65578 - Cardiology

Learning outcomes

Describe the clinical manifestations, etiology, epidemiology, risk factors, natural history, diagnosis, staging, prognostic indicators and management of the major cardiovascular diseases, with emphasis on those most commonly encountered in the clinical practice. Identify the major diagnostic and therapeutic options for each encountered clinical scenario, and discuss their benefits and limitations. Summarize decision-making algorithms for a correct differential diagnosis, prognosis, and treatment choice. Present and critically analyze clinical cases, discuss the differential diagnosis, and formulate appropriate diagnostic and therapeutic strategies for each case (Problem-Based Learning).

Course contents

• Stable coronary artery disease: definition, pathophysiology, classification, and epidemiology. Characteristics of chest pain/discomfort. ECG changes during ischemia. Risk Stratification. Medical therapy. Indications for revascularization procedures.

• Acute coronary syndromes: definition and classification: acute coronary syndromes with (STEMI) and without ST-segment elevation (unstable angina and NSTEMI). Epidemiology. Pathogenesis: atherosclerotic plaque rupture, plaque erosion, and calcified nodules. Diagnosis: symptoms, characteristics cardiac ischemic chest pain/discomfort ischemic ECG changes. Biomarkers of myocardial necrosis and their interpretation. Prognostication and bleeding risk assessment. 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 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 and diagnosis. Risk stratification. Acute phase management. Long-term management. Prevention.

• Heart failure (chronic and acute): definition, etiology, pathophysiology and classification. Triggers for the decompensation. Clinical classification. Clinical presentation and diagnostic workup. Prevention of heart failure, complications, and treatment of co-morbidities. Treatment strategies. Natural history. Palliative care.

• Valvular heart diseases (Aortic stenosis and aortic regurgitation; Mitral stenosis and mitral regurgitation): definition, classification, etiology, pathophysiology, clinical signs, and symptoms. Laboratory tests. Non-invasive and invasive investigation. Natural history. Medical therapy: prevention of complications, hemodynamic optimization. Long-term management after valve implantation.

• Pericardial and myocardial diseases: etiology, pathophysiology. Classification: acute pericarditis, chronic pericarditis, recurrent pericarditis, constrictive pericarditis, pericardial effusion and cardiac tamponade. Myocarditis. Clinical signs and symptoms. Diagnostic pathway: laboratory and imaging test. Differential diagnosis. Treatment

• Infective endocarditis: definition, epidemiology, pathogenesis, predisposing factors, infectious agents, clinical symptoms, and signs. Classification Diagnostic pathway: laboratory tests, blood culture test, transthoracic echocardiography, transesophageal echocardiography. Diagnostic criteria. Natural history and complications. Medical therapy. Prophylaxis of infective endocarditis.

• Cardiomyopathies: definition and classification: primary forms and secondary forms. Etiology, genetics and molecular biology. Clinical symptoms and signs. Investigation: laboratory tests, ECG, echocardiography, hemodynamic profiles. Diagnostic criteria. Natural history and complications. Risk Stratification. Management.

• Arrhythmias: Classification. Mechanisms. Supraventricular tachycardias: definition and classification, pathophysiology, symptoms, ECG characteristics, natural history. Complications and risk stratification. Initial medical management, ablation, and cardioversion. Follow-up plan and long-term management. Ventricular tachycardias: ECG characteristics. Management. Bradycardias and conduction blocks: definition and classification: ECG characteristics. Management

• Atrial septal defect: Epidemiology, definition, pathophysiology, diagnostic workup, natural history, therapeutic considerations.

Readings/Bibliography

Updated teaching material, will be made available on the platform for teaching support service: Insegnamenti online - IOL

Suggested guidelines:

• European Society of Cardiology Clinical Practice Guidelines
• ESC Pocket Guidelines App

Suggested textbooks

For more information on book location and book details visit SBN UBO, click on book title:

• Harrison's principles of internal medicine
• Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine 

Teaching methods

Interactive slide supported lectures with discussion breaks. Teaching materials and slides are made available to the students via the IOL (Insegnamenti On-Line) platform at least the day before the lesson.

Attending lessons plays an important role in the learning process. During lessons, the teachers guides the students in the critical reading of the teaching materials and provides opportunities for online formative assessment.

Attendance to learning activities is mandatory; the minimum attendance requirement to be admitted to the final exam is 60% of lessons. For Integrated Courses (IC), the 60% attendance requirement refers to the total amount of I.C. lessons. Students who fail to meet the minimum attendance requirement will not be admitted to the final exam of the course and will have to attend relevant classes again during the next academic year.

Professors may authorize excused absences upon receipt of proper justifying documentation, in case of illness or serious reasons. Excused absences do not count against a student’s attendance record to determine their minimum attendance requirement.

Assessment methods

The final exam/final summative assessment will be an oral exam/assessment consisting of a minimum of two, or possibly more questions focusing on the educational objectives and topics of the integrated course of Thoracic and Vascular Diseases (I.C.)

Professors of the integrated courses participate in an overall collegial assessment of the student's final profit. The final summative assessment is expressed with a scale of grades from 18 to 30.

• The final assessment (final summative assessment) is passed with a collegial grade of a minimum 18/30

• Honors (cum laude) can be awarded in case of a final maximum collegial assessment (30/30)

• The credits of the Integrated Course of Thoracic and Vascular Diseases (14 CFU) are awarded with a collegial grade of a minimum 18/30

If it is necessary to appoint several subcommittees for the same final summative assessment, the student has the right to ask, in advance, not later than the beginning of the assessment, to be assessed also by the professor responsible of the discipline

The final summative assessment takes also into account the level of mastery of the key concepts illustrated in the classroom, critical thinking and the ability to integrate the key concepts and take-home messages of the different modules of the integrated course.

Failure to pass the exam may be due to insufficient knowledge of these concepts.

Teaching tools

Students are encouraged to attend the lectures with a printout of the relevant file downloaded from IOL (Insegnamenti On-Line) platform or bringing electronic devices to access the relevant material during the lecture. This will allow easier interaction with the teacher when asked to discuss a problem.

E-learning material (including scientific literature and self-assessment tools) will be provided as well

Office hours

See the website of Raffaele Bugiardini