B9200 - Fisiopatologia dell'apparato cardiovascolare 1

Learning outcomes

At the end of the course, the student will have acquired knowledge on the main gender differences regarding the biological and pathophysiological mechanisms of the main valvulopathies, including the ability to apply diagnostic methods for diagnosis and for the choice of medical, surgical and interventional therapeutic strategies.

Course contents

(1) Anatomy and physiology of the cardiovascular system: fundamentals of anatomy of the heart and cardiovascular system. Heart valves. Anatomy and course of the coronary arteries. The mechanics of the heart muscle. Principles of electrophysiology. Excitation-contraction coupling. The electrical conduction system of the heart. The functional work of the heart. The pressure-volume curves. The large circulation. The small circulation.

(2) Diagnostic techniques: Principles of electrocardiography. Principles of echocardiography. The trans-esophageal echocardiogram. Cardiac catheterization. The anatomical study of coronary arteries. The coronary angiography technique. Radial access towards the femoral. Angiographic projections.

(3) Coronary heart disease: acute coronary syndrome. Pathophysiology of unstable plaque. Unstable angina versus NSTEMI versus STEMI: pathophysiology, differential diagnosis and treatment. The STEMI hub and spoke network. Discussion of clinical cases.

(4) Coronary heart disease: chronic coronary syndrome. Pathophysiology of stable plaque. Exertional angina. Differential diagnosis with non-anginal chest pain. Provocative stress ischemia tests. The prognostic significance of exertional ischemia. Therapy and prognosis of chronic coronary syndrome. The morphological complexity of coronary artery disease. The SYNTAX score. Coronary angioplasty versus coronary artery bypass grafting.

(5) Aortic valve stenosis. Definition, epidemiology, etiopathogenesis and pathophysiology. The formation of the transvalvular aortic gradient. Cardiac remodeling secondary to pressure overload. Symptoms, natural history and therapy. La TAVI. Surgical aortic valve replacement.

(6) Aortic valve insufficiency. Definition, epidemiology, etiopathogenesis and pathophysiology. The primary form versus the secondary form. Volume overload. Cardiac remodeling secondary to volume overload. Symptoms, natural history and therapy. La TAVI. Surgical aortic valve replacement.

(7) Mitral valve stenosis. Definition, epidemiology, etiopathogenesis and pathophysiology. The formation of the mitral transvalvular gradient. The passive retrograde transmission of the pressure increase in the left atrium to the pulmonary circulation. Symptoms, natural history and therapy. Mitral valvuloplasty. The Wilkins score. Surgical aortic valve replacement.

(8) Mitral valve insufficiency. Definition, epidemiology, etiopathogenesis and pathophysiology. The primary form versus the secondary form. Volume overload. Cardiac remodeling secondary to volume overload. Symptoms, natural history and therapy. Phenotypes of mitral valve insufficiency in ischemic heart disease. Transcatheter mitral valve repair techniques. The implantation of trans-catheter valves. Surgical mitral valve plasty. Surgical mitral valve replacement.

(9) Tricuspid valve diseases. Tricuspid stenosis. Tricuspid insufficiency. Primary and secondary forms. Transcatheter tricuspid valve repair techniques. The implantation of trans-catheter valves. Surgical plasty of the tricuspid valve. Surgical tricuspid valve replacement.

(10) Cardiomyopathies. Dilated cardiomyopathy. Hypertrophic cardiomyopathy. Restrictive cardiomyopathy. Cardiomyopathy of the right ventricle.

(11) Heart failure. Etiopathogenesis and pathophysiology. Systolic and diastolic forms of heart failure. Heart failure with preserved ejection fraction. Neuro-hormonal activation. Symptoms and signs. The NYHA classification. Clinical diagnosis and diagnostic techniques. The prognosis. Heart failure drugs. Heart transplantation.

Readings/Bibliography

Il materiale didattico presentato a lezione verrà messo a disposizione dello studente in formato elettronico reperibile online Virtuale.

Con riferimento agli argomenti del programma, si consigliano i seguenti testi:

Core Curriculum Cardiologia. A. Branzi, F. Picchio. McGraw Hill Education

Linee guida cardiologiche - Società Europea di Cardiologia [https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines]

Malattie del cuore di Braunwald - Trattato di medicina cardiovascolare [https://sol.unibo.it/SebinaOpac/query/braunwald%20s%20heart%20disease%20a %20textbook%20of%20cardiovascular%20medicine?context=catalogo]

Teaching methods

Interactive lectures.

The lessons aim to facilitate the learning of the most relevant topics of the program, facilitating their understanding.

Assessment methods

The end-of-course exam aims to assess the achievement of the educational objectives.

For the specific segment of Cardiovascular Diseases:

a) know the pathophysiological mechanisms of the main cardiovascular diseases;

b) know the clinical manifestations of the main diseases of the cardiovascular system with the acquisition of a correct diagnostic and clinical methodological approach;

c) know the diagnostic-therapeutic process of the main cardiovascular diseases."

The assessment of learning is divided into oral exams aimed at ascertaining the knowledge of the topics and the solution to practical problems such as those faced during the lesson hours.

The evaluation also takes into consideration the level of critical analysis achieved by the student.

Final grade graduation

18-20: knowledge of basic concepts without serious gaps, acceptable exposition and language.

21-25: knowledge of basic concepts without gaps, partial autonomy in the ability to analyze and connect, discrete exposition and language.

26-29: preparation of a good, very good or excellent level but with errors and inaccuracies, good autonomy in the ability to analyze and connect, good or very good exposition and language.

30-30L: excellent preparation without inaccuracies, complete autonomy in the ability to analyze and connect, excellent level of exposure and full mastery of the specific language.

Teaching tools

During the lessons, slides containing diagrams, photos, films and figures will be projected.

The teaching material presented in class will be made available on https://virtuale.unibo.it/ in electronic format, with access allowed via username and password.

Office hours

See the website of Tullio Palmerini