CuRe PreClerkship Presentation CARDIOVASCULAR COURSE Anita Soni MD FRCP (C) January 23, 2014
DRAFT 5 Nov 1, 2013 Y1 M1 Y2 M2 CuRe Preclerkship M0, 1/2: Human Biology, Health and Human Disease Biology and Health wks.days ( w. 2 days eval ) FOUNDATION 1.Blood & Immunology I (+ Skin I) 2.CV I & Resp (+ ET) I 3.NeuroScience I(Psych, Neuro + Opth) 4.Musculoskeletal I 5.Endocrine I & Woman s Reproduction I 6.GI/ Nutrition I & Urinary system I Health and Disease 1. Intro to week Infectious Disease and Therapeutics 2. CV II 3. Resp (+ ET) II 4. Introduction to Oncology 5. Blood & Immunology (+ autoimmune diseases) II 6. NeuroScience II (Psych, Neuro, Opth) 7. WRP II 8. Endocrine II 9. GI & Nutrition II 10. Urinary system II 11. Musculoskeletal II & Skin II 4 ---- 2014 Aug 25 - Sept 19 3------------ Sept 22 - Oct 11 6 ------------ Oct 14 - Nov 21 4 --------- Nov 24 - Dec 19 Dec break 2------2015 Jan 5 - Jan 16 4------------- Jan 19 - Feb 13 4------------- Feb 17 - Mar 13 TOTAL 27.Mar 16-20..Reading 2--------------Mar 23 - April 2 ( Friday April 4 ) 7--------------April 7 - May 22 (Easter Monday April 6) ----------------May 25-29. Rural week 4--------------Aug 24 - Sept 18 7--------------Sept 21 - Nov 6 3. Nov 9- Nov 27 3-----------Nov 30 Dec 18 break 3 -----2016 Jan 4 - Jan 22 3--------------Jan 25 - Feb 12 M3 2 Consolidation 4---------------Feb 10-------------Mar 24 16 - Mar May 11 27 Dec
CV Course Objectives- Module I 1. Describe the scope and burden of cardiovascular disease in our community 2. Describe the normal anatomy of the heart and great vessels 3. Describe the normal development and embryology of the cardiac system 4. Describe normal cardiovascular physiology including: (1) properties of the vascular system, (1) the cardiac cycle, (3) the autonomic nervous system, (4) blood pressure regulation, (5) hemodynamics, (5) cardiac indices and (6) cardiac performance. Contrast normal physiology to abnormal. 5. Describe basic cardiac electrophysiology including normal and abnormal 6. Understand the basis of the electrocardiogram (ECG). Have an approach to ECG interpretation. 7. Understand the physiologic basis and pharmacology of cardiovascular drugs including (1) inotropic drugs & vasopressors, (2) vasodilator drugs (3) diuretics(4) antiadrenergic drugs, and (5) antiarrhythmic drugs. 8. Have a basic introduction to cardiac imaging including (1) cardiac radiography (2) echocardiography (3) cardiac catheterization (4) nuclear imaging and (5) computed tomography & magnetic resonance imaging. 9. Have an introductory approach to the cardiovascular patient- basic history skills, and physical exam skills including (1) blood pressure, (2) JVP, (3) precordial exam and (4) peripheral exam.
M0 and M1 Course Hour Allocation June 25, 2013 M CuRe 90% Available Surplus Allocated FLEX 1st Iteration HOURS HOURS Avail-90% HOURS HOURS HOURS MO MO 57 63 6 57 6 M1 B/I1 52 46-6 43 3 CV1 48 47-1 44 3 RESP1 39 38-1 35 3 ET 9 9 0 7 2 COMBO 96 94-2 86 8 47 56 6 5 5 NS1 58 56-2 50 6 MS 1 34 29-5 29 0 EM1/ 28 30 2 26 4 WRP1 30 33 3 29 4 COMBO 58 63 5 55 8 GI1/ 37 34-3 32 2 UT1 33 29-4 26 3 COMBO 70 63-7 58 5
Module 1-45 hours Introduction to Cardiovascular Anatomy Development of the heart Physiology Cardiovascular Physiology The Cardiac Cycle (include heart/valves background) Autonomic Nervous System CV Hemodynamics BP Regulation- ANS/RAAS Pressure Volume Loops Cardiac Performance Cardiac Indices Introduction to Shock Pathology: abnormal hemodynamics Pharmacology: Vascular and Autonomic Drugs (inotropic, vasopressors, antiadrenergic) Vasodilators, Diuretics Electrophysiology Basic Cardiac Electrophysiology Mechanism of Arrhythmia Pharmacology: Antiarrhythmic drugs ECG Cardiac Imaging- CXR, echo, catheterization, nuclear, CT, MRI Introduction to investigations, incorporating anatomy/physiology. Review Mid Instructional test Anatomy Review Course Review
CV Module 1 See Excel Spreadsheet
CV Course Objectives- Module 2 1. Know the following learned previously: Objectives from CV Module 1 Antithrombotic drugs- covered in the Blood Course Lipids- covered in the Endocrinology Course. 2. Describe the pathophysiology and clinical approach (diagnosis, investigations and management (both non-pharmacologic and pharmacologic) for various cardiovascular diseases including: (1) valvular heart disease, (2) atherosclerosis & ischemic heart disease, (3) heart failure, (4) cardiomyopathies, (5) arrhythmias, (6) pericardial disease, (7) hypertension, (8) diseases of the peripheral vasculature, (9) acquired pediatric heart disease, and (10) congenital heart disease. 3. Describe primary prevention, risk factors and risk factor modification for cardiovascular diseases. 4. Describe physiologic and pathologic changes of the cardiovascular system that occur with aging. 5. Be aware of genetic and molecular aspects of cardiac disease 6. Evaluate the clinical presentations of cardiovascular diseases including the workup of chest pain syndromes, shortness of breath, palpitations, and syncope. 7. Have an approach to the cardiovascular patient- be able to perform a pertinent history and physical examination.
M2 Course Hour Allocation June 25, 2013 M CuRe 90% Available Surplus Allocated FLEX 1st Iteration HOURS HOURS Avail-90% HOURS HOURS HOURS M2 ID ONC 25 32 28 4 BI2 45 48 42 6 COMBO 70 80 10 70 10 CV2 50 63 13 55 8 Decrease by 3 hours YEAR 2 RS2 46 63 ET 8 RS2 54 63 9 54 9 EM2 38 39 1 36 3 WRP2 44 46 2 42 4 GI2 50 46-4 46 0 UT2 38 46 8 36 10 NS2 116 114-2 105 9 MSK2 56 56 52 4 skin 7 7 6 1 MSK2 63 63 0 58 5
Module 2 ~61 hours Introduction to Cardiovascular- Valvular heart disease- Includes review of the cardiac cycle, valvular disease, diagnostics, treatment Pathology ID and surgery Atherosclerosis/Ischemic heart disease- Pathophysiology: atherosclerosis (including risk factors), chronic IHD, and ACS. Diagnostics: exercise physiology, stress testing, ECG (tutorial), treatment/drugs Pathology Instructional and Mid-Term Exam- CV/RS Hypertension Heart Failure and Cardiomyopathies Pathophysiology of heart failure, including review of hemodynamics Diagnostics, treatment/drugs Pathology Arrhythmias- Bradyarrhythmia and tachyarrhythmia Includes review of mechanism, treatment/drugs, and ECG Pericardial Diseases Diseases of the Peripheral Vasculature Diseases of the aorta Peripheral artery disease Congenital and Pediatric Heart Disease Includes acquired conditions (ie. rheumatic fever, Kawasaki) and congenital disease Genetics/Molecular Aspects Aging Course Review Unknown Patient Cases CV/RS- 3 hours combined with RS Exam
CV Module 2 See Excel Spreadsheet
Common Topics Lipids- moved to Endocrine course Antithrombotic drugs- moved to Blood course Volume Regulation/RAAS/Diuretics/ARB/ACE- overlap with Urinary Course HTN exclusive to CV Not to Forget: pulmonary HTN/ path- consider integrate in unknown patient cases) Ensure pregnancy and cardiac issues covered (not in CV course right now)
Skills INTRO SESSION CV- 2 hours (students rotate through 5 demonstration stations) RS- 2 hours (WGS) SMALL GROUP SESSIONS 5-6 students per group Run by Cardiologists/Respirologists Real patients Total of 6 hours exposure to CV (3 sessions of 2 hours each) Total of 6 hours exposure to RS (3 sessions of 2 hours each)
Skills small group sessions 110 students Divide class into ¼ (A, B, C, D) A subdivides into 5 small groups, each with 5-6 students A1, A2, A3, A4, A5 B subdivides into 5 small groups, each with 5-6 students B1, B2, B3, B4, B5 C subdivides into 5 small groups, each with 5-6 students C1, C2, C3, C4, C5 D subdivides into 5 small groups, each with 5-6 students
Skills small group sessions For CV and RS: each group gets 3 sessions of 2 hours each SESSION 1: Group A- CV Group B- RS Group C- free time or other CS activity Group D- free time or other CS activity SESSION 2: Group A- RS Group B- CV Group C- free time or other CS activity Group D- free time or other CS activity etc
Skills small group sessions For CV and RS: each group gets 3 sessions of 2 hours each Total: 12 sessions needed to accommodate all students to get: 3 CV sessions 3 RS sessions & 6 free time/other CS activities.
Week 1 April 7-10, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CV INTRO LECTURE 9-10 CV INTRO PATIENT ILLUS. 10-11 RS INTRO LECTURE CV VHD LECTURE REVIEW CARDIAC CYCLE/MURMURS CV VHD LECTURE AORTIC VALVE 11-12 RS INTRO PATIENT ILLUS CV VHD LECTURE MITRAL VALVE CV VHD CSA (T1) CASES 12-13 BREAK BREAK BREAK BREAK 13-14 14-15 15-16 CV VHD ASSIGNEDSTUDY CV/ID VHD LECT. ENDOCARDITIS
Week 2 April 13-17, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CLINICAL SKILLS CV INTRO CLINICAL SKILLS RS INTRO 9-10 STATION DEMO SESSIONS SESSION IHD 10-11 CV VHD TUTORIAL IHD 11-12 CV VHD TUTORIAL ATHEROSCLEROSIS AND RISK FACTORS 12-13 BREAK BREAK BREAK BREAK BREAK 13-14 CV PATHOLOGY ATHEROSCLEROSIS 14-15 CV PATHOLOGY IHD TUTORIAL 15-16
Week 3 April 20-24, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CV ACS ASSIGNED STUDY CV TUTORIAL IHD 9-10 ACS CV TUTORIAL IHD 10-11 ACS 11-12 1 & 2 PREVENTION 12-13 BREAK BREAK BREAK BREAK BREAK 13-14 CV TUTORIAL ECG IN IHD 14-15 15-16 CV HTN ASSIGNED STUDY
Week 4 April 27-30, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CV/ RESP/ENT INSTRUCTIONAL CV TUTORIAL HF/CM 9-10 CV/ RESP/ENT INSTRUCTIONAL CV TUTORIAL HF/CM 10-11 HTN HEART FAILURE 11-12 12-13 HTN REVIEW HEMODYNAMICS/ HEART FAILURE HEART FAILURE BREAK BREAK BREAK BREAK BREAK 13-14 CV CSA HTN CASES CARDIOMYPATHIES 14-15 CARDIOMYOPATHIES 15-16 PATHOLOGY TUTORIALHF/CM
Week 5 May 4- May 8, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 CV PERICARDIUM ASSIGNED STUDY CV TUTORIAL ARRHYTHMIA 9-10 CV PERICARDIUM CSA (T1) CASES CV TUTORIAL ARRHYTHMIA 10-11 11-12 BRADYARRHYTHMIA CV ASSIGNED STUDY ARRHYTHMIA CV TUTORIAL ECG ARRHYTHMIA 12-13 BREAK BREAK BREAK BREAK BREAK 13-14 REVIEW EP 14-15 TACHYARRHYTHMIA 15-16 TACHYARRHYTHMIA
Week 6 May 11- May 15, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 THORACIC AORTA CV TUTORIAL PEDS CARDIO 9-10 CV TUTORIAL PEDS CARDIO 10-11 PERIPHERAL VASCULAR CV TUTORIAL AGING CV REVIEW 11-12 CV TUTORIAL PVD ACQUIRED PEDS RESP REVIEW 12-13 BREAK BREAK BREAK BREAK BREAK 13-14 CONGENITAL 14-15 CONGENITAL 15-16 CV -GENETICS & MOLECULAR?ASSIGNED STUDY
Week 7 May 18- May 22, 2015 TIME MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 8-9 9-10 CLINICAL SKILLS E CLINICAL SKILLS X 10-11 CV/ RESP CV/ RESP A 11-12 12-13 UNKNOWN PATIENT CASES UNKNOWN PATIENT CASES BREAK BREAK BREAK M 13-14 14-15 15-16
Community Health Community Health topics- moved to Epidemiology of Heart Disease Prevention of Vascular Disease Community Health Concepts (CV/Resp)
Indiginous Health Need to coordinate sessions to CV topics
Other Themes to consider: Professionalism/ethics Multidisciplinary care- ie post MI rehab
Meeting next week (CR/CV/RS)
CP4 topics SYMPTOMS & SIGNS 9- cardiac murmurs 10- chest pain 13- cyanosis 22- edema 23- extremity pain- acute and chronic 45- palpitations 56- syncope
CP4 topics ABNORMAL LABS 70- cardiac markers and ECG 74- lipid abnormalities (with endo) FACTORS AFFECTING HEALTH 83- chronic disease
CP4 topics HEALTH CONDITIONS 102-CVD 110-hypertension 120- palliative care 125- shock/ rescucitation
Consolidation Topics (M3) To be considered - Chest pain, dyspnea, palpitations, syncope