08957 - Cardiovascular Diseases (LZ-B)

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.

Readings/Bibliography

• Harrison – Principles of internal medicine
• Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine
• European Society of Cardiology Clinical Practice Guidelines
• Updated teaching material, will be made available on the 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

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, P.C.
• Platform for teaching support service: Insegnamenti online - IOL

Office hours

See the website of Raffaele Bugiardini