study guide cardio tayang by gextha 30 maret 2015
1.
PREFACE
The curriculum theme on Cardiovascular System and Disorder is developed collectively by the academic staff from various departments: Anatomy- Histology, Physiology, Pharmacology, Pathology, Pediatric, Cardiology, Thorax surgeon, Radiology and Physiotherapy.
The number of Cardiovascular System credits is five. This book consists of general information on the learning schedule, block members, facilitators, and the core curriculum, such as learning outcomes, learning situation, learning task and self-evaluation.
Lecture is only given to emphasize crucial things or objectives of material and to guide the students before discussion. During discussion, student also has to evaluate their learning progress independently (self evaluation). For difficult concepts in discussion and self evaluation, the students are also being asked to discuss several example of case. More than half of the learning material should be learned independently and in small group discussion.
Curriculum content, study load and teaching-learning are specified in curriculum and study guide, student assessment is carried out mainly by objective test at the end of theme course, and the minimum passing level is set at 70 (70%). A remedial is provided for those who failed, and later they have to re-sit a second summative test.
Since the integrated curriculum at Faculty of Medicine Udayana University is still in progress, this guide book will also still have some changes in the future. Regarding that, we invite readers to give any positive comments for its development.
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2. CONTENTS
1. Preface ……….
1
2. Contents .….………...
2
a. Planners Team ...
3
b. Lectures………...
3
c. Facilitators ………
4
3. Seven General Core Competency ………
6
4. Time Table
-
English Class ………. 7
-
Regular Class .………... 7
5. Meeting Students Representatives ...……… 13
6. Assessment ...………. 13
7. Learning program ……… 16
8. References ……… 75
9. Standart of Medical Competence ……… 75
10. Evaluation Form ……… 76
11. Item Grid ………. 80
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2. a. PLANNERS TEAM
No
NAME
DEPT
PHONE
1. dr. I.G.A. Widianti, M.Biomed (Head) Anatomy 08123921765
2. dr. I Md Junior Rina A, Sp.JP, Fiha (Secretary) Cardiology 08123814814
3. dr. Made Muliarta, M.Kes Physiology 081338505350
4. dr. I G.N Mayun, PHK Histology 08155715359
5. dr. Bajra Nadha, SpJP Cardiology 0818353925
6. dr. Eka Guna Wijaya, Sp A Pediatric 081338599801
b. LECTURERS
No
NAME
DEPT
PHONE
1. dr. I.G.A. Widianti, M.Biomed Anatomy 08123921765
2. dr. I G.N Mayun,PHK Histology 08155715359
3. Dr. dr. Adiatmika, M.For Physiology 08123811019
4. dr. Made Muliarta, M.Kes Physiology 081338505350
5. Prof. dr. Dewa Putu Sutjana, PFK, M.Erg. (M.Kes)
Physiology 08123924477
6. Prof dr. I Gusti Made Aman, SpFK Pharmacology 081238770650
7. dr. I G Md Gd Surya Candra Trapika, MSc Pharmacology 081337991177
8. dr.Ni Wayan Winarti, SpPA Patology Anatomy 087862457438
9. Prof . Dr. Dr. Wita, SpJP Cardiology 08123809780
10. Dr. dr. I Ketut Rina, SpPD, SpJP Cardiology
08123812808 11. dr. Bagus Ari Pradnyana Dwi Sutanegara,
SpJP
Cardiology 08123800055
12. dr. Bajra Nadha, SpJP Cardiology 0818353925
13 dr. I Made Junior Rina Artha, Sp.JP Cardiology 08123814814
(4)
14. dr. Eka Guna Wijaya, Sp A Pediatric 081338599801
15. Prof. Dr.dr. I Made Wiryana, Sp.An.KIC Anesthesia 0811392171
16. dr. Lisna Astuti,Sp.R Radiology 03617422632
17. dr. Luh Kamiati, Sp.RM Physiotherapy 08123998787
18. dr. Semadi, SpB, SpBTKV Surgery 08123838654
c. FACILITATORS
REGULAR CLASS (A)
No NAME GROUP DEPT PHONE (2Venue rd floor)
1. dr. Sianny Herawati, Sp.PK A1 Clinical
Pathology 081236172840
2nd floor: R.2.09 2. dr. Ni Nengah Dwi Fatmawati,
Sp.MK, Ph.D A2 Microbiology 087862200814
2nd floor: R.2.11 3. dr. Cynthia Dewi Sinardja, Sp.An A3 Anasthesi 08123870037 2nd floor:
R.2.12
4. dr. Gde Somayana, Sp.PD A4 Interna 081345136913 2nd floor:
R.2.13 5. dr. I Nyoman Gede Wardana,
M.Biomed A5 Anatomy 087860405625
2nd floor: R.2.14 6. dr. Elysanti Dwi Martadiani,
Sp.Rad A6 Radiology 081805673099
2nd floor: R.2.15 7. dr. I Wayan Losen Adnyana,
Sp.PD A7 Interna 08123995536
2nd floor: R.2.16 8. Dr. dr. I Wayan Suranadi,
Sp.An.KIC A8 Anasthesi 08123847575
2nd floor: R.2.20 9. Dr. dr. I Dewa Made Sukrama,
MSi, Sp.MK(K) A9 Microbiology 081338291965
2nd floor: R.2.21
10. dr. Kunthi Yulianti, Sp.KF A10 Forensic 081338472005 2nd floor:
R.2.22
ENGLISH CLASS (B)
No NAME GROUP DEPT PHONE (2Venue rd floor)
1. dr. Desak Made Wihandani,
M.Kes B1 Biochemistry 081338766244
2nd floor: R.2.09 2. dr. Henky, Sp.F., M.BEth, FACLM B2 Forensic 08123988486 2nd floor:R.2.11
(5)
3. dr. Anom Suardika, Sp.OG B3 Obgyn 0817561966 2nd floor:R.2.12 4. dr. Dewa Ayu Agus Sri Laksmi,
M.Sc B4 Parasitology 081392017107
2nd floor: R.2.13 5. dr. Anak Agung Mas Putrawati Triningrat, Sp.M B5 Opthalmology 08123846995 2nd floor:R.2.14 6. dr. Tjokorda Gde Agung
Senapathi, Sp.An B6 Anasthesi 081337711220
2nd floor: R.2.15 7. dr. A.A.Bagus Ngurah Nuartha,
SpS.(K) B7 Neurology 08123687288
2nd floor: R.2.16 8. dr. Ni Gusti Ayu Agung Manik
Yuniawaty Wetan, Sp.B B8 Surgery 08123214075
2nd floor: R.2.20 9. dr. Tjokorda Gde Dharmayuda,
Sp.PD-KHOM B9 Interna 0811394108
2nd floor: R.2.21 10. dr. Putu Yuliawati , Sp.M B10 Opthalmology 081338601724 2nd floor:R.2.22
3. THE SEVEN GENERAL CORE COMPETENCY
1.
Patient careDemonstrate capability to provide comprehensive patient care that is compassionate, appropriate, and effective for the management of health problem, promotion of health and prevention of disease in primary health care settings.
2.
Medical knowledge base(6)
Mastery of a core medical knowledge which includes the biomedical sciences, epidemiology and statistics, clinical sciences, the sosial aspect of medicine and the principles of medical ethics, and apply them
3.
Clinical skillDemonstrate capability to effectively apply clinical skill and interpret the findings in the investigation of patient
4.
CommunicationDemonstrate capability to communicate effectively and interpersonally to establish rapport with the patient, family, community at large, and professional associates, that results in effective information exchange, the creation of a therapeutically and ethically sound relationship
5.
Information managementDemonstrate capability to manager information which includes information access, retrieval, interpretation, appraisal, and application to patient’s specific problem, and maintaining records of his or her practice for analysis and improvement
6.
ProfessionalismDemonstrate a commitment to carrying out professional responsibilities and to personal probity, adherence to ethical principles, sensitivity to a diverse patient population, and commitment to carrying out continual self-evaluation of his or her professional standart and competence
7.
Community-based and health system-based practiceDemonstrate awareness and responsiveness to large context and system of health care, and ability to effectively use system resources for optimal patient care
4. TIME TABLE
Day
Date
Topic
Learning
situation
English
Class
Regular
Class
(7)
1 Monday
30th of
March
Introduction lecture General anatomy, topography and surface anatomy of the heart and great vessels.
Intro. Lecture Intro. Lecture
Ind. Learning SGD
Break Pleno
08.00 – 08.15 08.15 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 14.00 – 15.00
09.00 – 09.15 09.15 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 15.00 – 16.00
Prof Wita Dr. Widianti
Facilitator Dr. Widianti
2 Tuesday
31st of
March
Microscopic structure of the heart and valves
The heart as a pump
Intro. Lecture
Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 08.15
08.15 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 09.15
09.15 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr Mayun
Dr. Muliarta Facilitator
Team
3 Wednesday
1st of April
Intrinsic Conduction System and Cardiac Action Potential
Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Muliarta
Facilitator
Dr. Muliarta
4 Thursday
2nd of April
Cardiac Out Put and Regulation of Heart Pumping
Intro. Lecture
Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Prof Sutjana
Facilitator
Team
5 Monday
6th of April
Overview of Circulation and Its Function
Intro. Lecture Ind. Learning SGD
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00
Prof Sutjana
(8)
Break
Student Project Pleno
12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
11.30 – 12.00 10.00 – 11.30
15.00 – 16.00 Prof Sutjana
6 Tuesday
7th of April
Factors that Affect Blood Pressure Microscopic Anatomy of The Great Vessel
Intro. Lecture Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 08.45 08.45 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 09.45 09.45 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Adiatmika Dr. Mayun
Facilitator
Team
7 Wednesday
8th of April
Myocardial perfusion Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Muliarta Facilitator
Dr. Muliarta
8 Thursday
9th of April
Blood Pressure Regulation
Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Adiatmika
Facilitator
Dr. Adiatmika
9 Friday
10th of April
The formation of anomalies of the heart and great vessels.
Intro. Lecture
Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Widianti
Facilitator
Dr. Widianti
10 Monday
13rd of April
Approach to Patient With Cardiovascular Disease:
Intro. Lecture
Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 –10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Prof. Wita
Facilitator
Prof. Wita
(9)
14th of April Examination I BCS Practical Anatomy-Histology
10.00 – 13.00 13.00 – 16.00
13.00 – 16.00 10.00 – 13.00
Team Cardio Team
12 Wednesday
15th of April
CV Physical Examination II Intro. Lecture BCS Practical Anatomy-Histology
08.00 – 09.00 10.00 – 13.00 13.00 – 16.00
09.00 – 10.00 13.00 – 16.00 10.00 – 13.00
Dr. Bajra Team Cardio Team
13 Thursday
16th of April
ECG, Ecocardiografi, Fonografi and USG Dopler
Intro. Lecture
BCS
08.00 – 09.00
10.00 – 13.00
09.00 – 10.00
13.00 – 16.00
Dr. Bajra
Team Cardio
14 Friday
17th of April
Chest Imaging Measure Workload
Intro. Lecture Intro. Lecture BCS
08.00 – 08.30 08.30 – 09.00 10.00 – 13.00
09.00 – 09.30 09.30 – 10.00 13.00 – 16.00
Dr. Lisna Dr. Muliarta Team
15 Monday
20th of April
IV line Procedure,
CVP Intro. Lecture BCS
08.00 – 09.00 10.00 – 13.00
09.00 – 10.00 13.00 – 16.00
Prof Wiryana Prof Wiryana
16 Tuesday
21st of April
Non-cyanotic and Cyanotic CHD and Acute Rheumatic Fever
Intro. Lecture
Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Eka Guna
Facilitator
Dr. Eka Guna
17 Wednesday
22nd of April
Ischemic Heart Disease = ACS
Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. K. Rina
Facilitator
Dr. K. Rina
18 Thursday
23rd of April
Pathologic aspect of IHD
Drug used in Angina Pectoris
Intro. Lecture Intro. Lecture Ind. Learning
08.00 – 08.30 08.30 – 09.00 09.00 – 10.30
09.00 – 09.30 09.30 – 10.00 12.00 – 13.30
Dr. Winarti Prof Aman
(10)
SGD Break
Student Project Pleno
10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Facilitator
Team
19 Friday
24th of April
Arrhytmias
Antiarrhythmic Drugs
Intro. Lecture Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 08.45 08.45 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 09.40 09.40 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Bajra N Dr. Surya Facilitator
Team
20 Monday,
27th of April
Hypertension Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Susila Facilitator
Dr. Susila
21 Tuesday
28th of April
Heart Failure Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Junior R Facilitator
Dr. Junior R
22 Wednesday
29th of April
Antihypertensive Drugs
Positive Inotropes
Intro. Lecture Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 08.40 08.40 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 09.40 09.40 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Prof Aman Dr. Surya Facilitator
Team
23 Thursday,
30th of April
Acute and Chronic Cor-pulmonale
Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Bagus Ari
Facilitator
Dr. Bagus Ari
24 Monday,
4th of May
Valvular Heart and Pericardial & Endocardial Disease
(11)
Physiotherapy to patient with Cardiovascular Disease
Intro. Lecture Ind. Learning SGD
Break
Student Project Pleno
08.45 – 09.00 09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.45 – 10.00 12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr. Kamiati
Facilitator
Team
25 Tuesday,
5th of May
Common Peripheral Vascular (artery & Venous) and lymphatic disease
Intro. Lecture
Ind. Learning SGD
Break
Student Project Pleno
08.00 – 09.00
09.00 – 10.30 10.30 – 12.00 12.00 – 12.30 12.30 – 14.00 14.00 – 15.00
09.00 – 10.00
12.00 – 13.30 13.30 – 15.00 11.30 – 12.00 10.00 – 11.30 15.00 – 16.00
Dr Semadi
Facilitator
Team
26 Thursday
7th of May
Evaluation
BASIC CLINICAL SKILL
(12)
situation
Class
Class
1
Tuesday14th of April
CV Physical Examination I BCS
Intro. Lecture 08.00 – 09.00 10.00 – 13.00
09.00 – 10.00 13.00 – 16.00
Dr. Bajra R.302 Skill Lab
2
Wednesday15th of April
CV Physical Examination II BCS
Intro. Lecture 08.00 – 09.00 10.00 – 13.00
09.00 – 10.00 13.00 – 16.00
Dr. Bajra R.302 Skill Lab
3
Thursday16th of April
ECG,
Ecocardiografi, Fonografi and USG Dopler
BCS
Intro. Lecture 08.00 – 09.00
10.00 – 13.00
09.00 – 10.00
13.00 – 16.00
Dr. Bajra R.302
Skill Lab
4
Friday17th of April
Chest Imaging Measure Workload BCS
Intro. Lecture Intro. Lecture
08.00 – 08.30 08.30 – 09.00
09.00 – 09.30 09.30 – 10.00
Dr. Lisna Dr. Muliarta R.302 R.302 Skill Lab
5
Monday20th of April
IV Line Procedure and CVP
BCS
Intro. Lecture 08.00 – 09.00 10.00 – 13.00
09.00 – 10.00 13.00 – 16.00
Prof Wiryana
R.302 Skill Lab
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English 1-5 English 5-10 Reg 1-5 Reg 5-10 Place Tuesday 14th April 2015
CV Physical Examination I 10.00 – 13.00 10.00 – 13.00 13.00 – 16.00 13.00 – 16.00 Skill Lab
Anatomy 13.30 – 15.30 10.00 – 12.00 Lab. Anatomy
Histology 13.30 – 15.30 10.00 – 12.00 Lab. Bersama
Wednesday 15th April 2015
CV Physical Examination II 10.00 – 13.00 10.00 – 13.00 13.00 – 16.00 13.00 – 16.00 Skill Lab
Anatomy 13.30 – 15.30 10.00 – 12.00 Lab. Anatomy
Histology 13.30 – 15.30 10.00 – 12.00 Lab. Bersama
Thursday 16th April 2015
ECG 10.00 – 13.00 10.00 – 13.00 13.00 – 16.00 13.00 – 16.00 Skill Lab
Friday 17th April 2015
Chest Imaging 10.00 – 13.00 10.00 – 13.00 13.00 – 16.00 13.00 – 16.00 Skill Lab
Measure Workload 13.00 – 16.00 13.00 – 16.00 10.00 – 13.00 10.00 – 13.00 Lab. Faal
Monday 20th April 2015
IV line procedure, CVP 10.00 – 13.00 10.00 – 13.00 13.00 – 16.00 13.00 – 16.00 Skill Lab
5. MEETING OF STUDENT REPRESENTATIVES AND
FACILITATORS
Meeting of student representatives and facilitators are designed among the student representatives of the every small group discussion. The meeting will discuss the on going teaching learning process, quality of lecturers and facilitators as a feedback to improve the next process. The purpose of the meeting is to evaluate the teaching learning process of the block. Feebacks and suggestions are welcome for improvement of the block educational programs.
6. ASSESSMENT METHOD
Type of assessment is multiple choice questions (MCQ) and fill the blank and OSCE. A prerequisite condition to follow the assessment is attendance in at least 75% of all sheculed teaching-learning activities and follows the questionnare test during lecture. Assessment will be carried out on Thursday 7th of May 2015. There will be 100 question
consisting mostly of Multiple Choice Questions (MCQ) and OSCE will be conducted together with other block at semester VI.
Assessment in this block consists of: SGD: 5%, student project (review article): 10%, final exam : 85%. The passing score requirement is ≥ 70. The student who does not pass the passing level should follor remedial. Remedial will be held later.
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TITLE (subject/topic;choose from competency list)
Name
NIM
Faculty of Medicine, Udayana University 2015
1. Introduction (Pendahuluan)2. Content (Isi, sesuai topik yang dibahas) 3. Summary (Ringkasan)
4. References (Daftar Pustaka) Van Couver style Example :
Libby P. The Pathogenesis of Atherosclerosis. In: Braunwald E, Fauci A, Kasper D, Hoster S, Longo D, Kamason S (eds). Harrison`s Principle of Internal Medicine. 15th ed. New York: McGraw Hill; 2001. p. 1977-82.
5. 6 – 10 pages, 1,5 spasi, Times New Romance 12.
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Faculty of Medicine, Udayana University
Block
: Cardivascular System and Disorders
Name
:_____________________________________
Student No. (NIM) :_____________________________________
Fasilitator
:_____________________________________
Title
:_________________________________________________
_________________________________________________
_________________________________________________
Time table of consultation
Point of discussion
Week
Date
Tutor sign
1. Title
1
2. References
2
3. Outline of paper
3
4. Content
4
5. Final discussion
5
Assessment
A. Paper structure : 7 8 9 10
B. Content : 7 8 9 10
C. Discussion : 7 8 9 10
Total point
: ( A + B + C ) : 3 = _________________
Denpasar, ______________________
Facilitator,
7. LEARNING PROGRAM
(16)
MODULE 1
dr. I Gusti Ayu Widianti, M.Biomed
AIMS:
Describe the general and topography and surface anatomy of the cardiovascular system
LEARNING OUTCOME:
1. Describe the general and topography anatomy of the cardiovascular system 2. Describe the surface anatomy of the cardiovascular system
CURRICULUM CONTENS:
1. Topography anatomy of the heart and great vessel 2. Mediastinum
3. Pulmonary/lesser and systemic/ greater circulation ABSTRACT :
The heart is a hollow, fibromuscular organ of a conical or pyramidal form, with a base, apex and a series of surfaces (sternocostal/anterior, diaphragmatic/inferior and pulmonaries) and borders (acute and obtuse borders). Enclosed in the pericardium, occupies the middle mediastinum between the lungs. It is placed obliquely behind the body of the sternum and adjoining costal cartilage and ribs, one-third lies to the right of the midline. Because of intimate relation between left atrium, the arch of aorta and esophagus, enlargement of them resulting compression to each other.
The human heart is a pair of valved muscular pumps combined in a single organ. Right and left heart pumps is physiologically separate, being interposed in series of different point in the double circulation: pulmonary/lesser circulation for blood oxygenation and systemic/greater circulation for tissue perfusion.
Of the four cardiac chambers, the two atria received venous blood for filling of the two ventricles which then provide the powerful expulsive contraction, forcing blood into the main arterial trunks: pulmonal trunk and aorta.
On the anterior surface of the chest, the outline of the heart and the sound produced by the valves can be traced.
Standard References :
1. Moore KL, Agur AMR: Essential Clinical Anatomy, 3rd ed. Philadelphia, Lippincott & Wilkins, 2007. p. 26-30, 65-67, 80-115
SELF DIRECTING LEARNING
Basic knowledge that must be known:
1. Topography anatomy of the heart and great vessel. 2. Mediastinum
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SCENARIO CASE:
A student had a motorcycle accident with a bruise in the 4th left intercostals space, just lateral to the sternum. Her mother consult the physician because she thought that something bad may be happened with his heart.
LEARNING TASK :
1. What structures may have been injured?
2. Describe the location and functions of the heart. 3. What are the important contents of mediastinum? 4. Identify the major external features of the heart.
5. Comprehend the features of the chambers of the heart.
6. Discuss the surface anatomy of the heart and the great vessels and its clinical implications.
7. Compare the pulmonary and systemic circulation.
8. Identify the auscultatory point of mitral, aortic, pulmonal, and tricuspid valves. 9. Identify the intercostals space and important lines according to the heart lining. SELF ASSESSEMENT:
1. Identify the structures that build the arterial system and how the oxygenated blood flows through the body?
2. Identify on heart specimens: the four chambers of the heart; the atrioventricular, pulmonary, and aortic valves; papillary muscles and tendinous cords. Discuss their functions.
3. Identify and list all the openings in and out of each cardiac chamber. 4. Named the three layers of the heart’s wall from deep to superficial.
5. Describe the structures, locations and functions of the skeleton of the heart.
6. The heart has an apex, base, surfaces and borders, identify the structures that formed each of them.
7. Describe how the percussion of the heart performed.
8. Identify the atrioventricular and interventricular grooves and list the structures lie in them.
9. The surface anatomy of heart: identify in your friend chest the important lines: midclavicular line, midsternal line, sternal line, parasternal line, axillary line, sternal angle, jugular notch (incisura jugularis), and intercostals space. Feel and locate the apex beat of the heart.
MODULE 2
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dr. I G N Mayun, PHK & dr. Made Muliarta M.Kes
AIMS:
1. Describe the microscopic structure of the cardiovascular system
2. Comprehend the basic principles and practical implications of the heart as a pump
LEARNING OUTCOME:
1. Can describe the microscopic structure of the cardiovascular system
2. Can comprehend the basic principles underlying normal and abnormal myocardial, endocardial, and pericardial functions, including some common practical implications (the heart as a pump)
CURRICULUM CONTENS:
1. The microscopic structure of heart (type of the myocardio cytes and the valves) 2. The normal and abnormal heart wall and pericardial structures.
3. Describe Function of the heart
4. Describe the function of the heart as a pump 5. Describe cardiac cycle
ABSTRACT I:
The cardiovascular system is a part of the circulatory system that composed of the heart as a pump and blood vessels. The heart is musculatory organ consist of four chambers: two atria and two ventricles that separated by atrioventricular septal. The muscular wall of the heart is composed of cardiac muscle and the heart has three layers: endocardium, myocardium and epicardium. Myocardium is the thick middle layer of the heart composed of cardiac muscle cells.
Epicardium is the outhermost layer of the heart and also called the visceral layer of the pericardium. The subepicardial layer of loose connective tissue contains the coronary vessels, nerves and ganglia.
The endocardium, a simple squamous epithelium and underlaying subendothelial connective tissue lines the lumen of the heart. Deep to the endocardium is a subendocardial layer of loose connective tissue that contains small blood vessels, nerve and Purkinje fibers.
The atria separated from ventricles by atrioventricular septal in which houses of atrioventricular orifice at both right and left side of the heart.
At left atrioventricular orifice attached the mitral valves and at right atrioventricular orifice attached the tricuspidal valves. Both valves attached by chorda tendinae (a dense fibrous connective tissue) that connect to papillary muscles of ventricles preventing incompetence of the valves during ventricular contraction (systole).
The vascular components of the the cardiovascular system consist of arteries, capillaries and veins. The classification of blood vessels (artery and vein) based on their lumina diameter and composition of tissues in their wall.
The complete microscopic structure of blood vessels presents in muscular type of the arteries that composed of both the intima, media, adventisia layers with internal and external elastic membranes.
SA and AV node are specialized cardiac myocytes make up conducting system of te heart SA and AV node as a pace maker of the heart that impulse begin from SA node will referred to AV node via internodal pathway, bundle of His and spread to left and right branches to exite ventricular muscles of the heart
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ABSTRACT II:
The cardiovascular system serves a number of important functions in the body. Most of these support other physiological systems. The major cardiovascular functions divided into five categories: 1.delivery; 2. removal; 3. transport; 4. maintenance; 5. prevention. Any system of circulation requires three component : 1. a pump (the heart); 2. a system of channels (the blood vessel); 3. a fluid medium (the blood).
The heart is two pumps in series (the right and left sides) that are connected by pulmonary and systemic circulations. The heart consists of four chambers : the right atrium, right ventricle, left atrium, and left ventricle. The right atrium receives oxygen poor blood from systemic veins; blood moves to the right ventricle and is pump out to the pulmonary arteries to the lungs. The left atrium receives oxygenated blood from pulmonary veins; and moves to the left ventricle and is pump out the systemic arteries to the body tissues.
Each side of the heart consist of two valves that normally maintain one way flow of blood. Atrioventricular (AV) valves separate the atria from the ventricle.
a. The right AV valve is the tricuspid valve. b. The left AV valve is the mitral valve
c. These valves open during ventricular relaxation (diastole) to allow blood flow to the ventricles and close during ventricular contraction (systole) to prevent back flow (regurgitation) of blood from the ventricles into the atria
Semilunar valves (aortic and pulmonary) open during systole to allow blood flow from ventricles to the aorta and pulmonary artery. Semilunar valves close to prevent back flow of blood into the ventricles during diastole.
Closure of the heart valves produce mechanical vibration which are audible at the chest wall as the heart sound. The first heart sound is caused by closure of the atria-ventricular (AV) and the second heart sound is caused by closure of the aortic and pulmonary valves. A heart murmur is a condition in which abnormal heart sound are detected with the aid of stethoscope.
The cardiac events that occur from the beginning of one heartbeat to the beginning of the next are called the cardiac cycle. Each cardiac cycle is initiated by spontaneous generation of an action potential in the sinus node, in which the normal rhythmical impulse is generated and spread the cardiac impulse to all parts of the ventricles.
Cardiac cycle consists of a period of relaxation called diastole, the time during which cardiac muscle relaxes and contraction called systole, the time during which cardiac muscle is contracting. The atria and ventricles do not contract and relax at the same time. Standard References:
1. Gartner LP, Hiatte JL: Color Textbook of Histology, 2nd ed. Philadelphia, WB Saunders Company, 2001. p. 251- 265; 267-268; 268-269
2. Guyton AC: Medical Physiology, 11st ed. Philadelphia, Elsevier Saunders Company, 2006. p. 104-106, 116-122
Additional reading:
1. Fowcett DW, Jensh RP: Bloom & Fawcett’s Concise Histology, 2nd ed. London, Arnold. 2002. p. 135-136 ; 136-145; 136-139
SELF DIRECTING LEARNING
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1. Three layers of the heart, the connective tissue that support the heart and microscopic of the valves
2. Functions of Heart Valves 3. Blood flow
SCENARIO:
CASE:
A young man who was stabbed (about 5cm depth) in the chest was rushed to a hospital. The stab wound was in the 3rd left intercostals space, just lateral to the sternum. The emergency physician noted that the veins of his face and neck were engorged.
LEARNING TASK I:
1. Describe the microscopic structure of the heart? 2. Describe the three types of myocardium(cardiocytes)
3. How do you differentite the myocardium ( mucle of the heart) and purkinje fiber 4. Describe the microscopic structure of the conducting system in the heart (SA, AV,
and bundle of his)
5. Describe microscopic structure of the authoritmic cells fibers and contractile cell fibers of the myocardium.
6. Descibe the microscopic structure of the heart valves? LEARNING TASK II:
1. Describe the general functions of the cardiovascular system
2. Describe function of the heart provides the driving force for the cardiovascular system
3. Why do the ventricles contract as a single unit
4. Describe the pressure changes that occur in the ventricles during the cardiac cycle and relate these changes to the action of the valves and the blood flow
5. Explain the origin of of the heart sounds and when its produce during cardiac cycle 6. Name and explain the phases of cardiac cycle
SELF-ASSESSMENT I:
1. What are the basic structures of the heart wall? 2. What structures are form the endocardium?
3. Do you able to describe he relation of the endocardium and endothelium of the blood vessels that entering and leaving the heart?
4. Explain the microscopic structure of the purkinje fiber. Where does it location? 5. What is cardiac skeleton?
6. What are it components?
7. Explain the microscopic structure of the heart valves?
SELF-ASSESSMENT II:
1. What are major function of cardiovascular system?
2. What are three basic components of the cardiovascular system and it’s function? 3. Explain the origin of the heart sound and when its produce during cardiac cycle! 4. Describe function of the heart provides the driving force for the cardiovascular
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MODULE 3
dr. Made Muliarta, M.Kes
AIMS:
1. Comprehend the basic principles of Cardiac Action Potential 2. Comprehend the basic principles of Intrinsic Conduction System LEARNING OUTCOME:
1. Comprehend the functional structure of the conduction system and cardiac action potensial of the heart and its clinical implications
CURRICULUM CONTENS:
1. Mechanism of action potential 2. Conduction pathway of the heart
.ABSTRACT:
The intrinsic conduction system sets the basic rhythm of the heartbeat. It consists of auto rhythmic cardiac cell that initiate and distribute impulses (action potentials) throughout the heart.
The intrinsic conduction system of the heart initiates depolarization impulses. Action potentials spread throughout the heart (SA node, internodal pathways, AV node, AV bundle, bundle branches, Purkinje fibers ) causing a coordinated heart contraction (excitation contraction coupling).
Initiation of action potential in autorhythmic cells :
1. Pacemaker potential due to slow continous influx of sodium and reduced efflux of potassium
2. Depolarization and reversal of membrane potential 3. Repolarization due to rapid efflux of potassium. Action potential in contractile cells :
1. Opening of voltage regulated fast sodium channel triggered by entry of positive ion from adjacent cell depolarization due to rapid influx of sodium
2. Plateau produced by calcium influx balancing potassium efflux. 3. Repolarization due to efflux of potassium.
Plateau has important functional consequences for the mechanical activity of the heart An ECG wave tracing records the electrical activity of the heart. This is an important clinical tool, used both in the diagnosis of abnormal cardiac rhythms (arrhythmias) or defects in the conduction pathways and when investigating possible damage to the bulk of the myocardium e.g cause by ischemia
Standard Reference :
1. Guyton AC: Medical Physiology, 11st ed. Philadelphia, Elsevier Saunders Company, 2006. p. 104-106, 116-122
SELF DIRECTING LEARNING
Basic knowledge that must be known: 1. Autorhythmic cells potential
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2. Contractile cells potential 3. ECG wave tracing LEARNING TASK:
1. Describe the excitation – contraction process
2. What is the pace maker of the heart in normal condition
3. Describe the pathway of electrical conduction of the heart, starting with the SA Node
4. Describe the electrical activity of the cells of the SA Node 5. How the SA node functions as the normal pacemaker SELF-ASSESSMENT :
1. Describe the action potential of the cells of the SA Node 2. Describe the action potential of the cells of the contractile cells 3. Explain the relationship between cardiac cycle and ECG trace wave
MODULE 4
Prof. dr. D.P. Sutjana, PFK, Merg
AIMS:
1. Comprehend the cardiac output
2. Comprehend the basic principles of cardiac output regulation LEARNING OUTCOME:
1. Describe how to measure cardiac output 2. Describe the regulation of cardiac output CURRICULUM CONTENS:
1. Components of cardiac output 2. Factors influence cardiac output ABSTRACT;
The cardiac out put (COP) is the quantity of blood pumped into the aorta each minute by the heart. The outputs of the two sides of the heart are normally equal. Cardiac output is determined by two feature of cardiac function, the heart rate and the volume of blood ejected during a single contraction of the ventricle (the stroke volume). COP is defined as the amount of blood pumped per ventricle per unit time. It can be calculated by multiplying heart rate by stroke volume.
When a person is at rest, the heart pumps only 4 to 6 liters of blood each minute. During severe exercise, the heart may be required to pump four to seven times this amount. The basic means by which the volume pumped by the heart is regulated are: intrinsic cardiac regulation of pumping in response to changes in volume of blood flowing into the heart and control of heart rate and strength of heart pumping by the autonomic nervous system.
The intrinsic ability of the heart to adapt to increasing volumes of inflowing blood is called the Frank-Starling mechanism of the heart. The Frank-Starling mechanism means that the greate the heart muscle is stretched during filling, the greater is the force of contraction and the greater the quantity of blood pumped into the aorta.
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The pumping effectiveness of the heart also is controlled by the sympathetic and parasympathetic (vagus) nerves, which abundantly supply the heart. The amount of blood pumped each minute often can be increased more than 100 percent by sympathetic stimulation. By contrast, the output can be decreased to as low as zero or almost zero by vagal stimulation.
Standard References :
1. Guyton AC: Medical Physiology, 11st ed. Philadelphia, Elsevier Saunders Company, 2006. p. 111-115, 232-245
SELF DIRECTING LEARNING
Basic knowledge that must be known: 1. Components of Cardiac output 2. Factors influence Cardiac output SCENARIO:
CASE :
A woman, 45 year old, bus passenger from Jakarta to Bali went to see his physician complained about swelling of ankles and feet.
LEARNING TASK:
1. Why are the ankles and feet swelling?
2. What do you expect of stroke volume in this patient?
3. Describe how the stroke volume is intrinsically regulated by the end-diastolic volume
4. What should you suggest for this complaint? SELF-ASSESSMENT :
1. Describe the effects of autonomic nerve stimulation on the cardiac rate and stroke volume
2. List the factors that affect venous return.
3. Using a flowchart, show how an increased venous return can result in an increased cardiac out put
4. What is the name of the name of the structure that the margin of the valves attached?
5. Describe the chorda tendinae?
6. Where are the location of the valves in the heart?
MODULE 5
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Prof. dr. D.P. Sutjana, PFK, Merg
AIMS:
1. Comprehend the function of blood vessels 2. Comprehend the regulation of blood flow
LEARNING OUTCOME:
1. Describe the function of blood vessels 2. Describe the regulation of blood flow
CURRICULUM CONTENS:
1. Components of blood vessels 2. Factors influence blood flow ABSTRACT
The blood vessels of the body form a closed delivery system that begins and ends at the heart. Of the three types of vessels, arteries have the thickens tunica media (allowing stretch / recoil and vasoconstriction), vein have relatively thick tunica adventitia (reservoir vessel) and capillaries are the thinnest (allowing exchanges of material ).
One of the most basic principles of circulatory function is the ability of each tissue to control its own local blood flow in proportion to its metabolic needs. We shall see that nervous control the circulation has more global functions, such as redistributing blood flow to different areas of the body, regulating heart pumping, and providing very rapid control of systemic arterial pressure. The nervous system controls the circulation almost entirely through the autonomic nervous system.
Blood flow through individual organs is controlled intrinsically in respons to local tissue requirements. This phenomenon is called Autoregulation. When true capillaries are flushed with blood, exchange occurs between the capillary blood and tissue cells.
Arterial system consists of conducting arteries, distributing arteries and arterioles. Conducting arteries are the largest vessels of the body, begins with the aorta, a single artery with a large diameter, have generous amount of intramural elastic tissue. Elastic tissue permits both stretch of the wall during the ejection phase of cardiac systole and a propulsive elastic recoil during ventricular diastole. Weakness of the aortic wall result in enlargement of the lumen called aortic aneurysm.
Distributing arteries give off by the aorta, account for the remaining named arteries of the body and progressively divide into arteries with smaller and smaller diameter. Arterial anastomoses permit equalization of pressure and alternate channel of supply, abundant anastomoses occur in the region of joints in which movement might temporary occlude the main channel. Cerebral arterial cycle equalizes the blood supply to the brain. End arteries supply discrete regions of tissue that have no direct anastomoses between them (no collateral supply), found in the heart, kidney, liver, brain, and organs of gastrointestinal tract. A thrombosis or embolus lodged in an end-artery produces ischemia and necrosis (infarct) of the tissue.
Arterioles are the smallest arteries, nearly as small as capillaries, regulate the distribution of blood. Smooth muscle in the walls of arterioles control the size of the vessel lumen and the sympathetic innervation of vascular musculature regulates blood flow to the tissues.
Capillaries are exchange sites of the circulatory system and the total cross-sectional area is approximately 800 times that of the aorta. The velocity of circulation in
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the capillaries are very slow, changes from 0,5 m/sec in the aorta to 0,5 mm/sec in the capillaries.
Sinusoid substitute for capillaries in some organ, such as the liver, spleen, and red bone marrow, where circulation is slow.
Capillary beds drain into venules, the smallest vein, which come together to form veins that return blood to the heart at a lower pressure than arteries. Veins characteristically have large lumina, thin and relatively non muscular walls, relatively compressible by external forces which aids in blood flow. Valves in many veins limit flow proximally, toward the heart. Valves occur primarily in veins of limbs and movable viscera, but not in the cerebral veins. Pressure gradients between the periphery and the right side of the heart control venous flow.
Arteriovenous anastomoses permit direct transfer of blood from arterial to venous channels, bypassing the capillary bed. Usually occur in organs that function intermittently as in gut and skin.
The lymphatic system is composed of an extensive network of extremely variable lymphatic vessels and nodes, which serve as filters and a source of lymphocytes and plasma cells. Ascites is the accumulation of lymph (usually from the liver) in the peritoneal cavity. Pulmonary edema is caused by either increased permeability or a hydrostatic-osmotic pressure imbalance in the pulmonary vascular bed, result in fluid accumulation in the tissue spaces and transudation of fluid into the alveoli.
Standard References :
1. Guyton AC: Medical Physiology, 11st ed. Philadelphia, Elsevier Saunders Company, 2006. p. 161-170, 195-203
SELF DIRECTING LEARNING
Basic knowledge that must be known: 1. Components of blood vessels 2. Functions of each blood vessels
MODULE 6
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Dr. dr. I.P.G. Adiatmika, MKes & dr. I G N Mayun, PHK
AIMS:
1. Apply several factors that affecting blood pressure
2. Describe the microscopic structure of the vascular system LEARNING OUTCOME:
1. Can describe the stroke volume 2. Can describe the heart rate
3. Can describe several factors that affecting blood pressure
4. Can describe the microscopic structure of the vascular system (arterial and venous)
CURRICULUM CONTENS: 1. Frank Starlink Law
2. Factors influence blood pressure
3. Artery : elastic artery, muscular artery, arteriole and capiller Venae: large vein, midlle vein, small vein
ABSTRACT I :
The heart pumps blood continually into the aorta, as the blood flows through the systemic circulation, its mean pressure falls progressively to about 0 mmHg by the time it reaches the termination of the venae cavae where they empty into the right atrium of the heart.
Blood pressure (BP) is important indicator of the cardiovascular health. It is influenced by the contractile activities of the heart and conditions an activities of blood vessels.
1. Systolic pressure = highest pressure in artery result of ventricular contractions. 2. Diastolic pressure = lowest pressure in artery result of ventricular relaxation. 3. Mean arterial pressure (MAP) = diastolic pressure + 1/3 pulse pressure
When blood pressure is measured first sound indicate systolic pressure, end of sounds indicate diastolic pressure.
Blood pressure is affected by several factors: peripheral resistance, vessel elasticity, blood volume and cardiac output. Blood cells and plasma encounter resistance when they contact blood vessel walls. If resistance increases, then more pressure is needed to keep blood moving. Smaller blood vessel diameter cause more fluid in contact with wall and greater resistance, finally greater pressure. In addition, blood volume affects blood pressure. Greater volume of fluid in blod vessel cause more fluid pressing against walls and greater pressure. Cardiac output also has direct effect on blood pressure.
Cardiac output = Heart rate x Stroke volume ABSTRACT II;
The vascular components of the the cardiovascular system consist of arteries, capillaries and veins. The classification of blood vessels (artery and vein) based on their lumina diameter and composition of tissues in their wall. The complete microscopic structure of blood vessels presents in muscular type of the arteries that composed of both the intima, media, adventisia layers with internal and external elastic membranes. The coronary vessels are very important artery that serving the myocardium.
Atherosclerotic plaques reduce the lumina of the coronary vessels, may cause referred pain and pressure known as angina.
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1. Fox S.I.: Human Physiology, 9th ed. New York, McGraw-Hill, 2006. p. 448-454 2. Gartner LP, Hiatte JL: Color Textbook of Histology, 2nd ed. Philadelphia,
WB Saunders Company, 2001. p. 251-262 SELF DIRECTING LEARNING
Basic knowledge that must be known: 1. Frank Starlink law
2. Autonomic activation 3. The roles of several ions
4. Microscopic structure and classification the artery and vein LEARNING TASK:
1. Explain the blood pressure in the various parts of the vascular system
2. Explain how the baroreceptor reflex helps to compensate for a fall in blood pressure?
3. Why will a person who is severely dehydrated have a rapid pulse? 4. What are the pulse pressure and mean arterial pressure?
5. What is the effect of epinephrine in blood pressure?
6. Explain why a person in hypovolemic shock may have a fast pulse and cold clammy skin?
7. Describe the microscopic the structure of the coronary artery (muscular type artery)
8. Diffrentiate the muscular and elastic type artery. 9. Describe the microscopic the structure of the arteriole.
10. Describe the microscopic the structure of the capillary and it classification SELF-ASSESSMENT :
1. Explain why a person in severe dehydrated may have low blood pressure 2. Why a person with atherosclerosis may have high blood pressure
3. What are the main composition of the tunica media of the elastic artery? 4. Explain the variation of the tunica media of the blood vessel!
MODULE 7
Prof. dr. D.P. Sutjana, PFK, Merg
AIMS:
Comprehand the basic principles underlying myocard perfusion LEARNING OUTCOME:
1. Can describe how myocardial perfusion occurs
2. Can describe functional structure of the coronary arteries CURRICULUM CONTENS:
1. Function of coronary artery 2. The role of diastole
ABSTRACT ;
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Blood perfusion to the myocardium build by the reverse flow of blood during diastole and the autoregulation of the intramyocardial arterioles through the coronary arteries.
Epicardial coronary arteries serve as conduit, entered deep to the myocardium: intramyocardial arterioles referred as resistance vessels.
Right and left coronary arteries begin from the sinuses behind the right and left semilunar cusps of the aortic valve. They distribute blood in large part to their own half of the heart.
Blood flow in the coronary arteries is maximal during diastole and minimal in systole. During systole, no pressure differential exist between the myocardium and the left ventricle, flow is not possible. During diastole, a pressure differential does exist and the elasticity of the aorta propels blood through the coronary circulation.
Standard References
1. Moore KL, Agur AMR: Essential Clinical Anatomy, 3rd ed. Philadelphia, Lippincott & Wilkins, 2007. p. 37-38, 95-99, 101
2. Guyton AC: Medical Physiology, 11st ed. Philadelphia, Elsevier Saunders Company, 2006. p. 181-185; 249-256.
Additional reading :
1. Fowcett DW, Jensh RP: Bloom & Fawcett’s Concise Histology, 2nd ed. London, Arnold. 2002. p. 136-141
SELF DIRECTING LEARNING
Basic knowledge that must be known: 1. Systole-diastole
2. The function of coronary artery 3. Post exercise hypotension SCENARIO
CASE 1.
A 45-year-old woman was playing tennis and suddenly fell, complaining of a severe pain in her chest and down her left arm. Her playing partner rushed her to the hospital.
LEARNING TASK:
1.
What likely caused the pain in the women’s chest and arm?2.
Name the blood vessels that supply the heart.3.
Where they arised from?4.
List 4 major branches of the right coronary artery.5.
List 3 major branches of the left coronary artery.6.
Is the visceral pain from the chest usually referred to the left arm?7.
Where the most purposeful function of the circulation occur?8.
What the most important function of lymphatic capillaries in the microcirculation?9.
How the cell nutrients from capillaries entered the muscle cells of the heart?10.
How the cell excreta entered the capillaries?SELF-ASSESSMENT
1. Describe the arterial supply of the heart.
2. What are the symptoms of sudden occlusion of the major coronary artery?
3. Define the terms: arteriole, metarteriole, precapillary sphincter, anastomosis, collateral circulation, true terminal (end) arteries and functional terminal arteries in conjunction with coronary arteries.
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4. Discuss the terms: arteriosclerosis, thrombosis and atheromatous plaque. 5. Which condition stimulates pain endings in the myocardium?
6. Describe the cardiac referred pain
MODULE 8
Dr. dr. I.P.G. Adiatmika, MKes
AIMS:
Comprehend the basic principles underlying Blood Pressure Regulation LEARNING OUTCOME:
1. Can describe the basic principles underlying Blood Pressure Regulation CURRICULUM CONTENS:
1. Two basic mechanisms for regulating blood pressure. 2. The nervous system controls the circulation.
ABSTRACT:
There are two basic mechanisms for regulating blood pressure.
In short term mechanism, which regulate blood vessel diameter,heart rate, and contractility. Rising blood pressure stimulates increased parasymphatetic activity which leads to reduce heart rate (HR), vasodilation and lower blood pressure. Falling blood pressure stimulates increased sympathetics activity, which leads to increase HR, contractility, vasoconstriction, and rises blood pressure. Long term regulation, which regulate blood volume. Long term regulation involves renal regulation of blood volume (BV) via the rennin – angiotensin mechanism and aldosteron mechanism. Increase blood osmolarity stimulate antidiuretic hormone (ADH) which promote reabsorption of water and stimulates the thirst center, resulting in increase BV and BP
The nervous system controls the circulation almost entirely through the autonomic nervous system. The innervation of the small arteries and arterioles allows sympathetic stimulation to increase resistance to blood flow and thereby to decrease rate of blood flow through the tissues. The innervation of the large vessels, particularly of the veins, makes it possible from sympathetic stimulation to decrease the volume of these vessels. The effects of parasympathetic stimulation on heart function causes decrease heart rate and slide decrease in heart muscle contractility.
The body also has powerful mechanisms for regulating arterial pressure week after week and month after month. This long term control of arterial pressure is closely intertwined with homeostasis of body fluid volume, which is determined by the balance between the fluid intake and output.
Standard References
1. Guyton AC: Medical Physiology, 11st ed. Philadelphia, Elsevier Saunders Company, 2006. p. 161-170, 205-23.
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SELF DIRECTING LEARNING
Basic knowledge that must be known:
1. Short term mechanism for regulating blood pressure 2. Long term mechanism for regulating blood pressure 3. The nervous system controls the circulation
SCENARIO
CASE :
A woman, British, 30 year old, 60 kg, lie down in the beach under the sun exposure without drink enough water. Few hours after, she complains about weakness, dizziness, redness on the skin and feel hot. Pulse rate about 105 x/mnt
LEARNING TASK:
1. Predict the blood pressure in this patient? Why 2. Why the patient may have rapid pulse rate?
3. Explain two basic mechanisms for regulating blood pressure?
4. Describe the baroreceptor reflex and explain its significance in blood pressure regulation
SELF-ASSESSMENT :
1. Provide an integrated description of how nerves and hormones regulate blood pressure
2. Explain reflexes that responsible for short term control and long term control mechanisms to blood pressure
MODULE 9
dr. I Gusti Ayu Widianti, M.Biomed
AIMS:
Describe the basic principles underlying the formation of anomalies of the heart and great vessels
LEARNING OUTCOME:
1. Can describe the basic principles underlying the formation of anomalies of the heart and its impilcations
2. Can describe the basic principles underlying the formation of anomalies of the great vessels and its impilcations
CURRICULUM CONTENS: 1. Embryology of the heart
2. Embryology of the great vessels. ABSTRACT
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Septal defects are only problematic when the shunt flows from right-to-left. Anomalies of interventricular septum (VSD) is usually happened at the upper membranous portion that composed of connective tissue continuous with the annulus fibrosus. A small VSD may result in an inconsequential left-to-right shunt.
In the presence of pulmonary stenosis, a VSD produces a right-to-left shunt with cyanosis and the blue-baby syndrome. A large VSD is a principal factor in Tetralogy of Fallot.
Atrial septal defects (ASD) are most common in the vicinity of the fossa ovalis. Septum secundum defects, the typical patent foramen ovale, account for 10-15% of all cardiac anomalies. Normal left atrial pressure is slightly greater than right atrial pressure, a left-to-right shunt occur through an open ASD, oxygenated blood from the left side of the heart is shunted to the right side, thus not associated with cyanosis. An ASD is usually compatible with normal life, except at an extreme exercise, cardiac disease, or pulmonary disease alter chamber pressures, a right-to-left shunt will produce cyanosis.
Patent ductus arteriosus (PDA) is a persistence of the fetal connection (ductus arteriosus) between the aorta and pulmonary artery after birth, resulting in a left-to-right shunt. Symptoms may include failure to thrive, poor feeding, tachycardia and tachypneu. A continous machine-like murmur in the upper left sternal border is common. Diagnosis is by echocardiography.
Standard References:
1. Moore KL, Agur AMR: Essential Clinical Anatomy, 3rd ed. Philadelphia, Lippincott & Wilkins, 2007. p. 91, 93, 94
2. Sadler TW: Langman’s Medical Embryology, 10th ed. Philadelphia, Lippincott &
Wilkins, 2006. p. 167-178, 184 SELF DIRECTING LEARNING
Basic knowledge that must be known: 1. Embriologi of the heart
2. Embryology of the geart vessel SCENARIO:
CASE 1;
This baby aged 4 months has been known to have a cardiac murmur since birth. He was born 8 weeks prematurely and developed respiratory distress requiring high oxygen concentration for the first week. Since then he has feed satisfactorily but height and weight growth have been poor even allowing for prematurity.
The diagnosis after examination and investigations: Patent Ductus Arteriosus (PDA). LEARNING TASK I
1. What factors in the history were of possible importance in causing the ductus remain open? Why there is no cyanosis in this case?
2. Why is there no cyanosis in this case?
3. Why was the heart murmur audible in diastole as well as systole?
4. Why is there evidence of left ventricular hypertrophy and not right ventricular hypertrophy?
5. Why is there pulmonary congestion?
6. Why the shunt from aorta to pulmonary artery and not vice versa?
7. After an operation to close the PDA, why is there a risk of the patient becoming hoarse?
CASE 2 :
This 13 year old girl was recently found to have a cardiac murmur. She has been generally healthy with good growth, but on questioning her mother admitted she has noticed that girl tends to tire easily with exercise.
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The diagnosis after examination and investigations: Atrial Septal Defect (A.S.D.) LEARNING TASK II:
1. Why is there a mild chest deformity with a bulge in the thoracic cage to the left of the sternum?
2. Why is there no cyanosis?
3. Why does the right ventricle carry a volume load in A.S.D., while it is the left ventricle in PDA. Both are left-to-right shunt. Consider the appropriate anatomy involved.
4. Why is there a systolic murmur over the pulmonary valve and a diastolic murmur over the tricuspid valve?
CASE 3 :
A 2 year old boy was admitted to the hospital for evaluation of a heart murmur previously detect at birth. He was less active than other children his age, but although over-exertion was followed frequently by cyanosis of the lips and nails, there was no history of unconsciousness. Initial examination revealed a thin, physically retarded, cyanotic child with no respiratory difficulty. There was moderate clubbing of the fingers. A harsh systolic murmur was maximal over the mid-precardial area. The first heart sound was normal while the second was single, distinct and loud.The lungs were clear. X-ray showed a normal sized heart dominated by a boot-shaped right ventricular outflow tract.
Diagnosis of Tetralogy of Fallot. LEARNING TASK III:
1. Mention the cardiac abnormality you found in this case. 2. What is the basic defect of this heart malformation?
3. What is the most important abnormality causing cyanosis? 4. Why was he less active than other childres his age? 5. Why is he revealed thin and physically retarded? 6. Why was there clubbing of his fingers?
SELF-ASSESSMENT :
1.
Describe the principal normal development of the heart and pericardium.2.
Named the most common congenital anomalies of the heart with their clinical implications.3.
Describe the abnormities, the hemodynamic changes, the incidence and the clinical implications in general population of ventricular septal defect (VSD), Tetralogy of Fallot, and atrial septal defect (ASD).4.
Describe the blood flow before and after birth and changes occur in the vascular system after birthMODULE 10
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Prof dr. I Wayan Wita, SpJP
AIMS:
Able to do and practice the approach to patient with cardiovascular disease (common cardiological symptoms and consultations and investigations in Cardiology).
LEARNING OUTCOME:
1. Able to do and practice the approach to patient common cardiological symptoms
2. Able to do and practice the approach to consultations with cardiovascular disease
3. Able to do and practice the approach to investigations in Cardiology). CURRICULUM CONTENS:
1. The symptoms of the cardiovascular disease
2. The diagnostic tools to confirm patients with Cardiovascular Diseases ABSTRACT:
History taking remains the most important component of diagnostic process. Often diagnosis can be made from the history alone, with examination and investigations only serving to confirm it. Chest pain is a common symptom. Breathlessness caused by left ventricle failure may present as orthopnoea and paroxysmal nocturnal dyspnoea. Palpitation is usually a benign symptom unless it is accompanied by syncope or presyncope.
Cardiovascular examination begins the moment the patient enters the room. Is the patient pale, breathless or anxious? Examine the pulse, and check the pulse character. The blood pressure and auscultation should be performed in appropriate manner. The electrocardiogram (ECG) and chest-x ray remain the most valuable cardiac investigation in clinical practice. 24-hour ECG recording is most useful in those with very frequent arrhythmia symptoms. Stress testing is performed for 2 main reasons: to diagnose ischaemic heart disease and to assess prognosis. Echocardiography provides both structural and functional information that assists in the diagnosis of many cardiac conditions. Cardiac catheterization is an invasive procedure that assess systemic and pulmonary haemodynamic variables, as well as oxygen saturations and intracardiac shunts. It assess aortic, valvular, left ventricular and coronary artery structure and function. The assessment for coronary artery disease is the main indication.
The imaging investigation of the heart may be considered under the following: 1. Chest X-ray
The chest radiograph was one of the first clinical examinations to use the then-new technology of diagnostic radiography. It remains the most common x-ray examination and one of the most difficult examinations to interpret. With careful evaluation, it yields a large amount of anatomic and physiologic information. Chest X-ray remain the valuable cardiac investigation in clinical practice.
Radiologic method used in the roentgen cardiac examination: 1. Posteroanterior projection, PA/AP
2. Lateral projection
3. Right anterior oblique projection (RAO) 4. Left anterior oblique projection (LAO)
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Increase in cardiac size is the most consistent indication of cardiac disease 2. Computed tomography (CT-scan)
The basic principle of CT technology is the use of ionizing radiation within a gantry rotating around the patient in which x-rays are detected on a detector array and converted through reconstruction algorithms to images. It is these images, acquired at high spatial and temporal resolution, that have enabled cardiovascular medicine to enter the CT imaging era
3. Magnetic resonance imaging (MRI)
Over the past decade, cardiac magnetic resonance (CMR) has developed into a routine clinical imaging tool. With excellent spatial and temporal resolution, unrestricted tomographic fields, and no exposure to ionizing radiation, CMR offers detailed morphologic and functional characterization for most types of heart disease
4. Echocardiography
Echocardiography remains the most frequently used and usually the initial imaging test to evaluate all cardiovascular diseases related to a structural, functional, or hemodynamic abnormality of the heart or great vessels. Echocardiography uses ultrasound beams reflected by cardiovascular structures to produce characteristic lines or shapes caused by normal or altered cardiac anatomy in one, two, or three dimensions by M (motion)–mode, two-dimensional, or three-dimensional echocardiography, respectively. Doppler examination and color flow imaging provide reliable assessment of cardiac hemodynamics and blood flow.
5. Angiocardiography
Angiography is a technique used to visualize the lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins, and the heart chambers. This is traditionally done by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques such as fluoroscopy.
6. Cardiac catheterization
Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. Subsets of this technique are mainly coronary catheterization, involving the catheterization of the coronary arteries, and catheterization of cardiac chambers and valves of the Cardiac System.
7. Nuclear Cardiology
The era of noninvasive radionuclide cardiac imaging in humans began in the early 1970s with the first reports of noninvasive evaluation of resting myocardial blood flow. Since that time, there have been major advances in the technical ability to image cardiac physiology and pathophysiology, including that of myocardial blood flow, myocardial metabolism, and ventricular function.
Standard References :
1. McPhee SJ, Papadakis MA. Current Medical Diagnosis & Treatment. 47th ed. New York: Lange Mecical Book`s/The McGraw-Hill Companies, 2008.p.
2. Roentgen Signs in Diagnostic Imaging Isadore Meschan
SELF DIRECTING LEARNING
Basic knowledge that must be known: 1. History taking
2. Common cardiological symptom and consultation 3. Investigation in Cardiology
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LEARNING TASK I:
Investigation in pediatric cardiology
1. When you suppose that the patient may be suffering from CHD.
2. Which one who is the most sensitive sign and applied as the best screening of CHD.
3. What is the most specific sign of CHD.
4. Please explain sign of the left and right heart hypertrophy by inspection and palpitation.
5. Please mention diagnostic tool in pediatric cardiology. 6. When complete blood count should be perform.
7. Please describe site of classic heart sound and characteristics of that. LEARNING TASK II:
Investigation in cardiology
1. Please explain the symptoms in patients with cardiovascular disease
2. What are the diagnostic tools to confirm patients with Ischaemic Heart Disease? 3. What is the benefit of 24-hour electrocardiogram?
4. What is the objective of performing stress testing (treadmill test)?
LEARNING TASK III:
RADIOLOGY
1. What are the basic projections for cardiac radiography? 2. Explain normal anatomy of the heart on the chest x-rayZ? 3. Explain cardiac enlargement on the chest x-ray?
SELF ASSESSMENT :
1. Please explain the symptoms in patients with cardiovascular disease
2. What are the diagnostic tools to confirm patients with Ischaemic Heart Disease? 3. What is the benefit of 24-hour electrocardiogram?
4. What is the objective of performing stress testing (treadmill test)? 5. Please describe the chest x-ray finding in VSD
6. Differenciated between LVH and RVH on chest x-ray 7. Explain HHD on the chest x-ray
8. Explain tetralogy of Fallot on the chest x-ray
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MODULE 11 & 12
dr. Bajra Nadha, Sp.JP
AIMS:
Able to physical examination the cardiovasculer system LEARNING OUTCOME:
1. Able to physical examination and diagnostic the cardiovasculer system.
CURRICULUM CONTENS:
1. Evaluate General Appearance (inspection)
2. Blood Pressure Examination, The Arterial Pulse, The Jugular Venous Pulse evaluation.
3. Percussion, Palpation, Auscultation
ABSTRACT :
Physical examination is the procedure should be done to obtain any data from the patient. For cardiovascular system we should do the examination carefully. The physical examination for cardiovascular system consist of evaluate general appearance, blood pressure examination, arterial pulse evaluation, the jugular venous pressure, and percussion, palpation, auscultation, and examination for any edema.
Each of the procedure will reveal specific data from the patient. For cardiovascular system, auscultation will plays an important role in diagnosing the patient. From auscultation we should obtain the heart sound quality and identifying any murmur present. From percussion we should obtain any enlargement of the heart.
Physical examination skills in cardiovascular medicine have declined. Only minority has recognized classic cardiac finding in relevant disease. Bedside skills has decreased because on widely use of non invasive imaging technique. But still, cardiac bedside examination become cornerstone in diagnosis patient with cardiovascular disease. Physical examination can help determine the cause of given symptom, assess disease severity and progression, and evaluate the impact of specific therapies. It also can identify the presence of early stage disease in patients without signs or symptoms.
The examination begins with an appreciation of general appearance of the patient, including age, posture, demeanor, and general health status. Continue to the skin, looking for cyanosis, jaundice, ecchymosis, xanthoma and any other specific cardiac sign. On the head and neck we can assess sign of congenital anomalies, such as hypertelorism, low-set ears, micrognathia, and webbed neck in Noonan, Turner and Down Syndrome. From extremities find out about clubbing fingers, arachnodactyly, and nail changes, may accompanying with specific cardiac disease. Cutaneous venous collaterals over the anterior chest suggest chronic obstruction of the superior vena cava (SVC) or subclavian vein. Thoracic cage abnormalities, sauch as pectus carinatum (pigeon chest) or pectus excavatum (funnel chest) may accompany connective tissue disorder; the barrel chest of emphysema or advanced kyphoscoliosis may be associated with cor pulmonale.
The cardiovascular examination include assessment of jugular venous pressure (JVP), measuring blood pressure, assessing the pulse and chest using inspection, palpation, percussion, and auscultation methods. Jugular venous pressure aids in the estimation of volume status. Superior vena cava syndrome should be suspected if venous pressure is elevated. Other conditions made increase in JVP such as congestive heart failure, cor pulmonale, tricuspid stenosis, restrictive cardiomyopathy and constrictive pericarditis. Blood pressure should be measured with patient in the seated position, with the arm at the level of the heart, using appropriate-sized cuff. The use of an
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inappropriately small cuff result in overestimation of the true blood pressure, an issue of particular relevance in obese patients.
Palpation of arterial pulse include carotid pulse and symmetrically extremities pulses. The contour of the pulses depends on the stroke volume, ejection velocity, vascular capacity and compliance, and systemic resistance. Bifid pulse is created by two distinct pressure peaks can occur normally in person with fever or after exercise. Pulsus paradoxus termed for fall in systolic pressure of more than 10mmHg with inspiration (this sign is pathologic of pericardial or pulmonary disease).
Inspection of the heart for apical heartbeat may be visible in thin-chested adults. In patient with enlarged and hyperdynamic left ventricle, the left anterior chest wall may heave. Left parasternal lift indicate RV pressure or volume overload. Palpation of the heart should begin with patient in the supine position inclined at 30 degrees. Left lateral decubitus position may help to intensify apex beat. Looking for point of maximal impulse (normally in the midclavicular line at the fifth intercostal space). It is smaller than 2cm in diameter and moves quickly away from the fingers. Percussion of the heart can be done to identify heart border on the chest wall. Enlargement of heart will be shown by passing the normal heart borderline.
Auscultation is one of the important and maybe difficult examination of the heart. Heart sound component include S1 and S2. S1 indicate the sound produced when mitral and tricuspid valves are closed in systole, and S2 indicate the sound produced when aortic and pulmonic valve are closed in diastole. Another S3 and S4 of heart sound can be audible in several pathologic condition. Heart murmur results from audible vibrations caused by increased turbulence and are defined by their timing within the cardiac cycle. There are systolic murmur, diastolic murmur, and continuous murmur. Knowing the type of murmur and its location are important to identify which cardiac valves problem are exist and for further management.
Standard Reference:
1. Mann, DL et all. Braunwald’s Heart Disease, 10th ed. Philadelphia, Elsevier Saunders, 2015. p. 118-132
Additional reading:
2. Constant, Jules. Essential of Bedside Cardiology, 2nd ed. New Jersey, Humana Press Inc. 2003
SELF DIRECTING LEARNING
Basic knowledge that must be known:
1. Evaluate General Appearance (inspection)
2. Blood Pressure Examination, The Arterial Pulse, The Jugular Venous Pulse evaluation.
3. Percussion, Palpation, Auscultation
TRAINING TASK:
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NO
ITEMS
SCORE
0
1
2
1 Evaluate General Appearance
1. Inspection of the skin, nails, facies, eyes, mouth
2. Inspection neck, chest configuration, extremities
2 Blood Pressure Examination
1. Determine blood pressure
2. Rule out orthostatic hypotension, coarctatio of the aorta, cardiac tamponade
3 The Arterial Pulse
1. Rate and rhythm of the heart 2. Countour of the pulse
3. Amplitude of the pulse
4 The Jugular Venous Pulse
1. Determine the jugular wave forms 2. Estimate the jugular venous pressure 3. Evaluate the hepatojugular reflux
5 Percussion
1. Heart’s borders
6 Palpation
1. Palpate the point of maximum impulse 2. Palpate for localized motion
3. Palpate for generalized motion 4. Palpate for thrills
7 Auscultation
1. Auscultate the cardiac areas 2. The Influence of breathing 3. Describe any murmur present
8 Examination for Edema
1. Test for Edema
SCORE --- =
(1)
Heart
8 Cardiac Out Put and Regulation of Heart Pumping
9 Factors that Affect Blood Pressure
Microscopic Anatomy of The Great Vessel 10 Microscopic Anatomy of The Great Vessel
11 Myocardial perfusion
12 Blood Pressure Regulation
13 The formation of anomalies of the heart and great vessels.
14 Approach to Patient With Cardiovascular Disease
15 Non-cyanotic & Cyanotic CHD
16 Acute Rheumatic Fever
17 Ischemic Heart Disease = ACS
18 Pathologic aspect of IHD
19 Drug used in Angina Pectoris
20 Arrhytmias
21 Antiarrhythmic Drugs
22 Hypertension
23 Antihypertensive Drugs 24 Heart Failure
25 Positive Inotropes
26 Common Peripheral Vascular and lymphatic disease
27 Cardiomyopathi
28 Valvular Heart Disease Pericardial & Endocardial Disease
29 Measure Workload
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31 ECG
32 Chest Imaging
33 IV line Procedure
B Learning strategy
1 Lecture
2 Independent learning 3 Small group discussion
4 Practical
5 Case based learning 6 Problem based learning 7 Learning task
8 Self assessment
C Lecturer
1. DR. dr. Ketut Rina, Sp PD, Sp JP 2. Dr. I G.N Mayun, PHK
3. Dr. I Gusti Ayu Widianti, M.Biomed
4. Dr. Made Muliarta, M.Kes 5. Prof. dr. Dewa Sutjana, M
6 DR. Dr. Adiatmika, M.For
7. Prof dr. I G M. Aman
8 DR. Wayan Sumardika
9 Dr. IGM Gd Surya Candra Trapika,MSc
10 Dr W. Winarti, SpPA
11 Dr. Eka Guna Wijaya, Sp A
12 Prof dr. Wita, SpJP 13 Dr. Susila Surya Darma
14 Dr. Bajra Nadha, SpJP
15 Dr. Junior Rina A, SpJP 16 Dr. Bagus Ari D, SpJP
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18 Dr. Luh Kamiati, SpRM 19 Dr. N. Semadi, SpB
D Facilitator
1 Name of your group facilitator:
E Assessment
1 Time provide
2 Suitability of question with topic given
Score:
1. Bad or not suitable with expectation 2. Insufficient or inadequate with expectation 3. Sufficient or inadequate with expectation 4. Good or suitable with expectation
5. Excellent or exceed expectation
Problem you found during Block Cardiovascular System and Disorders for each point evaluated above:
Topic
Learning strategy
Lecturer
Facilitator
Assessment
Your suggestion/input:
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Learning strategy
Lecturer
Facilitator
Assessment
11. ITEM GRID
Question type: MCQ with vignette
No
Topic
Number of
question
PIC
Vignette
1. Introduction lecture Prof dr. Wita 2 General anatomy, topography and
surface anatomy of the heart and great vessels.
Dr. IGA Widianti
3 Microscopic structure of the heart
wall and pericardial Dr. IGN Mayun
4 The heart as a pump Dr. Made Muliarta, 5 Intrinsic Conduction System and
Cardiac Action Potential Dr. Made Muliarta, 6 Heart Valves and Heart Sounds Prof. Dewa Sutjana 7 Microscopic Anatomy of The
Valves of The Heart
Dr. I G N Mayun 8 Cardiac Out Put and Regulation
of Heart Pumping Prof. Dewa Sutjana
9 Factors that Affect Blood
Pressure DR. Dr. Adiatmika,
10 Microscopic Anatomy of The
Great Vessel Dr. IGN Mayun
11 Myocardial perfusion Dr. Made Muliarta 12 Blood Pressure Regulation DR. Dr. Adiatmika,
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vessels.
14 Approach to Patient With
Cardiovascular Disease Prof Dr. dr. Wita, 15 Non-cyanotic & Cyanotic CHD &
Acute Rheumatic Fever
Dr. Eka Guna W 16 Acute and Chronic Cor-pulmonale Dr Bagus Ari S 17 Ischemic Heart Disease = ACS Dr. Ketut Rina 18 Pathologic aspect of IHD Dr W. Winarti 19 Drug used in Angina Pectoris Prof dr. IGM Aman 20 Valvular Heart Disease &
Pericardial & Endocardial Disease Dr. Bajra Nadha
21 Arrhytmias Dr. Bajra Nadha
22 Antiarrhythmic Drugs Dr. W. Sumardika
23 Hypertension Dr. Susila Surya D
24 Antihypertensive Drugs Dr. IGM Gd Surya Candra Trapika,
25 Heart Failure Dr. Junior Rina
26 Positive Inotropes Prof dr. IGM Aman
27 Common Peripheral Vascular
disease and lymphatic disease Dr. Nyoman Semadi
28 Cardiomyopathi Dr. Luh Kamiati,
29 CV Physical Examination Dr. Bajra
30 ECG Dr. Bajra
31 Measure Workload Dr. Muliarta
32 IV line procedure Prof Wiryana
33` Chest Imaging Dr Lisna Astuti
TOTAL
100
question
~ CURRICULUM MAP ~
Smstr
Program or curriculum blocks
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9 Senior Clerkship
8 Senior clerkship
7
Medical Emergency (3 weeks) BCS (1 weeks)
Special Topic: -Travel medicine (2 weeks)
Elective Study III
(6 weeks) Clinic Orientation(Clerkship) (6 weeks) 6 The Respiratory System and Disorders (4 weeks) BCS (1 weeks)
The Cardiovascular System and Disorders (4 weeks) BCS (1 weeks)
The Urinary System and Disorders (3 weeks) BCS (1 weeks)
The Reproductive System and Disorders (3 weeks)
BCS (1 weeks)
5
Elective Study II (1 weeks) Alimentary & hepato-biliary systems & disorders (4 Weeks) BCS (1 weeks)
The Endocrine System, Metabolism and Disorders (4 weeks) BCS (1 weeks)
Clinical Nutrition and Disorders
(2 weeks) BCS (1 weeks)
Special Topic : - Palliative medicine -Compleme ntary & Alternative Medicine - Forensic (3 weeks) Elective Study II (1 weeks) 4 Musculoskeletal system & connective tissue disorders (4 weeks) BCS (1 weeks)
Neuroscience and
neurological disorders (4 weeks) BCS (1 weeks)
Behavior Change and disorders (4 weeks) BCS(1 weeks) The Visual system & disorders (2 weeks) BCS (1 weeks) 3 Hematologic system & disor-ders & clinical oncology (4 weeks) BCS (1 weeks)
Immune system & disorders (2 weeks) BCS(1 weeks) Infection & infectious diseases (5 weeks) BCS (1 weeks)
The skin & hearing system & disorders (3 weeks) BCS(1 weeks) 2 Medical Professionalism (2 weeks) BCS (1 weeks)
Evidence-based Medical Practice (2 weeks) Health System-based Practice (3 weeks) BCS (1 weeks)
Community-based practice (4 weeks) Special Topic - Ergonomi - Geriatri (2 weeks) Elective Study I (2 weeks) 1 Studium Generale and Humaniora (3 weeks) Medical communication (3 weeks) BCS (1 weeks)
The cell as bioche-mical machinery (3 weeks) BCS(1 weeks) Growth & development (4 weeks) BCS: (1 weeks) Pendidikan Pancasila & Kewarganegaraan (3 weeks)