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Date Course Title Echocardiography Pathology II/Advance Studies with Lab Pre-requisite (s) HSC 1000, BSC 1085/ BSC 1085L, ENC 1101, PHY 2053, DMS 1020, MAC 1105, BSC 2085/ BSC 2085L, PSY 1012, SPC 1017, STA 2003, DMS 1030, EKG 1010, CPR 1010, HAE 1000, ECH 1020, ECH 1040, DMS 1050, DMS 2060 Hours 105 theory hours/30 Lab hours (135 clock hours) Note: Subject to change Credits Course Number 8 Credits ECH 2030 Co-requisite (s) None Place and Time of Class Meeting International College of Health Sciences 2300 South Congress Ave, Suite 105 Boynton Beach, Florida 33426 Name and Contact Information of Instructor Instructor: Juan Carlos Zamora CCT, RCS, RDCS, RVT E-mail: [email protected] Office Hours: 9.00 am to 5.00 pm Campus Telephone: 561-202-6333 Delivery Method: On Campus Books required Textbook of Clinical Echocardiography: 5th Edition, Catherine M. Otto MD The Echocardiographer’s Pocket Reference 4th Edition, Terry Reynolds, BS, RDCS Attendance Policy Failure to maintain regular attendance may lead to a failing grade. The attendance policy at ICHS is as follows: Students must attend 80 percent (80%) of the total didactic class hours per semester and 100 percent (100%) of clinical externship hours. A student may have the opportunity to make up absences; however, this is only available at the discretion and approval of a lead instructor and can only be completed outside of scheduled classroom hours, if available. In the event that the student will be absent from his or her clinical externship, the student must call the assigned site and ICHS in advance. All absences must be justified in writing (i.e. doctor’s excuse). Students are not excused from attending the clinical externship except for grave emergencies or serious illness, and the student must call the assigned site and ICHS in advance. Additionally, these hours must be made up within a student’s scheduled dates for the course, the term, the semester or the scheduled clinical rotation. Instructors, in their discretion, may base a percentage of the grade on attendance. Termination may occur for any of the following attendance situations: 1. Eight (8) consecutive absences per semester. 2. Absence in excess of 20 percent (20%) of available course hours. 3. Absence in excess of 20 percent (20%) of externship hours. Tardiness for didactic or clinical education will not be tolerated. Anytime beyond the scheduled reporting time will be considered late or tardy. When attending clinical externship, if a student is to be late, he or she must notify the clinical instructor at the facility and the program clinical coordinator. If a student must miss class, he or she must contact the program director or instructor at least 30 minutes prior to the class beginning. For didactic education, four episodes of tardiness or leaving ICHS early per semester will result in an absence. If a student is more than 15 minutes late, he or she must obtain the instructor’s permission to attend the class. Four late arrivals will result in the equivalent “consequence” as one unexcused absence. Any student who has been excessively tardy in arriving to class or absent will receive a written advisement and guidance report by a faculty member. A student, who has more than one unexcused absence during clinical externship, may be removed from the site. DISTANCE EDUCATION ATTENDANCE POLICY Students must log into their online course prior to the third day of the course as dictated by the drop/ad policy of ICHS. Failure to log in by the end of the third day will result in the student being dropped from the course. Attendance in online courses is defined as active participation in the course. Active participation is defined as completion of all expectations outlined in the online course as contained in the lesson plan, syllabi and other course related documents within the course. These expectations may include but are not limited to participation in discussion forums, submission of completed assignments, and completion of quizzes and exams. VETERAN'S ATTENDACE POLICY Excused absences will be granted for extenuating circumstances only. Excused absences must be substantiated by entries in students' files. Early departures, class cuts, tardies, etc., for any portion of a class period will be counted as absence. Students exceeding 3 unexcused absences in a 7 day period for non-degree programs and 5 unexcused absences in a semester for degree granting programs will be terminated from their VA benefits for unsatisfactory attendance. The student's attendance record will be retained in the veteran's file for USDVA and SAA audit purposes. Course Description After completion of Echocardiography Pathology One, the course will be focusing on Pathology, Dysfunction, and the Disease process. Echo Pathology II covers Ischemic Heart Disease, Hypertension, Pericardial Disease, Cardiac Masses, Prosthetic Valves, Stress Testing, Congenital Heart Disease, and other Pathologies, Signs and Symptoms, 2-D, M-Mode, Doppler findings will be quantitated , Differential Diagnosis, Murmurs related to the disease, EKG findings, Treatment, Prognosis, Medical and Surgical Treatment, among other subjects will be covered in the course. Coordination of the Patient’s history, Physical findings and Sonographic images are evaluated for presentation. Discussions will be both detailed and concise for understanding and comprehension. Students will be provided with scan lab demonstration and techniques that will allow them to apply what they learn in class to a real medical setting. Upon successful completion of this course, the student will be able to: 1. Understand Ischemic Heart Disease 2. Understand Systemic and Pulmonary Hypertension 3. Understand Pericardial Diseases and Non-Cardiac Chest 4. Understand Cardiac Masses, Endocarditis, Intracardiac Thrombus 5. Understand Prosthetic Valves and Transcatheter Aortic Valve Replacement 6. Understand Diseases of the Great Vessels 7. Understand Stress Testing, Tissue Doppler, 3-D and Transesophageal Echo 8. Understand Intraoperative Echo and the Role of the Sonographer 9. Understand Congenital Heart Disease in Adults and Children 10. Integration of data Topical Outline and Schedule DATE WEEK 1 Distribute and review Syllabus SPECIFIC OBJECTIVES Describe the course. Discuss Presentations, Quiz, Test, and Lab Criteria Introduction to ischemic heart disease Review walls and corresponding views At the end of this chapter, the student will be able to: • Define ischemic heart disease and etiology • Understand the difference between Atherosclerosis and Arteriosclerosis • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe normal and abnormal values • Describe follow up, treatment, and prognosis • Understand coronary imaging • Describe ischemia vs infarction • Understand aneurysm and pseudoaneurysm • Describe other methods of assessing coronary artery disease TOPIC (S) Ischemic Heart Disease LEARNING Discussion of Syllabus ACTIVITIES Power Point Presentation Review of Coronary Distribution and Segmental Wall Motion Abnormalities Lab: Maximizing Endocardial Definition Discussion of Wall Thickening, Hypokinesis, Akinesis and Dyskinesis and Aneurysmal Wall Motion Report on Diastolic and Systolic Dysfunction OUTSIDE Homework: Complete Key Terms WORK & ASSIGNED Read: Chapter 8th Coronary Artery Disease Otto (page # 190) READINGS Echo Pocket Book (page 138) DATE WEEK 2 At the end of this chapter, the student will be able to: SPECIFIC OBJECTIVES • Define systemic and pulmonary heart disease and etiology • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Describe calculations used to determine severity of systemic and pulmonary hypertension • Describe Eisenmenger’s Syndrome TOPIC (S) Systemic and Pulmonary Heart Disease LEARNING Power Point Presentation ACTIVITIES Describe the Importance of properly calculating Velocities and Pressure Changes with in Cardiac Chambers and Great Vessels Lab: Students will work in Doppler Calculations and Ejection Fraction Review Power Point OUTSIDE WORK & Study for Quiz # 1 Homework: M-Mode Findings ASSIGNED READINGS Read: Chapter 9th Hypertensive and Pulmonary Heart disease Otto (page # 245), Echo Pocket Book (page 100) DATE WEEK 3 At the end of this chapter, the student will be able to: SPECIFIC OBJECTIVES • Define pericardial disease and etiology • Define pericarditis • Describe pericardial effusion and tamponade • Describe constrictive pericarditis vs restrictive cardiomyopathy • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Describe the difference between pericardial and pleural effusion • Discussion of non-cardiac chest • Understand ultrasound guided procedures, extrinsic compression, pneumothorax, pleural effusion • Understand limitations for non-cardiac chest (artifacts) TOPIC (S) Pericardial Disease and Non-Cardiac Chest LEARNING Power Point Presentation ACTIVITIES Discuss the importance of properly reporting Pericardial Disease Discuss Pericardiocentesis Quiz # 1 Lab: Students will work on Identification of Pericardium, and Locating Descending Ao from Different Views Review Power Point OUTSIDE Complete Key Terms WORK & Homework: Presentation on Non-Cardiac Chest ASSIGNED READINGS Read Chapter: 10 Pericardial Disease Otto (page 254) Echo Pocket Book (page 100) DATE WEEK 4 At the end of the chapters, the student will be able to: SPECIFIC OBJECTIVES • Describe the different cardiac masses and etiology • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Define benign and malignant ( primary and secondary) cardiac masses • Describe differences between endocarditis, thrombus, embolus, and predisposing factors TOPIC (S) Cardiac Masses and Potential Cardiac Source of Embolus LEARNING • Power point presentation ACTIVITIES • Video Presentation on Cardiac Source of Embolus Lab: Students will work on Blood Flow from Apical Five and Three Chambers Lab test Review Power Point OUTSIDE Complete Key Terms WORK & ASSIGNED Homework: Study for Quiz # 2 READINGS Read: Chapters 14 and 15 Otto (page 372 to 417) Echo Pocket Book (page 159) DATE WEEK 5 At the end of the chapter, the student will be able to: SPECIFIC OBJECTIVES • Describe types of prosthetic valves • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Mechanisms of prosthetic valve dysfunction • Understand echo approach to bioprosthetic, and mechanical valves • Describe microcavitation, valve conduits • Describe antegrade flow patterns and velocities • Understand pitfalls in prosthetic valve imaging • Discuss transcatheter valvular replacement TOPIC (S) Prosthetic Valves and TAVR • Power point presentation LEARNING ACTIVITIES • Discuss Lambl’s Excrescences, Pannus Formation, Paravalvular Regurgitation, Stenosis, and Dehiscence • Video on TAVR Quiz # 2 Lab: Practice Aortic Flow and Suprasternal Approach OUTSIDE Review for Mid-Term Exam Complete Key Terms WORK & ASSIGNED Homework: Study for Mid-Term Exam READINGS Read: Chapter 13 Prosthetic Valves Otto (page 342) DATE WEEK 6 At the end of the chapter, the student will be able: SPECIFIC OBJECTIVES • Describe the different diseases of the great arteries and etiology • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Understand aortic dilatation, aneurysm and dissection • Understand intramural hematoma, traumatic Ao disease • Understand Sinus of Valsalva aneurysm, atherosclerotic Ao disease • Understand pulmonary artery abnormalities • Describe TEE tomographic views, indications and risks • Understand indications, preoperative procedures, surgical manipulation and instrumentation, and time constraints • Understand clinical utility in transcatheter and hybrid procedures TOPIC (S) Diseases of the Great Vessels, Transesophageal and Intraoperative Echo LEARNING • Power point presentation ACTIVITIES • Discussion on the role of Transesophageal Imaging • Presentation on Intraoperative Echo Mid-Term Exam Lab: Mid-Term Lab Competency, Students will practice on Suprasternal and Supraclavicular Imaging and Doppler Review Power Point OUTSIDE Complete Key Terms WORK & Homework: Presentation on Ao Dissection ASSIGNED Read: Chapter 16 Diseases of the Great Arteries, Otto (page 418) and READINGS Chapter 3 Transesophageal Echocardiography, Otto (page 65 Echo Pocket Book (page 227) DATE WEEK 7 At the end of the chapter, the student will be able to: SPECIFIC OBJECTIVES • Understand indications and contraindications for stress testing • Describe protocols • Describe changes in ventricular function due to stress testing • Describe dobutamine stress echo • Understand limitations and technical aspects • Describe 3-D examination protocol • Understand three-dimensional echo, quantitation from 3-d images • Understand tissue Doppler, strain and strain rate • Understand speckle tracking strain imaging • Understand contrast echocardiography TOPIC (S) Stress Testing, Myocardial Mechanisms (Tissue Doppler, 3-D, Contrast) LEARNING • Power point presentation Video on 3-D Echocardiography ACTIVITIES Lab: Students will mock a stress test and work on tissue Doppler Review Power Point OUTSIDE Homework: Complete Key Terms WORK & ASSIGNED Read: Chapter 4, Advance Echocardiographic Modalities READINGS Chapters 6 Left and Right Ventricular Systolic Function Echo Pocket Book (pages 280-308) DATE WEEK 8 At the end of the chapter, the student will be able to: SPECIFIC OBJECTIVES • Define congenital heart disease • Understand the sonographers approach to pediatric echocardiography • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Understand surgical procedures • Describe congenital defects seen in adults TOPIC (S) Congenital Heart Disease; ASD, VSD, EBSTEIN’S, TRICUSPID ATRESIA LEARNING • Power point presentation ACTIVITIES Lab: Students will practice on Pulmonary Flow from PLAX and PSAX Visualization of RPA and LPA Lab test Review Power Point OUTSIDE Homework: Complete Key Terms WORK & ASSIGNED Read: Chapter 17, The Adult with Congenital Heart Disease READINGS Otto(page 443) Study for Quiz # 3 DATE WEEK 9 At the end of the chapter, the student will be able to: SPECIFIC OBJECTIVES • Define endocardial cushion defect, and atrioventricular canal • Describe Down Syndrome • Define anomalous venous return • Define Tetralogy of Fallot • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Describe Fontan physiology • Understand calculations of shunt ratios TOPICS Endocardial Cushion Defect, Abnormal Venous Connections, Tetralogy of Fallot LEARNING • Power point presentation ACTIVITIES • Video on Tetralogy of Fallot and other Congenital Disease • Discuss Fontan Physiology and Other Available Surgeries Quiz # 3 Lab: Students will practice Pulmonary Flow Review Power Point and Normal Values OUTSIDE Complete Key terms WORK & Homework: Pick a Subject for Final Presentation ASSIGNED READINGS DATE WEEK 10 At the end of the chapter the students will be able to: SPECIFIC OBJECTIVES • Describe transposition of the great vessels (D-TGA, and CC-TGA) • Describe truncus, coarctation and interrupted Ao Arch • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Understand available surgeries • Describe arterial switch and atrial switch TOPIC (S) Transposition of the Great Vessels, Truncus Arteriosus, Coarctation of the Ao, Interrupted AO Arch Power point presentation LEARNING Presentation of Fetal Development of Intracardiac Formation ACTIVITIES Lab: Assessment of the Great Arteries Review Power Point OUTSIDE Complete Key Terms WORK & Homework: Presentation in Conotruncal Abnormalities ASSIGNED READINGS DATE WEEK 11 At the end of the chapter the student will be able to: SPECIFIC OBJECTIVES • Describe double outlet RV, hypoplastic left ventricle • Describe coronary fistulas • Describe complications, symptoms, 2-D, M-Mode and Doppler findings • Describe murmurs, normal and abnormal values • Describe follow up, treatment, and prognosis • Describe available surgeries TOPIC (S) Double Outlet Right Ventricle, Hypoplastic Left Ventricle, Coronary Fistula LEARNING • Power Point Presentation ACTIVITIES • Summary of Congenital Heart Disease Lab: Practice Protocol OUTSIDE Study for Final Exam and Lab Competencies Homework: Complete Key Terms WORK & ASSIGNED READINGS DATE WEEK 12 SPECIFIC Final Exam OBJECTIVES Review of Echo Pathologies and the Sonographers Role TOPIC (S) Final Exam and Overview of Cardiac Pathology LEARNING Final Exam ACTIVITIES Final Lab Competencies Integration of data: Incorporate outside data (clinical assessment, physical, lab values, compare with previous exams, provide preliminary reports to physician) Review Echocardiography Pathology II OUTSIDE WORK & ASSIGNED READINGS Instructional Methods The following strategies may be used in this class: 1. Class Lectures 2. Sketch drawings 3. PowerPoint Presentation 4. Class Discussion 5. Practice tests 6. Internet research 7. Student evaluation of course References and Resources ICHS Virtual Library Login to the ICHS Virtual Library at http://www.lirn.net, access code 40149 to online books, journals, and other reference resources selected to support ICHS curricula. Medline Plus http://www.nlm.nih.gov/medlineplus/ Health information from the National Library of Medicine National Institutes of Health. Easy access to Medline and Health topics, medical dictionaries, directories, drug information, videos and more. PALM BEACH COUNTY LIBRARY ONLINE RESOURCES You need a free Palm Beach County Library card to access, or register for a free “Temporary Research Access Code” at http://edb.pbclibrary.org/TRAC/ If you need help using any of the library websites, click on the “Ask a Librarian” icon and “chat” with a librarian. Consumer Health http://www.pbclibrary.org/health.htm CINAHL® with Full Text - full text articles for more than 610 nursing and allied health journals (and indexing for an additional 3000 journals) as well as health care books, nursing dissertations, selected conference proceedings, and more. http://www.pbclibrary.org/databases/ LearningExpress - (Practice Tests) Contains online learning with skill building modules, test preparation materials and practice exams; including test preparation E-books. Take practice tests for Health Careers, Radiography, Registered Medical Assistant and NCLEX-RN for Nursing. Learn techniques for job searching, resumes, interviewing and workplace skills. http://www.pbclibrary.org/databases/ Health and Wellness Resource Center http://www.pbclibrary.org/databases/ Assessment Criteria and Methods of Evaluating Students A B C F equivalent to equivalent to equivalent to equivalent to 90 – 100 80 – 89 75 – 79 74 and below 4.0 3.0 2.0 0.0 Generally, the grades “A” through “C” are considered passing grades. Grades "W" and "I" indicate that no grades were earned for the course. A "W" grade indicates that the student withdrew from the course. An "I" grade indicates that the student was passing the course, but failed to complete all the required course work. The instructor, in his/her discretion may grant an "I" grade instead of an "F", pending completion of the course work by the student within a specified time arranged by the instructor and told to the student. It is the student's responsibility to follow-up with the instructor to complete the course work. If the course work is not completed by the arranged time, the “I” grade becomes an “F". Distribution of Grade Elements Quizzes 25% Mid-Term 25% Final 30% Lab Competencies 20% Total 100% Syllabus Revised September 10, 2015