* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Chronic forms of coronary heart disease
Survey
Document related concepts
Electrocardiography wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Saturated fat and cardiovascular disease wikipedia , lookup
Remote ischemic conditioning wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Cardiovascular disease wikipedia , lookup
Echocardiography wikipedia , lookup
Cardiac surgery wikipedia , lookup
Drug-eluting stent wikipedia , lookup
History of invasive and interventional cardiology wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
Transcript
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.