning Objectives:
At the end of the lecture, the student should
be able to recognize the investigational
note of:
1. ECG at rest.
2. Stress ECG.
3. CXR.
4. MRI / CT.
5. Echocardiography.
6. Angiograpy (Cardiac
cathetarization).
7. Nuclear scan (Thalium scan..etc.)
Not to over lookthe importance of
cardiac enzymes such as Troponin …
etc.
Suggested references:
1. Davidson's Principles & Practice of
Medicine.
2. Crush Module of Cardiovascular
Diseas
(Insert here handouts and additional
pages for notes if needed)
King Abdul Aziz University
84
Faculty of Medicine and Allied Sciences
.
Phase 2
Cardiovascular Module
Year 2
Lecture 35:
Cardiovascular causes of chest pain
Student Notes:
Department: Medicine
Lecturer :Dr. Aisha Siddiqui/ Dr. Layth
mimash
Suggested references:
1. Davidson's Principles & Practice of
Medicine.
2. Crush Module of Cardiovascular
Disease.
Learning Objectives:
1. Provide a differential diagnosis of
acute chest pain.
2. Differentiate chest pain due to cardiac
disease.
3. Differentiate ischaemic cardiac pain
from non ischaemic cardiac pain.
4. Differentiate pain due to angina from
pain due to myocardial infarction.
5. Outline the principals of managment
of acute myocardial infarction &
complications.
King Abdul Aziz University
85
Faculty of Medicine and Allied Sciences
.
Phase 2
King Abdul Aziz University
Cardiovascular Module
86
Year 2
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Practical
King Abdul Aziz University
87
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Department of Anatomy
Practical (1)
Middle mediastinum, heart in situ
Demonstrator: The staff members
Learning OBJECTIVES:
At the end of this practical lesson, student should be able to:

List the subdivisions of the mediastinum and their components.

Develop clear concept on the anatomy of the pericardium.
Detailed Contents:
1- Mediastinum: position, divisions, components and relations.
2- Pericardium: types, layers, sinuses, blood and nerve supply.
READING:
Suggested textbooks and other references:

Richard S. Snell: Clinical Anatomy of Medical Students, 7th edition, Lippincott,
William and Wilkins.

Grant J. C.B.: Grant Anatomy, 10th edition, Lippincott, William and Wilkins.

Practical notes in the department of Anatomy web site and its attached links:
www.kauanatomy.com
King Abdul Aziz University
88
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Department: Physiology
Practical 2:
Heart sounds – prediction of timing of uncomplicated
murmurs
TUTOR: Dr. Al-hazimi – Dr. Maha Hegazi
Department: Physiology
SUMMARY:
The stethoscope has two ends, the bell and the diaphragm. The diaphragm is better for
listening to higher pitched sounds; therefore, it is best for hearing:

first and second heart sounds

systolic murmur

aortic incompetence
The bell of the stethoscope is best for low-pitched sounds e.g third and fourth heart
sounds.
Many sounds can be heard with stethoscope. Try to concentrate on hearing the heart
sounds first.
At the end of this session you will be able to:

Describe the principle that creates the heart sounds

Where on the chest wall can you best hear which sounds and why?

Understand the genesis of murmurs.

Classify the four most important valvular lesions and their corresponding
murmurs.

Draw, on a graph, the classic pattern of murmur in the case of mitral stenosis,
mitral regulation, aortic stenosis, and aortic regulation.
Ganong, Review of Medical Physiology, 20th edition, page: 547 - 549
You have the opportunity to watch the CD-ROM about “heart sounds” you
can access the CD-ROM during your spare time. The computer cluster is
in the 2nd floor of the medical library, building No. 7.
King Abdul Aziz University
89
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Department of Anatomy
Practical (3)
External features of the heart and coronary
vessels
Demonstrator: The staff members
Learning OBJECTIVES:
At the end of this practical lesson, student should be able to:

Recognize and identify the external features of the heart

Identify the coronary arteries and coronary sinus
Detailed Contents:
1- Surfaces and borders of the heart
2- Grooves on the surfaces of the heart and their contents
3- Coronary arteries (origin and branches)
4- Coronary sinus (site, termination and tributaries)
READING:
Suggested textbooks and other references:

Richard S. Snell: Clinical Anatomy of Medical Students, 7th edition, Lippincott,
William and Wilkins.

Grant J. C.B.: Grant Anatomy, 10th edition, Lippincott, William and Wilkins.

Eroschenko V.P. Di Fiore’s: Atlas of histology with functional correlations. 9th
edition. Lippincott, William and Wilkins.

Practical notes in the department of Anatomy web site and its attached links:
www.kauanatomy.com
King Abdul Aziz University
90
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Department of Anatomy
Practical (4)
Internal features of the heart
Demonstrator: The staff members
Learning OBJECTIVES:
At the end of this practical lesson, student should be able to:
 Demonstrate the significance of a knowledge and understanding of the great
vessels in the superior mediastinum and their surface marking.
 Understand the position of the cardiac chambers and their appearance of the chest
radiograph.
 Understand the different methods of the cardiovascular imaging (ultrasonography.
Computer topography, and Magnetic image resonance
 Understand the different radiographic procedures (Plain-X- ray chest,
arteriography, venography and Doppler).
Detailed Contents:
1- Heart: position, size and appearance.
2- Chambers of the heart and their sizes.
3- Features of the cavity of different chambers of the heart
READING:
Suggested textbooks and other references:

Richard S. Snell: Clinical Anatomy of Medical Students, 7th edition, Lippincott,
William and Wilkins.

Grant J. C.B.: Grant Anatomy, 10th edition, Lippincott, William and Wilkins.

Stimac,: Diagnosis Imaging.

Practical notes in the department of Anatomy web site and its attached links:
www.kauanatomy.com
King Abdul Aziz University
91
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Department: Physiology
Practical 5:
ECG Recording
TUTOR: Prof Hosam Awad – Prof. Maha Hegazi
SUMMARY:
In student volunteers, students will locate, and connect the four limb electrodes to the
volunteer. A recording will be made of each student at rest.
The recording will be analysed by the students, and the following values will be
measured: PQ interval, QRS duration, QT-interval, heart rate and the mean QRS vector.
OBJECTIVES:

To be familiar with recording an ECG

To analyse an ECG.

To determine the heart rate, several intervals and mean electrical axis.
READING:

Fagan, cardiovascular system,
Physiology, 2nd edition,
page: 143 -154
King Abdul Aziz University
92
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Department: Biochemistry
Practical 6:
Determination of lipoproteins/plasma lipids
TUTOR: Prof. Mohd Ali Ajab Noor - Dr. Enayat Hashem……
SUMMARY:
An introduction will be given to laboratory methods for the assessment of plasma lipids
and lipoproteins of patients. The following practical tasks will be set: (a) Visual
inspection of normal and pathological (hyperlipoproteinaemic) plasma specimens and
relation of the findings to the Fredrickson Classification. (b) Separation of normal and
pathological lipoproteins by electrophoresis on agarose gel. N.B: staining, destaining and
densitometric scanning of replicate electropherograms will be done for you. The practical
will be concluded with a general discussion of the findings and their clinical importance.
OBJECTIVES:
At the end of this practical session you will be able to:
1) Recognise the role of the biochemistry laboratory in the assessment of the patient’s
plasma lipid and lipoprotein status.
2) Recognise that valid results for patient lipid and lipoprotein status require that fasting
blood samples be tested.
3) Interpret the results of plasma lipid and lipoprotein investigations and to relate them
to the health care needs of the patient.
READING:

Practical Manual of Biochemistry Lab (See the technician in Biochemistry Lab)
King Abdul Aziz University
93
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Practical 7:
Atherosclerosis
TUTOR: Dr. Ali Sawan
& Dr. Sawsan Jalalah…
Department: Pathology
SUMMARY:
The gross and microscopic morphology of atherosclerosis will be discussed and
illustrated using gross specimen, digital images and microspic slides.
OBJECTIVES:
At the end of the session you should be able to:
1) Compare and contrast fibrofatty atheromas and fatty streaks.
2) Identify and describe the components of atheromas.
3) Describe the complications that occur in atheromas.
READING:
Robbins Basic Pathology 8 th edition
Chapter 10; Pages: 348-351

King Abdul Aziz University
94
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Department: Biochemistry
Practical 8:
Cardiac enzymes and proteins
TUTOR: Prof. Mohd Ali Ajab Noor – Dr. Enayat Hashem
SUMMARY:
The practical use of the traditional enzymes in the diagnosis of MI in a clinical setting
will be discussed. The pitfalls of CK-MB as the gold standard will also be addressed.
Modern understanding of myocardial ischemia has resulted in new clinical syndromes.
How the latest biochemical markers (CK isoforms, troponins, myoglobin) help to make a
diagnosis of these syndromes will be outlined.
At the end of this session you will be able to:

Evaluate the diagnostic value of the cardiac enzymes.

Determine the use of CK-MB in the diagnosis of myocardial infarction.

Summarize the newer enzymes for the early diagnosis of the new syndromes of
cardiac injury.

Rubin & Farber, Essential Pathology, 2nd edition. Page 249 - 260
King Abdul Aziz University
95
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Practical 9:
Myocardia Infarction/ Valvular Heart Diseases
Department: Pathology
TUTOR: Dr. Ibrahim Alzahrani,
Taha Moatamad,
Dr. Sawsan Jalalah
Dr. Rana Bokhary
SUMMARY:

The morphology of myocardial infarction (gross and microscopic) will be
discussed in different time durations after coronary artery occlusion.

The morphology of rheumatic valvular disease (acute and chronic).

The morphology of valvular changes in cases of infective endocarditis.
At the end of the session you should be able to:
1) Analyse the histological features of myocardial infarction.
2) Explain the chronology of MI pathology.
3) Differentiate between vegetations of rheumatic fever and infective endocarditis.
4) Describe the valvular changes in chronic rheumatic heart disease.
Robbins Basic Pathology 8 th edition
 Chapter 11; Pages: 391-394 & 403-405
King Abdul Aziz University
96
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Department: Pharmacology
Practical # 10:
Effects of Drugs on Isolated Mammalian Heart
Tutor: Prof. Abdel Moneim M. Osman
Dr. Hoda Alkarby
Summary:
This session describes different types of drugs affecting heart rate or force of
contraction (either stimulant or depressant).
It will show different types of receptors & the site of action of stimulatory or
inhibitory drugs.
References:
Pharmacological Experimentson Isolated Preparations. By the Staff of the Dep.
of Pharmacology, University of Edinburgh. E& S Livingstone LTD pp 104-111
King Abdul Aziz University
97
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Tutorial
Department of Anatomy
Tutorial (1):
Anatomy of the Heart and Coronary vessels.
Tutor: Staff members
Learning Objectives:
At the end of this practical lesson, student should be able to:
1. Structure of the heart and big vessels.
2. Relations of the heart and big vessels to the surroundings.
3. Development of the Heart and big vessels.
4. Fetal circulation and Common congenital heart diseases.
Detailed Contents:
 Pericardium (shape, layers, sinuses, nerve and blood supply).
 Heart (shape, surfaces, borders, external features, surface anatomy,
chambers, valves, conducting system, blood supply and nerve supply).
 Big vessels (Aorta, Pulmonary trunk, Superior and Inferior venae vcavae).
 Some important relations of the heart and big vessels to the surrounding
structures.
 Development of the heart and big vessels (phases, sinus venosus, cardiac
septa, conducting system, difference between fetal and adult circulations,
Congenital malformations, Histological difference between skeletal and
cardiac muscles).
Suggested Textbooks and Other Reverences:
 Richard S. Snell. Clinical Anatomy for Medical Students, 7th edition, Lippincott,
Williams and Wilkins.
 Grant J.C.B. Grant's Atlas of Anatomy. 10th edition. Lippincott, Williams and
Wilkins.
 Stimac, Diagnostic Imaging.
 Practical notes in the Department of Anatomy Web Site and its attached links:
 www.kauanatomy.com
King Abdul Aziz University
98
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Tutorial:
Atherosclerosis /MyocardiacInfarction/ Valvular Heart Diseases/
Hypertension
Department: Pathology
TUTOR: Dr. Ibrahim Alzahrani,
Ali Sawan,
Taha Moatamad,
Dr. Sawsan Jalalah
Dr. Rana Bokhary
SUMMARY:

Discuss problems, questions, or mini cases provided by the tutor or suggested by
the students.

Small group and/or general discussion is encouraged between students.
At the end of the session you should be able to:
1) Discuss topics covered in the module lectures and practical.
2) Analyze the cases in view of the knowledge gained during the course.
Robbins Basic Pathology 8 th edition
 Chapter 10 & 11
King Abdul Aziz University
99
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Independent learning
“Independent learning is a very essential skill for tomorrow’s doctors. We
will train you to gain this important skill by asking you to read
independently about specific topics in cardiovascular system”
Study Histology of blood vessels and
Relate structure to function in the circulation
You may use the following objectives as guidelines:

describe the histological structure of different blood vessels

recognise specific cell types for the different tissues as well as those common to
many tissues.

relate the structure to function in all types of blood vessels.

Ganong, Review of Medical Physiology, 20th edition, page: 556 – 559

Wheather’s Functional Histology (3rd ed) pp. 140 - 152
I would recommend you to use the key word – blood vessels &
histology–in the search engine google (www.google.com).

http://www. Google.com
King Abdul Aziz University
100
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Embryology of the heart and great vessels
You may use the following objectives as guidelines:

describe the process of angiogenesis

list the part of the primitive heart

describe the basic plan of early embryonic circulation

describe the process of interatrial septum development

list the embryonic sources of membraneous interventricular septum

describe the development of arch of the aorta, carotid arteries and subclavian
arteries

Sadler T. W. (ed), Langmans Medical Emberyology, 5th ed, 168 - 194

I would recommend you to use the key words – Embryology of the heart –in the
search engine google (www.google.com).

http://www. Google.com
King Abdul Aziz University
101
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Congenital heart diseases
You may use the following objectives as guidelines:

Classify congenital heart diseases by incidence.

Describe the hemodynamics involved in common congenital heart diseases

Describe the clinical presentation of the common heart diseases

Explain the embryologic basis of Fallot’s tetralogy

Describe the emberyonic basis of patent ductus arteriosus, coarctation of the aorta,
and transposition of great vessels.

Explain the complications of congenital heart diseases

Ganong, Review of Medical Physiology, 20th edition, page: 664

Rubin & Farber, Essential pathology, 2nd edition. PP. 284-291

I would recommend you to use the key words – Congenital Heart Disease–in the
search engine google (www.google.com).

http://www. Google.com
King Abdul Aziz University
102
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Factors affecting tissue perfusion
You may use the following objectives as guidelines:

Define autoregulation and describe its role in physiology

Describe the important factors that affect tissue perfusion.

List the principal vasoregulatory factors secreted by endothelial cells, and describe
the function of each.

Name the main hormones that affect tissue perfusion.

Ganong, Review of Medical Physiology, 20th edition, page: 568 - 573

I would recommend you to use the key word – tissue perfusion, factors–in the
search engine google (www.google.com).

http://www. Google.com
King Abdul Aziz University
103
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
PBL

PBL process
 The clinical scenario

Key information
 Explore the problem
 What you know
 What you need to know
 Identify learning issues
 Self/group study
 Share the knowledge
 Solve the problem
 Give feedback & reflect
King Abdul Aziz University
104
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
 Introduction
During this week you will work through the case of a patient who has a
history of chest pain.
50 year old taxi driver admitted with a two hours history of sever “crushing” central chest pain. He
has 8 children.
He also gives a history of being tired recently and under stress. He has had “indigestion” for some
weeks especially if walking after a heavy meal. His father died of a heart attack aged 48. He takes
no exercise and spends his time at work behind the wheel of his taxi. He smokes 40 cigarettes a day.
He is still in pain. Physical examination shows that he is pale clammy and sweating profusely. He
has tachycardia of 100/min. Blood pressure is 100/70 mmHG. The jugular venous pressure is
elevated to 6 cm. There are no other signs of cardiac failure. The heart sounds are normal.
ECG shows ST elevation in leads II, III, and aVF. The changes are consistent with an acute inferior
myocardial infarction.
The first CK is normal. The cardiothoracic ratio on chest X-ray is normal and the lung field is clear.
The following day the CK has risen to 1800 U/L.
After making good progress, the patient suddenly becomes breathless. On examination, the pulse is
irregularly irregular, the blood pressure is 80/40 mmHg and there is a new pansystolic murmur at
the apex radiating to the axilla. There are wide spread cripitations over both lung fields. The chest
X-ray now shows cardiomegaly with pulmonary congestion most marked around the hila.
Echocardiography shows normal left ventricular function with turbulent Doppler flow in systole
from the left ventricle into the left atrium. ECG shows atrial fibrillation.
The patient makes good progress and has no further complications during his convalescence. He is
due to go home shortly.
He wishes to know what treatment he has received, what he will receive in the weeks a head and
what rehabilitation program he should follow.
Despite an advice to the contrary you find out that he has returned to work a taxi driver six weeks
following his MI.
King Abdul Aziz University
105
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module

Year 2
Aims of the PBL sessions
 Provide differential diagnosis of acute chest pain
 Differentiate chest pain due to cardiac disease from non-cardiac
causes
 Differentiate pain due to angina from pain due to myocardial
infarction
 Describe the principles of management of acute myocardial
infarction
 Describe the principles of management of an acute myocardial
infarction and its complications
 Appreciate the importance of primary and secondary prevention,
including cardiac rehabilitation, of acute myocardial infarction.
 Prerequisite
 You should be able to describe the gross anatomy of the heart with
special reference to the area supplied by each coronary artery.
 You should be able to take a full cardiovascular history including a
risk factor profile
 You should understand the clinical events which are responsible
for each part of the ECG waveform
 You should be familiar with the biochemical markers of
myocardial cell damage.
King Abdul Aziz University
106
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
 Learning opportunity
 Fagan, cardiovascular system,
Physiology, 2nd edition,
page: 121 -140
 Ganong, Review of Medical
Physiology, 20th edition
Try to access CD-ROM series about the CVS. The computer
cluster is in the 2nd floor of the medical library, building No. 7.
I would recommend you to use the key words – chest pain & case
study –in the search engine google (www.google.com). The aim is
to recognize the rich resources in the web.
o http://www. Google.com
King Abdul Aziz University
107
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
 Learning issues
At the end of the first session you will be able identify the learning issues
which related to the above clinical problem. Try to summarize these
learning issues in the table below. We recommend you to learn about
these issues. This will help you to solve the problem in the next session.
Learning issues
 …………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

…………
Notes






……………………………………………………………

King Abdul Aziz University
108
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Key Facts






Causes of chest pain include:






Myocardial infarction
Pulmonary embolus
Aortic dissection
Peumothorax
Herps Zoster
Pericarditis
Arrhythmic complications of myocardial
infarction:
Emergency Care of acute myocardial
infarction:





Active peptic ulceration
CVA in previous six months
Uncontrolled hypertension
Aggressive CPR
Warfrin therapy
Proliferative diabetic retinopathy





IV access
Asprin
Analgesia with opiates
Oxygen if breathless
Thrombolysis if indicated


Ventricular fibrillation
Ventricular tachycardia
Atrial fibrillation
Atrial flutter
First second or third (complete)
degree heart block
Asystole
Electromechanical dissociation
Indications for thrombolysis
Unequivocal acute myocardial infarction
in the absence of contra-indications i.e.
chest pain for more than 12 hours with
ECG showing ST elevation or a new
LBBB.
Secondary prevention of myocardial
infarction:
Risk factors can be divided into those
which are modifiable such as smoking,
hypertension and hypercholesterolaemia
and those which are not modifiable such
as age, sex, ethnic origin, family history,
and past medical history.
Contraindications to thrombolysis:



Suspected aortic dissection
Recent haemorrhage
Major surgery or trauma within
previous two weeks
King Abdul Aziz University
Secondary preventive treatment is
targeted on the modifiable risk factors.
109
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
 Introduction
During this week you will work through the case of a patient who has a
history of heart failure.
A 62-year-old man is transferred to your hospital because of recurrent dyspnoea 5 days
after suffering a large myocardial infarction. On the day of arrival he is free of chest pain
but is still breathing with moderate difficulty.
You obtain a chest radiograph, which confirms increased distended pulmonary vasculature,
septal lines, and an enlarged heart. An echocardiogram shows an enlarged heart and an
ejection fraction of 30% with minimal systolic motion of the anterior and apical portions of
the heart.
The patient is in normal sinus rhythm, with a heart rate of 110. Arterial blood pressure is
96/68, mean 82, respiratory rate 25/min.
On cardiac auscultation you hear a S3 gallop, a S4 gallop, a normal S1 and S2, and a soft
murmur that encompasses systole (holosystolic), and has uniform intensity that is heard at
the apex and radiates to the left axilla. There are fine, late-inspiratory crackles (crepitations)
heard about a third of the way up both lung fields.
Arterial blood gases reveal a PaO2 of 60 mmHg, PaCO2 of 30 mmHg and pH of 7.37
King Abdul Aziz University
110
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module

Year 2
Aims of the PBL sessions
 Provide differential diagnoses of heart failure
 Differentiate dysnoea due to cardiac disease from non-cardiac
causes
 Describe the principles of management of acute heart failure
 Describe the principles of management of an acute myocardial
infarction and its complications
 Appreciate the importance of primary and secondary prevention,
including cardiac rehabilitation, of heart failure.
 Prerequisite
 You should be able to describe the gross anatomy of the heart with
special reference to the area supplied by each coronary artery.
 You should be able to take a full cardiovascular history including a
risk factor profile
 You should be familiar with the nurohumoral regulation of the
cardiovascular system.
 Learning opportunity


Fagan, cardiovascular system,
Physiology, 2nd edition,
page: 121 -140
Ganong, Review of Medical
Physiology, 20th edition
Try to access CD-ROM series about the CVS. The computer cluster is in
the 2nd floor of the medical library, building No. 7.
I would recommend you to use the key words – heart failure & case study –in
the search engine google (www.google.com). The aim is to recognize the rich
resources in the web.
http://www. Google.com
King Abdul Aziz University
111
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
 Learning issues
At the end of the first session you will be able identify the learning issues
which related to the above clinical problem. Try to summarize these
learning issues in the table below. We recommend you to learn about
these issues. This will help you to solve the problem in the next session.
Learning issues
 …………………………………………………………………………

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……
Notes

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




…
King Abdul Aziz University
112
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Key Facts
Mechanical complications of myocardial infarctions include:







Actute left ventricular failure
Cardiogenic shock
Cardiac rupture
Pericardial tamponade
Ventricular aneurysm
Ventricular septal defect
Mitral regulation
Causes of heart failure:






Myocardial dysfunction
Volume overload
Pressure overload
Impaired filling
Arrythmias
High output
King Abdul Aziz University
113
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Introduction
During this week you will work through the case of a patient who has a
history of valvular disease.
You are asked to supervise an exercise stress test on a 65-year-old man. He saw his doctor
last week for exertional chest pain and mild dysnoea. He has had chest discomfort for about
a year, but the increased frequency of angina promoted him to see his doctor. He has chest
pain when he walks more than one block, and if he continues he becomes breathless.
He never has chest pain or dyspnea at rest. He has no ankle swelling, orthopnoea, or
paroxysmal nocrtornal dysnoea. When you examine him before the stress test, his blood
pressure is 120/86, heart rate 82 and regular, jagular venous pressure is 120/86. Heart rate
82 and regular, jugular venous pressure 5 cmH2O, and lungs are clear. His apex beat is
slightly lateral to the midclavicular line and mildly sustained. He has a soft crescendodecrescendo systolic murmur, best heard at the upper right sternal border, radiating to the
carotids and the apex. The carotid pulses are delayed and diminished.
You call the refereeing doctor to discuss the signs and symptoms, cancel the stress test, and
perform an echocardiogram instead.
King Abdul Aziz University
114
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module

Year 2
Aims of the PBL sessions
 Provide a differential diagnosis of dysnoea
 Differentiate dysnoea due to cardiac disease from non-cardiac
causes
 Describe the principles of stress test
 Describe the principles of management valvular dieases
 Appreciate the importance of primary and secondary prevention,
including cardiac rehabilitation, of valvular dieases.
 Prerequisite
 You should be able to describe the gross anatomy of the heart with
special reference to the area supplied by each coronary artery.
 You should be able to take a full cardiovascular history including a
risk factor profile
 You should be familiar with the neurohumoral regulation of the
cardiovascular system.
 Learning opportunity


Fagan, cardiovascular system,
Physiology, 2nd edition,
page: 121 -140
Ganong, Review of Medical
Physiology, 20th edition
Try to access CD-ROM series about the CVS. The computer cluster is in
the 2nd floor of the medical library, building No. 7.
I would recommend you to use the key words – heart failure & case study –in
the search engine google (www.google.com). The aim is to recognize the rich
resources in the web.
http://www. Google.com
King Abdul Aziz University
115
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
 Learning issues
At the end of the first session you will be able identify the learning issues
which related to the above clinical problem. Try to summarize these
learning issues in the table below. We recommend you to learn about
these issues. This will help you to solve the problem in the next session.
Learning issues
 …………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

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………………………………………………………………………
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………………………………………………………………………

………………………………………………………………………

…………
Notes






……………………………………………………………

King Abdul Aziz University
116
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Key Facts
Mechanical complications of myocardial
infarctions include:







Actute left ventricular failure
Cardiogenic shock
Cardiac rupture
Pericardial tamponade
Ventricular aneurysm
Ventricular septal defect
Mitral regulation
Causes of heart failure:






Myocardial dysfunction
Volume overload
Pressure overload
Impaired filling
Arrythmias
High output
King Abdul Aziz University
117
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Introduction
During this week you will work
through the case of a patient who
has a history of shock.
A 27 year old male is involved in a road traffic accident (RTA). He has multiple wounds
and fractures in his leg. He has been transferred to the ER in your hospital. You have been
called to see the patients. You found the patient comatose. On examination his blood
pressure is 80/40 and his heart rate is 120 bpm.

How would you classify this patients' haemodynamic status?

How would you manage this patient?

What is the role of primary and secondary prevention in this case?
King Abdul Aziz University
118
Faculty of Medicine and Allied Sciences
Phase 2
Cardiovascular Module
Year 2
Aims of the PBL sessions
 Provide a differential diagnosis of shock
 Differentiate shock due to cardiac disease from non-cardiac causes
 Describe the effect of shock on the cardiovascular system
 Describe the principles of management shock
 Appreciate the importance of primary and secondary prevention of
shock.
 Prerequisite
 You should be able to describe the gross anatomy of the heart with
special reference to the area supplied by each coronary artery.
 You should be able to take a full cardiovascular history including a
risk factor profile
 You should be familiar with the types and causes of shock.
 Learning opportunity


Fagan, cardiovascular system,
Physiology, 2nd edition,
page: 121 -140
Ganong, Review of Medical
Physiology, 20th edition
Try to access CD-ROM series about the CVS. The computer cluster is in
the 2nd floor of the medical library, building No. 7.
I would recommend you to use the key words – shock & case study –in the
search engine google (www.google.com). The aim is to recognize the rich
resources in the web.
http://www. Google.com
King Abdul Aziz University
119
Faculty of Medicine and Allied Sciences
 Learning issues
At the end of the first session you will be able identify the learning issues
which related to the above clinical problem. Try to summarize these
learning issues in the table below. We recommend you to learn about
these issues. This will help you to solve the problem in the next session.
Learning issues
Notes
 …………………………………………………………………………

………………………………………………………………………

………………………………………………………………………

………………………………………………………………………
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…………
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……………………………………………………………
Phase II
Cardiovascular Module
Key facts
Cardiogenic shock

Acute myocardial infarction

Acute aortic incompetence

Ischaemic mitral regurgitation

LV aneurysm

Myocardial contusion

~ 40% of myocardium damaged leading to Shock
Obstructive shock
Outflow obstruction ->pulmonary embolus
Inflow obstruction -> Cardiac tamponade
Hypovolaemic shock
Exogenous loss from haemorrhage
Endogenous loss -> third space loss & capillary leak syndrome
Distributive shock
A state of relative hypovolaemia (eg. loss blood oncotic pressure).
Impaired distribution and oxygen utilisation.
121
Faculty of Medicine