Veidlapa Nr. M-3 (8)
Study Course Description
Internal Diseases (Cardiology)
Course Code
ISK_240
Branch of Science
Clinical medicine; Internal medicine
ECTS
4.00
Target Audience
Medicine
LQF
Level 7
Study Type And Form
Full-Time
Study Course Implementer
Course Supervisor
Oskars Kalējs
Structure Unit Manager
Jūlija Zepa
Structural Unit
Department of Internal Diseases
Contacts
Rīga, pilsoņu iela 13, P.Stradiņa KUS; Hipokrāta iela 2, isk@rsu.lv, +371 67042338
About Study Course
Objective
1. Learn subjective and objective examination methods in practice – survey, examination, palpation, percussion and auscultation; interpret the obtained information in the context of cardiovascular diseases. 2. Train students how to interpret data gained from laboratory tests and instrumental examination, including modern examination methods in cardiology. 3. Learn the epidemiology of cardiovascular pathology, basic diagnostic principles and treatment methods. 4. Promote the development of student clinical thinking and decision-making. 5. Promote analytical and synthetic approaches to data interpretation of modern examinations (imaging diagnostics, invasive examinations and computer-assisted examination methods).
Preliminary Knowledge
Normal anatomy, histology, normal physiology, biochemistry, basics of medical physics, biology and genetics, basics of internal medicine from the 4th semester course.
Learning Outcomes
Knowledge
1.Demonstrate orientation in the newest medical technologies, examination methods and scientific disciplines. • Collect the anamnesis, sequentially arrange it, identify possible risk factors of the disease. • Considering the patient's investigation data (check-up, palpation, percussion, auscultation, assessing instrumental finding results) identify the possible level of pathology. • Analyse the obtained information to evaluate the pathological degree and the corresponding risks. • Be competent in pathological processes under consideration and be able to analyse those aspects of pathophysiology.
Skills
1.• Be able to communicate with patients, their relatives, colleagues, other people or organizations involved in health care. • Obtain information about the patient's complaints and anamnesis; • Perform physical examination of the patient with palpation, percussion and auscultation methods and methods derived from those. • Take the peripheral pulse, heart rate, respiratory rate and arterial pressure indicators, relate them to a particular clinical situation and link it with the overall examination process. • Be competent in ECG results. • Be competent in the results of instrumental examination and their indications (load tests, imaging methods, invasive diagnostic techniques, contrast tests) used in cardiology practice. • Be competent in the diagnosis of heart disease, modern heart disease treatments (pharmacotherapy, surgery, mini-invasive methods); be able to interpret auscultation findings and imaging data. • Have a grasp of the diagnosis of coronary heart disease and early recognition and treatment tactics of various acute situations. • Able to evaluate electrocardiographic findings in a variety of heart rhythm disorders. Be competent in assessment of different risk degrees of arrhythmia. • Be competent in the diagnosis of different cardiomyopathies, able to interpret auscultation findings, imaging data, be competent in modern diagnostic options of cardiomyopathy (nuclear magnetic resonance, genetic examinations, implantable rhythm recorders). • Be competent in the diagnosis of acute and chronic heart insufficiency, able to interpret auscultation findings, imaging data, and be competent in modern diagnostic options and pathophysiological comprehension. • Able to summarize the acquired symptoms and present the diagnosis and medical history.
Competences
1.• Evaluate the acquired symptoms, linking them with pathological processes in the patient's body. • Interpret basic imaging (echocardiography, CT, MRI) data. • Explain the necessity of instrumental examinations. • Interpret the findings of instrumental examinations at the most basic level. • Able to interpret auscultation findings, imaging data; be competent in modern treatment options of heart diseases. • Able to interpret auscultation findings, imaging data; be competent in modern diagnostic options of cardiomyopathy (nuclear magnetic resonance, genetic examinations, implantable rhythm recorders). • Be competent in the diagnosis of acute and chronic heart failure, be able to interpret auscultation findings, imaging data, and be competent in modern diagnostic options and pathophysiological comprehension. • Able to analyse situations, substantiate, logically formulate and explain their opinion.
Assessment
Individual work
|
Title
|
% from total grade
|
Grade
|
|---|---|---|
|
1.
Individual work |
-
|
-
|
|
Independent individual work – patient examination, analysis and interpretation of investigation results, filling in of medical history. Preparation of study material for the course. Improvement of the existing learning material.
|
||
Examination
|
Title
|
% from total grade
|
Grade
|
|---|---|---|
|
1.
Clinical situation |
35.00% from total grade
|
10 points
|
|
Clinical situation tasks with examination results |
||
|
2.
Test |
30.00% from total grade
|
10 points
|
|
Choice of answer tests (OSCE) |
||
|
3.
exams |
35.00% from total grade
|
10 points
|
|
Results of investigations and their interpretation (electrocardiography, echocardiography, coronarography, MRI/description/) |
||
Study Course Theme Plan
FULL-TIME
Part 1
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Typical complaints of cardiovascular patients, history. Initial examination. Inspection, palpation, percussion, auscultation. Information about the patient's condition obtained by inspection (inspectio), palpation.
Auscultation of the heart. Methodology, basic principles. Information about the patient's condition obtained by auscultation. Changes in heart sounds
Description
Group work, clinical situations, as much clinic work as possible. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
ECG - basics. ECG interpretation. Atrial enlargement, ventricular hypertrophy.
Description
Group work, ECG analysis with introduction to clinical interpretation |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
ECG – diseases of the cardiac conduction system and their ECG signs (sinus node, AV node, His bundles)
Description
Group work, ECG analysis |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
ECG - changes related to changes in myocardial blood supply and metabolism and their ECG signs.
Description
Group work, ECG analysis. Summary of the topic |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Instrumental methods of cardiovascular system examination, informative value. Exercise tests (VEM, 6 min. walking test, treadmill, MPS, cardiopulmonary exercise test), Imaging diagnostics (ehoKG, CT, MR etc.)
Assessment of possible vascular pathologies. Assessment of coronary vessels (coronary angiography etc.). Assessment of vessels (endothelium, elasticity, structure). Pulse wave velocity. Assessment of carotid artery wall. Methods of central venous pressure determination.
Description
Work in clinics, research laboratories |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Clinical evaluation of heart diseases. The most common acquired valvular diseases (Mitral stenosis and regurgitation, Mitral valve prolapse, Aortic valve stenosis and regurgitation, Tricuspid regurgitation) - etiology, pathophysiology, clinical picture (complaints, objective findings) and diagnosis.
Description
As far as possible, work with patients in the clinic, use of audiovisual material |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Evaluation of heart diseases by imaging methods (Echo kg, CT, MRI). ECG possibilities in early diagnosis of heart diseases.
Therapeutic methods for heart valve diseases (Valve prosthetics surgically and minimally invasively, valve plastics, etc.). Theme summary
Description
Working at the clinic |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Concept of arrhythmias, classification, main forms, prognostic and clinical assessment. The role of ECG in arrhythmia diagnosis. Types of narrow QRS complex tachyarrhythmias, ECG features.
Description
Group work, clinic, ECG analysis, clinical case scenarios |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Hypertension and risk of complication. Hypertensive crysis. Pseudoresistant hypertension. Secondary hypertension. Treatments. Summary of topic.
Description
Group work, clinic, ECG analysis, clinical situations. Summary of the topic |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Chronic heart failure: pathophysiological mechanisms, ABCD and NYHA classifications, risks, clinical, laboratory (BNP), echocardiographic and ECG assessment of systolic and diastolic function.
Acute heart failure: pathophysiological mechanisms, clinical assessment of the main clinical types (pulmonary oedema, cardiogenic shock). Additional investigations (central venous pressure, pulmonary capillary wedge pressure, etc.).
Description
Group work, clinic, ECG analysis, clinical case assignments |
Total ECTS (Creditpoints):
3.00
Contact hours:
30 Academic Hours
Final Examination:
Test (Semester)
Part 2
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Typical complaints of cardiovascular patients, history. Initial examination. Inspection, palpation, percussion, auscultation. Information about the patient's condition obtained by inspection (inspectio), palpation.
Auscultation of the heart. Methodology, basic principles. Information about the patient's condition obtained by auscultation. Changes in heart sounds
Description
Group work, clinical situations, as much clinic work as possible. |
|
ECG - basics. ECG interpretation. Atrial enlargement, ventricular hypertrophy.
Description
Group work, ECG analysis with introduction to clinical interpretation |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
ECG – diseases of the cardiac conduction system and their ECG signs (sinus node, AV node, His bundles)
Description
Group work, ECG analysis |
|
ECG - changes related to changes in myocardial blood supply and metabolism and their ECG signs.
Description
Group work, ECG analysis. Summary of the topic |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Instrumental methods of cardiovascular system examination, informative value. Exercise tests (VEM, 6 min. walking test, treadmill, MPS, cardiopulmonary exercise test), Imaging diagnostics (ehoKG, CT, MR etc.)
Assessment of possible vascular pathologies. Assessment of coronary vessels (coronary angiography etc.). Assessment of vessels (endothelium, elasticity, structure). Pulse wave velocity. Assessment of carotid artery wall. Methods of central venous pressure determination.
Description
Work in clinics, research laboratories |
|
Clinical evaluation of heart diseases. The most common acquired valvular diseases (Mitral stenosis and regurgitation, Mitral valve prolapse, Aortic valve stenosis and regurgitation, Tricuspid regurgitation) - etiology, pathophysiology, clinical picture (complaints, objective findings) and diagnosis.
Description
As far as possible, work with patients in the clinic, use of audiovisual material |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Evaluation of heart diseases by imaging methods (Echo kg, CT, MRI). ECG possibilities in early diagnosis of heart diseases.
Therapeutic methods for heart valve diseases (Valve prosthetics surgically and minimally invasively, valve plastics, etc.). Theme summary
Description
Working at the clinic |
|
Concept of arrhythmias, classification, main forms, prognostic and clinical assessment. The role of ECG in arrhythmia diagnosis. Types of narrow QRS complex tachyarrhythmias, ECG features.
Description
Group work, clinic, ECG analysis, clinical case scenarios |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Hypertension and risk of complication. Hypertensive crysis. Pseudoresistant hypertension. Secondary hypertension. Treatments. Summary of topic.
Description
Group work, clinic, ECG analysis, clinical situations. Summary of the topic |
|
Chronic heart failure: pathophysiological mechanisms, ABCD and NYHA classifications, risks, clinical, laboratory (BNP), echocardiographic and ECG assessment of systolic and diastolic function.
Acute heart failure: pathophysiological mechanisms, clinical assessment of the main clinical types (pulmonary oedema, cardiogenic shock). Additional investigations (central venous pressure, pulmonary capillary wedge pressure, etc.).
Description
Group work, clinic, ECG analysis, clinical case assignments |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Arterial hypertension. Primary and secondary hypertension. Clinical assessment – risk factors, target organ damage. Resistant AH, Pseudoresistant hypertension – definition, reasons. Emergency hypertensive situations – types, clinical manifestation, diagnosis.
Description
Working in groups, in the clinic. |
|
Arterial hypertension: treatment – non-pharmacological and pharmacotherapy principles. Pharmacotherapy selection justification. Resistant AH, urgent hypertensive conditions – treatment basic principles.
Description
Working in groups, in the clinic |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
coronary heart disease. Causes, epidemiology, risk factors, pathophysiological mechanisms, classification. Chronic coronary syndrome: Diagnosis, classification, examinations, treatment.
Description
Working in groups, in the clinic |
|
Acute coronary syndrome, its classification. Acute coronary syndrome without ST elevation - diagnosis and treatment principles. Acute coronary syndrome with ST elevation - diagnosis and treatment principles.
Description
Work in the clinic, laboratories, departments. Summary of the topic |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Treatment of chronic heart failure: non-pharmacological and pharmacological. Treatment of acute heart failure.
Description
Working in groups, in clinical departments. |
|
Inflammatory heart diseases: main types (endocarditis, pericarditis), diagnostics (clinical, laboratory, echocardiography, biopsy, etc.). Basic principles of treatment of inflammatory heart diseases.
Concept of thrombosis. Thrombosis of venous system. Pulmonary thromboembolism. Pulmonary hypertension.
Description
Working in groups, in the clinic. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Classification of cardiomyopathies, clinic. Myocarditis, classification, clinic. Non-classified cardiomyopathies. Pathophysiological features, treatment. High risk groups of cardiomyopathies. Principles of treatment. Non-pharmacological treatment options. CRT, CRT-D, ICD, alcohol ablation, heart transplantation.
Description
Teamwork, departmental work, clinical case studies. |
|
Arrhythmias I. Supraventricular tachyarrhythmias. Pharmacological and non-pharmacological treatment.
Bradyarrhythmias. Pharmacological and non-pharmacological treatment.
Description
Departmental work, clinical case studies, ECG |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Arrhythmias II. Pharmacological and non-pharmacological treatment of atrial fibrillation. Prevention of thromboembolic events.
Description
Departmental work, clinical case studies, ECG |
|
Arrhythmias III. Ventricular arrhythmias. Hereditary arrhythmias. Pharmacological and non-pharmacological treatment. Concept of Sudden Cardiac Death
Description
Section work, clinical case studies, ECG. Summary of the topic |
Total ECTS (Creditpoints):
1.00
Contact hours:
30 Academic Hours
Final Examination:
Exam
Bibliography
Required Reading
1.
Klīniskā Medicīna, I., II., III. daļa. A. Lejnieka redakcijā, 2010.-2012. Nacionālais Apgāds (akceptējams izdevums)
2.
Kalvelis, Andrejs. Klīniskā Elektrokardioloģija. 2008. Nacionālais Apgāds. (akceptējams izdevums)
3.
Braunwald's Heart Disease. A Textbook of Cardiovascular Medicine. 12th edition. 2022. Elsevier and following edt.Suitable for English stream
4.
Harrisson's Principles of Internal Medicine 20th edition. (Vol.1 & Vol.2.). McGrawHill, 2021Suitable for English stream
5.
Hampton, John. ECG Made Practical. 7th edition, Kindle Edition. 2019Suitable for English stream
6.
Guidelines of international professional associations in the diagnosis and treatment of cardiovascular diseasesSuitable for English stream
7.
Praktiskie Materiāli Kardioloģijas kursam
Additional Reading
1.
Siegenthaler, Walter. Differential Diagnosis in Internal Medicine: From Symptom to Diagnosis Hardcover, 2007Suitable for English stream
2.
Siegenthaler, Walter. Siegenthalers Differenzialdiagnose: Innere Krankheiten - vom Symptom zur Diagnose. 2013Suitable for English stream
3.
Goldberger, Ari L. Clinical Electrocardiography E-Book (Clinical Electrocardiography: A Simplified Approach). 8th edition, Kindle Edition, 2018Suitable for English stream
4.
Surawicz, B., Knilans, T. Chou's Electrocardiography in Clinical Practice E-Book: Adult and Pediatric. 6th edition, Kindle Edition.Suitable for English stream
5.
Douglas, P., William, G., et al. Zipes and Jalife's Cardiac Electrophysiology: From Cell to Bedside. 11th edition, 2022Suitable for English stream
6.
Armstrong, William F., Thomas, R. Feigenbaum's Echocardiography (Englisch) Gebundenes Buch – 30. Oktober 2018Suitable for English stream
7.
Catherine M., et.al. Textbook of Clinical Echocardiography (Englisch) Gebundenes Buch – 28. Februar 2018Suitable for English stream
8.
Flachskampf, Frank Arnold. Kursbuch Echokardiografie: Unter Berücksichtigung nationaler und internationaler Leitlinien Gebundenes Buch. 2022Suitable for English stream
9.
Antonio Pelliccia The ESC Textbook of Sports Cardiology. 2019Suitable for English stream
Other Information Sources
1.
www.hrsonline.orgSuitable for English stream
2.
www.cardiosource.comSuitable for English stream
3.
www.kardiologija.lv
4.
e-studijasSuitable for English stream
5.
radiologija.lv