Download Chronic forms of coronary heart disease

Subject 1 - Chronic forms of coronary heart disease
(4 hours)
Place
Educational room, dpt. of Cardiology
Purpose
Students must know:
• Classification of CHD. Classification of functional classes of stable angina .
• Etiology and pathogenesis of coronary artery disease , the role stenozuvalnoho
atherosclerosis, spasm and "dynamic " stenosis of coronary arteries in the pathogenesis of
chronic coronary artery disease.
• Clinical manifestations of chronic ischemic heart disease, the clinical course of angina,
atherosclerosis and postinfarction cardiosclerosis and silent myocardial ischemia .
• Methods of diagnosis , the role of the ECG, echocardiography , exercise testing ( bicycle
ergometry, transesophageal pacing , drug tests) , radionuclide techniques, coronary
angiography , biochemical parameters in the diagnosis and differential diagnosis.
• Differentiated therapy of chronic ischemic heart disease, various options for angina ( stable ),
and atherosclerotic postinfarction cardiosclerosis form and without pain. Indications for surgery (
CABG transluminal angioplasty and stenting ).
• Primary and secondary prevention
• Weather and performance in chronic forms of coronary artery disease
To Able:
Based on survey data of the patient with a chronic form of CHD
to formulate a clinical diagnosis
• to the differential diagnosis
• identify and evaluate tactical test results
• prescribe treatment
• identify and forecast performance
• recommend preventive measures
Professional orientation of students
Gained greater prevalence of coronary artery disease , available in different shapes and
variants of the disease , the doctor often faced with the necessity of differential diagnosis with
other pathologies , it must , on the one hand, hiperdiahnostytsi prevent iatrogenic coronary
artery disease and the other - do not miss a threat to the life of the patient , Modern Methods
diagnosis and treatment of coronary artery disease , can significantly improve and speed up the
diagnostic process and improve the prognosis and quality of life.
Base level of knowledges and abilities
№
Discipline
To know
1.
Anatomy
Heart Anatomical structure of
the coronary arteries
2.
Histology
Structure and functioning of the
coronary vessels, myocardium
and conduction system of the
heart
3.
Biochemistry
Biochemistry of lipid metabolism To interpret lipidogramm Rate
4.
Pathophysiology
Mechanisms of disorders of the
coronary
circulation
and
myocardial various options for
state
5.
Patanatomy
morphological changes in
various forms of ischemic heart
disease
6.
Propedevtik
diseases
7.
Radiation medicine
of
To able
internal Semiotics of disorders of the to
assess
the
clinical,
coronary circulation
instrumental and laboratory
tests
Radiation Diagnostic Methods Rate coronarografic data and
for
assessing
coronary
( isotopic studies of myocard
coronary angiography ) and the
state of
the myocardium
( stintihrafy )
Plan of practical employment
№
Elements of practical employments
1.
Verification of present's students
5
2.
Entrance control and his analysis
15
Time(minutes)
3. * Distributing patients for Supervision ( card or clinical tasks )
10
4. * Review patients or study of educational hospital chart
40
5.
Discussion of findings, formulation of previous diagnosis, determination of
methods of additional inspection of patient, interpretation of their results,
formulation of final diagnosis and plan of treatment
50
6.
Exercises with clinical formulations for solving clinical situation tasks
20
7.
Output control of knowledge and its evaluation
15
8.
Results and final assessment of knowledge and skills of students and tasks
to self- preparation for the next lesson
5
Note: * - in the case of patients absence in clinical, practice can be made in the form of
preparation and decision of situational tasks.
List of theoretical questions addressed in class
Classification of coronary artery disease. Classification of functional classes of stable angina .
2. Etiology and pathogenesis of coronary heart disease, atherosclerosis and the role of
constrictive spasm
coronary arteries in the pathogenesis of chronic coronary artery disease.
3. Clinical manifestations of chronic ischemic heart disease, the clinical course of angina,
atherosclerotic and postinfarction kardiosklerosis, silent myocardial ischemia .
4. Methods of diagnosis , the role of ECG, exercise testing ( bicycle ergometry,
chrezstravohidna pacing , drug tests) , echocardiography , coronary angiography ,
radionuclide methods of biochemical parameters in the diagnosis and differential
diagnosis.
5. Differentiated treatment of chronic ischemic heart disease, angina various options
( stable ), and atherosclerotic postinfarction cardiosclerosis and forms without
pain. Indications for surgery ( CABG transluminal angioplasty and
stenting ).
6. Primary and secondary prevention
7. Weather and performance in chronic forms of coronary artery disease
Method of leadthrough of practical employment *
On the first employment teacher hold instructing from accident (if there are such terms) which
registers in the magazine of teacher's signature of student prevention.
* Students answer in writing on the tests of base knowledges entrance control. Then a teacher
distributes students for kuration patients and determines them a task.
№
Task
Teasher's
students
pointing
to Teacher's note for students
1.
To provide curation of During an inspection to 
patient diagnosed with a discover:
chronic form of coronary
Signs of a violation of the
artery disease, assess
coronary circulation (clinical
the results of the survey,
and more )
write a clinical diagnosis ,
evaluation and treatment 2. The presence of impaired
plan (with an extract lipid metabolism
recipe )
1. 3. 4. Characteristic
Pay particular attention to the
period of existence of the
identified complaints and
objective data , the disease , the
presence and duration of ECG
changes , determine the
indications for coronary
angiography
changes in coronary heart
disease ECG
renthendoslidzhenni ,
echocardiography.
A teacher works in obedience to the plan of organization of employment, in the end - initial
control of knowledges. Before completion of employment teacher announce his results with the
estimation of every student and declares the theme of next employment.
Forms and methods of self-control
Tests
Specify more typical for postinfarction cardiosclerosis changes that
detected by echocardiography :
A. Mitral valve insufficiency .
B. Regional wall dyskinesia .
C. Increased heart cavities .
D. Thickening of the walls of the myocardium.
E. Reducing heart cavities .
2. Specify the most typical for ischemic cardiomyopathy changes:
A. Mitral valve insufficiency .
B. Stenosis of the aortic valve.
C. Increased heart cavities .
D. Thickening of the walls of the myocardium.
E. Reducing heart cavities .
3. What research should be conducted primarily to clarify the reasons negation of the T wave in
leads V2- 4 in patients without major complaints.
A. Bicycle ergometer .
B. Coronary angiography .
C. Radiography UCP .
D. Echocardiography.
E. ECG test with nitroglycerin.
Situational tasks
1. Male 47 years, complains of constricting chest pain during rapid walking, climbing on the 3rd
floor . Sick 6 months. Ob-no: height 172 cm, weight 98 kg. In the lungs , vesicular breathing.
Limits hearts are not changed. muted tones , the rhythm right , HR = RA = 72 per min. , BP =
135 /80 mm Hg. century. The liver was not palpable, swelling of legs there. The ECG - no
change. In blood : red blood cells - 4,5 1012 WBC - 7,0 109 ESR - 5 mm / h. Formulate the
clinical diagnosis. A plan of survey . Identify treatment strategy.
2. Women 55 years, complains of burning chest pain that appears when you walk up to 200
meters, climbing 1 flight after food shortages in the heart. He considers himself sick about 3
years old when the complaint appeared that over time gradually strengthened . No Lunar 5
years. Regularly take beta blockers , aspirin , for pain - nitroglycerin. Ob-no: In the lungs ,
vesicular breathing. Limits of the heart left + 1 cm, muted tones , isolated extrasystoles , heart
rate = 86 , AC = 82 per min. , BP = 155 /85 mm Hg. century. Shin pastozni . In blood :
Leukocyte - 5,6
109, ESR - 12 mm / h. ECG - ventricular extrasystoles , left ventricular
hypertrophy. Specify the most likely diagnosis. Is there a need for dyfdiahnostitsi ? As so , it is
necessary to investigate how no, why not? Your tactics in the management of patients.
Ilustrative material
1. Tables and slides to the classification of CHD.
2. Audiocassette with entry arrhythmias .
3. Video cassettes of educational film and echocardiography in coronary artery disease and
heart coronary angiography .
4. Set ECG, radiographs , tests.
5. A set of control tests and situational problems with standard answers.
Sources of information (literature)
Basic:
Therapy. Course of lectures. Simferopol. -2003.- 444p.
Additional:
1. Harrison's Principles of Internal Medicine 18th edition.
.org)
2. ESC Guidelines. Cardiovascular medicine. (Www.escardio.org / guidelines)
The program of preparation students to the theme
To learn:
• Classification of CHD. The concept of chronic coronary artery disease.
• Etiology and pathogenesis of coronary heart disease, atherosclerosis and the role
stenozuvalnoho "dynamic " stenosis of coronary arteries in the pathogenesis of various forms of
CHD.
• Clinical manifestations of chronic ischemic heart disease, the clinical course of stable angina ,
silent form, atherosclerotic and postinfarction cardiosclerosis.
• Methods of diagnosis , the role of ECG, exercise testing ( bicycle ergometry, transesophageal
pacing , drug tests) , echocardiography , coronary angiography , radionuclide techniques,
biochemical parameters in the diagnosis and differential diagnosis.
• Principles of treatment and prevention , especially the treatment of chronic coronary artery
disease. Differentiated treatment of different variants of stable angina , indication for surgery (
CABG transluminal angioplasty and stenting ).
Draw :
• Changes in the coronary artery with stable angina and silent forms of CHD.
To Able:
Based on survey data of the patient with coronary artery disease to formulate a final diagnosis.
Pay attention to the use of modern methods of instrumental and laboratory examination with
coronary artery disease, and determining the indications for coronary angiography and invasive
treatments for coronary artery disease.