Internal Diseases (Cardiology)
Study Course Implementer
Rga, 2 Hipokrāta Street, 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 – 35% |
||
|
2.
test |
30.00% from total grade
|
10 points
|
|
choice of answer tests (OSCE) - 30% of total grade |
||
|
3.
exams |
35.00% from total grade
|
10 points
|
|
exam results and their interpretation (electrocardiography, echocardiography, coronarography, MRI/description/) – 35%. |
||
Study Course Theme Plan
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Basic examination methods and principles of the cardiovascular system. The most typical complaints of patients with the cardiovascular system, anamnesis. Initial examination. Inspection, palpation, percussion, auscultation
Description
The most typical complaints of patients with cardiovascular system diseases: anamnesis. Initial examination. Inspection, palpation, percussion, auscultation. Information about the patient's condition obtained through inspection (inspectio) and palpation. Cardiac auscultation. Methodology, basic principles. Information about the patient's condition obtained through auscultation. Changes in heart sounds. Heart murmurs. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
ECG – basics. Interpretation of ECG data. Atrial enlargement, ventricular hypertrophy.
Description
Working with ECG, introduction to ECG analysis, information extraction from ECG |
|
Arrhythmias III. Atrial fibrillation and atrial flutter. Reasons, classification, clinic. Arrhythmias: conduction disorders, clinical and ECG assessment. Pharmacological and non-pharmacological treatment. Prevention of thromboembolic events. Topic summary.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
ECG – diseases of the cardiac conduction system and their ECG signs (sinus node, AV node, bundle of His)
Description
Working with ECG, ECG analysis. Information extraction and clinical interpretation. |
|
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
Working in the clinic. Reviewing theoretical issues. Audiovisual material. |
|
Concept of thrombosis. Thromboses of the venous system. Pulmonary artery thromboembolism. Pulmonary hypertension. Practical test: disease history.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
ECG - changes related to changes in myocardial blood supply and metabolism and their ECG signs.
Description
Working with ECG, ECG analysis. Information extraction and clinical interpretation. |
|
Arterial Hypertension, classification, mechanisms, risks.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
-
|
3
|
Topics
|
Instrumental methods of cardiovascular system examination, informative value. Exercise tests (VEM, 6 min. walking test, treadmill, MPS, cardiopulmonary exercise test), Imaging diagnostics (echoCG, 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 measurement
Description
Practical session. Use of visual aids. Visit to clinics and laboratory |
|
Acute heart failure: pathophysiological mechanisms, clinical evaluation of major clinical types (pulmonary oedema, cardiogenic shock). Additional examinations (central venous pressure, pulmonary capillary entrapment pressure, etc.). Treatment of chronic heart failure: non-pharmacological and pharmacological. Treatment of acute heart failure. Topic summary.
|
-
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
Working in the clinic. Reviewing theoretical issues. Audiovisual material. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Evaluation of heart diseases by imaging methods (Echo kg, CT, MRI). ECG possibilities in early diagnosis of heart diseases.
Treatment methods of heart valve diseases (Valve prosthetics surgical and mini-invasive way, valve plastics, etc.).
Description
Practical session. Use of audio-visual material. Clinic visits |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized room
|
3
|
Topics
|
Concept of arrhythmias, classification, main forms, prognostic and clinical assessment. The role of ECG in arrhythmia diagnosis. Types of narrow QRS tachyarrhythmias, ECG features.
Description
Working with EKGs, working in clinical departments. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Broad QRS complex tachyarrhythmias (ventricular and supraventricular) – ECG diagnostic features
Description
Working with EKGs, working in the clinic wards. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Specialized 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
Clinical problem-solving, emphasis on pathophysiology. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Basic examination methods and principles of the cardiovascular system. The most typical complaints of patients with the cardiovascular system, anamnesis. Initial examination. Inspection, palpation, percussion, auscultation
Description
The most typical complaints of patients with cardiovascular system diseases: anamnesis. Initial examination. Inspection, palpation, percussion, auscultation. Information about the patient's condition obtained through inspection (inspectio) and palpation. Cardiac auscultation. Methodology, basic principles. Information about the patient's condition obtained through auscultation. Changes in heart sounds. Heart murmurs. |
|
ECG – basics. Interpretation of ECG data. Atrial enlargement, ventricular hypertrophy.
Description
Working with ECG, introduction to ECG analysis, information extraction from ECG |
-
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, bundle of His)
Description
Working with ECG, ECG analysis. Information extraction and clinical interpretation. |
|
ECG - changes related to changes in myocardial blood supply and metabolism and their ECG signs.
Description
Working with ECG, ECG analysis. Information extraction and clinical interpretation. |
-
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 (echoCG, 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 measurement
Description
Practical session. Use of visual aids. Visit to clinics and laboratory |
|
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
Working in the clinic. Reviewing theoretical issues. 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.
Treatment methods of heart valve diseases (Valve prosthetics surgical and mini-invasive way, valve plastics, etc.).
Description
Practical session. Use of audio-visual material. Clinic visits |
|
Concept of arrhythmias, classification, main forms, prognostic and clinical assessment. The role of ECG in arrhythmia diagnosis. Types of narrow QRS tachyarrhythmias, ECG features.
Description
Working with EKGs, working in clinical departments. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Broad QRS complex tachyarrhythmias (ventricular and supraventricular) – ECG diagnostic features
Description
Working with EKGs, working in the clinic wards. |
|
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
Clinical problem-solving, emphasis on pathophysiology. |
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Arterial Hypertension, classification, mechanisms, risks.
|
|
Arterial hypertension II. treatment, specific situations, secondary hypertension.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Acute coronary syndrome. Diagnosis, therapeutic strategy, methods. Treatment tactics: conservative and/or invasive (PCI, bypass, hybrid operations).
|
|
KSS. Arterial changes. Chronic Coronary Syndrome. Concept, diagnosis, risks, treatment options today..
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Acute heart failure: pathophysiological mechanisms, clinical evaluation of major clinical types (pulmonary oedema, cardiogenic shock). Additional examinations (central venous pressure, pulmonary capillary entrapment pressure, etc.). Treatment of chronic heart failure: non-pharmacological and pharmacological. Treatment of acute heart failure. Topic summary.
|
|
Arrhythmias I. Supraventricular tachyarrhythmias. Pharmacological and non-pharmacological treatment.
Arrhythmias II. Ventricular arrhythmias. Inherited arrhythmias. Pharmacological and non-pharmacological treatment.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Arrhythmias II. Ventricular arrhythmias. Inherited arrhythmias. Pharmacological and non-pharmacological treatment. Risk identification and prevention
|
|
Arrhythmias III. Atrial fibrillation and atrial flutter. Reasons, classification, clinic. Arrhythmias: conduction disorders, clinical and ECG assessment. Pharmacological and non-pharmacological treatment. Prevention of thromboembolic events. Topic summary.
|
-
Class/Seminar
|
Modality
|
Location
|
Contact hours
|
|---|---|---|
|
On site
|
Study room
|
3
|
Topics
|
Primary cardiomyopathies. Life treatening cardiomyopathies. Secundary cardiomyopathies. Typical pathophysiological mechanisms. Nuances of treatment. Prevention. Sudden Cardiac Death.
|
|
Concept of thrombosis. Thromboses of the venous system. Pulmonary artery thromboembolism. Pulmonary hypertension. Practical test: disease history.
|
Bibliography
Required Reading
Klīniskā Medicīna, I., II., III. daļa. A. Lejnieka redakcijā, 2010.-2012. Nacionālais Apgāds (akceptējams izdevums)
Kalvelis, Andrejs. Klīniskā Elektrokardioloģija. 2008. Nacionālais Apgāds. (akceptējams izdevums)
Braunwald's Heart Disease. A Textbook of Cardiovascular Medicine. 12th edition. 2022. Elsevier and following edt.Suitable for English stream
Harrisson's Principles of Internal Medicine 20th edition. (Vol.1 & Vol.2.). McGrawHill, 2021Suitable for English stream
Hampton, John. ECG Made Practical. 7th edition, Kindle Edition. 2019Suitable for English stream
Guidelines of international professional associations in the diagnosis and treatment of cardiovascular diseasesSuitable for English stream
Praktiskie Materiāli Kardioloģijas kursam
Additional Reading
Siegenthaler, Walter. Differential Diagnosis in Internal Medicine: From Symptom to Diagnosis Hardcover, 2007Suitable for English stream
Siegenthaler, Walter. Siegenthalers Differenzialdiagnose: Innere Krankheiten - vom Symptom zur Diagnose. 2013Suitable for English stream
Goldberger, Ari L. Clinical Electrocardiography E-Book (Clinical Electrocardiography: A Simplified Approach). 8th edition, Kindle Edition, 2018Suitable for English stream
Surawicz, B., Knilans, T. Chou's Electrocardiography in Clinical Practice E-Book: Adult and Pediatric. 6th edition, Kindle Edition.Suitable for English stream
Douglas, P., William, G., et al. Zipes and Jalife's Cardiac Electrophysiology: From Cell to Bedside. 11th edition, 2022Suitable for English stream
Armstrong, William F., Thomas, R. Feigenbaum's Echocardiography (Englisch) Gebundenes Buch – 30. Oktober 2018Suitable for English stream
Catherine M., et.al. Textbook of Clinical Echocardiography (Englisch) Gebundenes Buch – 28. Februar 2018Suitable for English stream
Flachskampf, Frank Arnold. Kursbuch Echokardiografie: Unter Berücksichtigung nationaler und internationaler Leitlinien Gebundenes Buch. 2022Suitable for English stream
Antonio Pelliccia The ESC Textbook of Sports Cardiology. 2019Suitable for English stream