08957 - Cardiovascular Diseases (LZ-C)

Course Unit Page

SDGs

This teaching activity contributes to the achievement of the Sustainable Development Goals of the UN 2030 Agenda.

Good health and well-being

Academic Year 2018/2019

Learning outcomes

At the end of the course the student should be able to:

  • describe and identify the major cardiovascular diseases.
  • define primary and secondary prevention of cardiovascular disease.
  • describe and compare the diagnostic procedures performed in the management of patients with cardiovascular disease. In particular, the student should be able to define the non-invasive investigation, invasive testing and main prognostic models used for clinical assessment and therapeutic management.
  • define differential diagnosis, complications, and management of cardiovascular disease.
  • define benefits and risks of a particular diagnostic or therapeutic procedure in everyday clinical decision-making.
  • define the potential benefits and limitations of current treatment strategies in the management of cardiovascular disease.

Course contents

  • Ischemic heart disease: definition, pathophysiology, and epidemiology. Atherosclerosis: formation of atherosclerotic plaque. Risk factors. Laboratory tests. Diagnostic tests: resting ECG, exercise stress tests, Holter monitoring, echocardiography, nuclear cardiology tests, cardiac CT, cardiac MRI, cardiac catheterization and percutaneous coronary intervention.
  • Stable coronary artery disease: definition, pathophysiology, classification, and epidemiology. Characteristics of chest discomfort. ECG changes during ischemia. Risk Stratification. Medical therapy. Clinical indications for revascularization procedures.
  • Acute coronary syndromes: definition and classification: acute coronary syndromes with and without ST-segment elevation. Epidemiology. Pathogenesis: atherosclerotic plaque rupture, plaque erosion, and calcified nodules. Coronary atherothrombosis. Coronary remodeling. Coronary spasm.
  • Chest pain: ischemic cardiac chest pain causes, non-ischemic cardiac chest pain causes, non-cardiac chest pain causes.
  • Unstable angina and acute myocardial infarction without ST-segment elevation: Diagnosis: symptoms, ischemic ECG changes. Biomarkers of myocardial necrosis. Differential diagnosis. Prognostication and bleeding risk assessment: GRACE risk score, TIMI risk score, CRUSADE bleeding risk score. Medical therapy. Indications for percutaneous coronary intervention. Complications. Long-term follow-up and secondary prevention.
  • Acute myocardial infarction with ST-segment elevation: definition and epidemiology. Diagnosis: symptoms, ischemic ECG changes, biomarkers of myocardial necrosis. Emergency care: management at first medical contact, fibrinolytic therapy, primary percutaneous coronary intervention. Management of cardiac arrest. Pre-hospital logistic of care and impact on the effectiveness of therapeutic interventions. Management during the hospital stay, long-term management, and secondary prevention. Hemodynamic complications, rhythm disturbances, and mechanical complications. Prognosis.
  • Pulmonary embolism: definition, epidemiology, pathogenesis and predisposing factors. Classification of clinical severity. Diagnosis: assessment of clinical probability (Wells score; Revised Geneva Score), clinical presentation, laboratory tests, ECG, chest X-ray, transthoracic echocardiography, transesophageal echocardiography, CT angiography, ventilation/perfusion scintigraphy, lower limb compression venous ultrasonography, pulmonary angiography. Risk stratification: PESI score, simplified PESI score. Acute phase management. Long-term management. Prevention.
  • Chronic heart failure: definition, etiology, and pathophysiology. Triggers for the decompensation Clinical classification. Classification of heart failure: functional classification of heart failure according to the New York Heart Association (NYHA). Classification according to the American Heart Association Stages of Heart Failure. Clinical presentation: symptoms and signs. Laboratory tests. Non-invasive and invasive investigation: chest X-ray, ECG, exercise stress test, echocardiography, cardiac catheterization. Prognostication: measures of cardiac performance, exercise capacity, and neurohormonal markers; clinical scores: Heart Failure Survival Score (HFSS), Seattle Heart Failure Score. Pharmacological treatment, invasive treatment, treatment of rhythm disturbances. Prevention of heart failure. Prevention of complications, and treatment of co-morbidity. Indications for cardiac transplantation. Palliative care.
  • Acute heart failure: definition, classification, and hemodynamic profiles. Acute triggers for the decompensation. Diagnostic criteria: findings and physical examination. Natural history. Treatment strategies
  • Aortic stenosis and aortic regurgitation: definition, classification, etiology, pathophysiology, clinical signs, and symptoms. Laboratory tests. Non-invasive and invasive investigation: baseline ECG, stress ECG, chest X-ray, echocardiography, MRI, CT-scan, cardiac catheterization. Natural history. Medical therapy: prevention of complications, hemodynamic optimization. Indications for transcatheter aortic valve implantation, balloon valvuloplasty and surgery in aortic stenosis. Indications for surgery in aortic regurgitation. Long-term management after valve implantation.
  • Mitral stenosis and mitral regurgitation: definition, classification, etiology, pathophysiology, clinical signs, and symptoms. Laboratory tests. Non-invasive and invasive investigation: baseline ECG, stress ECG, chest X-ray, echocardiography, MRI, CT-scan, cardiac catheterization. Natural history. Medical therapy: prevention of complications, hemodynamic optimization. Invasive treatment: indications for percutaneous intervention in mitral stenosis and mitral regurgitation. Indications for surgery. Long-term management of invasive treatment.
  • Mitral valve prolapse: definition, pathophysiology, epidemiology. Clinical symptoms and signs. Non-invasive and invasive investigation. Natural history and complications. Treatment
  • Tricuspid disease: etiology, pathophysiology, clinical signs and symptoms. Non-invasive and invasive investigation. Medical management. Indications for surgery
  • Pericardial diseases: etiology, pathophysiology. Classification: acute pericarditis, chronic pericarditis, recurrent pericarditis, constrictive pericarditis, pericardial effusion and cardiac tamponade. Clinical signs and symptoms. Diagnostic pathway: laboratory tests, ECG, echocardiogram, chest X-ray, CT, MRI. Differential diagnosis. Pericardiocentesis. Treatment.
  • Infective endocarditis: definition, epidemiology, pathogenesis, predisposing factors, infectious agents, clinical symptoms, and signs. Classification Diagnostic pathway: laboratory tests, blood culture, transthoracic echocardiography, transesophageal echocardiography. Diagnostic criteria. Natural history and complications. Medical therapy. Indications for surgery. Prophylaxis of infective endocarditis.
  • Cardiomyopathies: definition and classification: primary forms and secondary forms. Etiology, genetics and molecular biology. Clinical symptoms and signs. Investigation:, laboratory test, ECG, echocardiography, hemodynamic profiles. Diagnostic criteria. Natural history and complications. Risk Stratification. Management.
  • Arrhythmias: Classification. Mechanisms. Supraventricular tachycardias: Definition and classification. Sinus tachycardia; Premature supraventricular contractions; Atrial fibrillation: pathophysiology, symptoms, ECG characteristics, natural history. Complications and risk stratification. Initial medical management, ablation, and cardioversion. Follow-up plan and long-term management. Atrial flutter; Wolff-Parkinson-White syndrome; Paroxysmal supraventricular tachycardia. ECG characteristics. Ventricular tachycardias: Premature ventricular contractions; Ventricular tachycardia; Ventricular fibrillation; ECG characteristics. Management. Bradycardias and conduction blocks: Definition and classification. Sinus bradycardia; Sick sinus syndrome; Atrioventricular blocks; Bundle branch blocks. ECG characteristics. Management.
  • Adults congenital heart disease: Epidemiology (with focus on the most common forms in adults), definition, pathophysiology, diagnostic workup, natural history, therapeutic considerations.
  • Pulmonary hypertension: epidemiology, definition, classification, etiology, pathophysiology, risk factors. Diagnostic pathway. Management.

Readings/Bibliography

  • Harrison – Principles of internal medicine
  • Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine
  • Updated teaching material, will be made available on the online platform for teaching support service: Insegnamenti online - IOL

Teaching methods

  • Slides presentation supported lectures with discussion breaks
  • Teaching resources and material: teaching material presented in class will be made available on the online platform for teaching support service: Insegnamenti online - IOL
  • The professor recommend not to print/download the teaching material in large advance: the professor could make updates

Assessment methods

The final exam will be an oral exam consisting of questions on the obligatory readings (books and lecture notes) focusing on the educational objectives and topics of the course of Cardiovascular and Respiratory Apparatus Diseases (I.C.)

  • On-line registration through AlmaEsami

Teaching tools

  • Projector, PC
  • Platform for teaching support service: Insegnamenti online - IOL

Office hours

See the website of Raffaele Bugiardini