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Y1B2M4 - Cardiovascular System

Expand a subject to review the topics and learning objectives retained from the official NUMS MBBS Year I source. Reviewed Study Materials links are shown only where an exact teaching match is available.

5Subjects
26Topics
58Linked
Embryology5 listed topics
Histology5 listed topics
  • Heart & Cardiac Muscle Learning objectivesExplain the histomorphological features of heart.
  • Blood VesselsLearning objectivesCorrelate the microscopic features of arteries, veins and capillaries with their functional & clinical aspectsDifferentiate among various slides of arteries & veins under light microscope in H&E stain
  • Lymphoid Organs Learning objectivesCorrelate the histomorphological features of lymph node, thymus, spleen, palatine tonsil with their functions.Demonstrate the histomorphological features of lymphoid organs by focusing the slides at various magnifications under light microscope and illustrate them with the help of hematoxylin and eosin.Differentiate among various lymphoid organs under light microscope in H&E stained slides :Differentiate lymph node, thymus, spleen, and palatine tonsils under light microscope in H&E-stained slides.
  • Clinical RelevanceLearning objectivesInterpret the histomorphological changes in atherosclerosis, arteriosclerosis and Marfan`s Syndrome.Explain the histological basis of tonsillitis.
  • Histology PracticalsLearning objectivesDifferentiate among slides of arteries and veins under light microscope in H&E stain.Differentiate among lymph node, thymus, spleen, and palatine tonsils under light microscope in H&E-stained slides.Demonstrate the histomorphological features of circulatory system & lymphoid organs by focusing the slides at various magnifications under light microscope and illustrate them with the help of hematoxylin and eosin.
Gross Anatomy4 listed topics
  • Thoracic Wall & MediastinumLearning objectivesCorrelate the cartilaginous, bony and muscular framework of the thoracic cage with its functional and clinical aspects.Explain the gross features of thoracic wall including its blood supply, innervation & lymphatic drainage.Describe the joints of thorax with reference to their types and movementsDifferentiate between gross features of typical and atypical thoracic vertebrae and ribs.Demonstrate gross features of sternumRecognize gross features of thoracic wall, including its layers and contents of a typical intercostal space on prosected specimens and models.Identify the major structures of thoracic wall in standard medical imaging.Mark the sternal angle on the surface of giving subject, mentioning the importance of sternal angle with reference to great vessels and rib counting.Palpate the surface projections to mark major thoracic structures in a basic surface examination, exhibiting ethics, professionalism and effective communication skillsInterpret the anatomical basis of fractures of sternum, ribs and vertebrae, cervical rib, flail chest, thoracotomy, sternal biopsy, thoracic outlet syndrome, and dislocation of ribs.Justify the selection of a site for invasive chest procedures (Intercostal nerve block, chest intubation on right and left side) giving anatomical reasons.Explain the divisions & contents of mediastinumExplain the topographic anatomy of major longitudinal structures (trachea, esophagus, vagus nerves, phrenic nerves, aorta, sympathetic trunk, azygous system and thoracic duct) running through the thoracic cavity.Trace the primary drainage routes of lymph from the organs and wall of the thoracic cavity to the points of venous connection.Interpret the anatomical basis of deflection of mediastinum, mediastinitis, mediastinal tumors/cysts, compression of trachea, tracheitis/bronchitis, foreign body aspiration, bronchoscopy, aneurysm and coarctation of aorta, patent ductus arteriosus, azygos veins and caval obstruction, and damage/irritation to phrenic nerve.
  • HeartLearning objectivesRelate the topographic anatomy of pericardium and pericardial sinuses with their functional and clinical aspects.Explain the gross features of borders, surfaces, apex and base of heart.Explain the internal features of various chambers of heart.Describe the arterial supply, venous drainage and nerve supply of heart.Interpret the clinical conditions associated with heart on anatomical basis.Outline the borders of the heart and the auscultatory areas on the surface of the given subject while exhibiting effective communication skills, professionalism and ethics.Identify gross features of heart on museum models and prosected specimensIdentify blood vessels of heart on museum models and prosected specimensIdentify major features of heart in standard medical imaging
  • Clinical Relevance of the HeartLearning objectivesExplain the surgical significance of transverse pericardial sinus.Interpret the anatomical basis of pericarditis, cardiac tamponade, pericardial rub, pericardial effusion.Interpret the anatomical basis of coronary artery disease/ coronary heart disease (angina pectoris and myocardial infarction).Interpret the anatomical basis of cardiac referred pain.Apply your knowledge of anatomy to appraise cardiac catheterization, echocardiography, coronary angiography, coronary bypass graft, coronary angioplasty, electrocardiography, paracentesis, artificial cardiac pacemaker, and central venous line.
  • Anatomy PracticalsLearning objectivesDifferentiate between gross features of typical and atypical thoracic vertebrae and ribs.Demonstrate gross features of sternumRecognize gross features of thoracic wall, including its layers and contents of a typical intercostal space on prosected specimens and models.Identify the major structures of thoracic wall in standard medical imaging.Identify parts of tracheobronchial tree in standard medical imaging.Demonstrate division and contents of mediastinum on the models.Identify gross features of heart on museum models and prosected specimensIdentify major features of heart in standard medical imagingMark the sternal angle on the surface of giving subject, mentioning the importance of sternal angle with reference to great vessels and rib counting.Outline the borders of the heart and the auscultatory areas on the surface of the given subject while exhibiting effective communication skills, professionalism and ethics.Outline the course of trachea and thoracic aorta on the surface of given subject exhibiting ethics, professionalism & effective communication skills.
Physiology6 listed topics
  • Cardiac PhysiologyLearning objectivesDifferentiate the physiological arrangement of right and left hearts along with the parallel arrangement of systemic circulation.Trace the path of blood flow through the whole circulatory system with comparisons of pressures in various components of heart and circulatory treeExplain the basic functional anatomy of the atrioventricular and semilunar valves, and how they operate.Compare cardiac and skeletal muscle with respect to: cell size, electrical connections between cells, and arrangement of myofilaments, ion permeability, and electrical resistance.Describe role of gap junctions in creating a functional syncytium.Explain the ionic mechanism of pacemaker automaticity and rhythmicity, and identify cardiac cells that have pacemaker potential and their spontaneous rate.Identify neural and humoral factors that influence their rate.Discuss the significance of “overdrive suppression” and “ectopic pacemaker”.Trace the normal sequence of cardiac activation (depolarization) beginning in the SA node, and the role played by specialized cells of the cardiac conductive system.Explain the functional significance of slow conduction through the AV node and describe factors that influence conduction velocity through the AV node.Draw a diagram and trace the path of spread of cardiac impulse through conductive system, atrial and ventricular myocardium and associate it with the function of heart.Sketch a typical action potential in a ventricular muscle labeling both the voltage and time axes accurately.Describe how ionic currents through various ion channels contribute to the four phases of the cardiac action potential.Explain what accounts for the long duration of the cardiac action potential and the resultant long refractory period and the advantage of the long plateau of the cardiac action potential and the long refractory periodContrast the duration of the action potential and the refractory period in a cardiac muscle and a skeletal muscle.Sketch the temporal relationship between AP in a cardiac muscle and the resulting contraction of that cell.Explain why cardiac muscle cannot remain in a state of sustained (tetanic) contraction.Contrast the sympathetic and parasympathetic nervous system influence on heart rate and cardiac excitation in general.Identify which arm of the autonomic nervous system is dominant at rest and during exercise.Discuss ionic mechanisms of these effects on both working myocardium and pacemaker cells.Explain how changes in sympathetic activity alter ventricular work, cardiac metabolism, oxygen consumption and cardiac output.Draw, in correct temporal relationship, the pressure, volume, heart sound, and ECG changes in the cardiac cycle.Identify the intervals of iso-volumic- contraction, rapid ejection, slow ejection, iso-volumic relaxation, rapid ventricle filling, slow ventricular filling and atrial contraction.Compare the various phases of ventricular systole and ventricular diastole.Contrast the relationship between pressure and flow into and out of the left and right ventricles during each phase of the cardiac cycle.Analyze various cardiac events in relation to each otherDefine ejection fraction and calculate it from end diastolic volume, end systolic volume, and/or stroke volume.Predict the change in ejection fraction that would result from a change in a) preload, b) afterload, and c) contractility.Draw a ventricular pressure volume loop and label the phases and events of the cardiac cycle (ECG, valve movement).Describe the role of Starling’s Law of the Heart in keeping the output of the left and right ventricles equal.Describe the difference in the way changes in preload and changes in contractility influence ventricular force development.Define preload and contractility.Explain why ventricular end-diastolic pressure, atrial pressure and venous pressure all provide estimates of ventricular preload.Explain why ventricular end-diastolic pressure provides the most reliable estimate.Explain how arterial pressure influences afterload.Describe the impact of changes in preload, afterload, and contractility in determining cardiac performance.Define the term dipole.Describe characteristics that define a vector.Describe how dipoles generated by the heart produce the waveforms of the ECG.Describe the electrode conventions used by clinicians to standardize ECG measurements.Know the electrode placements and polarities for the 12 leads of a 12-lead electrocardiogram and the standard values for pen amplitude calibration and paper speed.Name the parts of a typical bipolar (Lead II) ECG tracing and explain the relationship between each of the waves, intervals, and segments in relation to the electrical state of the heart.Explain why the ECG tracing looks different in each of the 12 leads.Correlate between vector and lead, type and locations of leads and principles for vector analysis.Recognize the significance of waves, segments and intervals of ECG recording.Describe the timing and causes of the four heart sounds.Examine the Heart Sound on Pulmonary, Aortic, Mitral and Tricuspid areasRecord & Interpret normal ECG by placing all the chest and limb leads on an SPPerform Cardiopulmonary resuscitation on a dummy according to the American Heart Association Guidelines
  • Clinical Cardiovascular PhysiologyLearning objectivesDescribe the expected auscultation sounds that define mitral stenosis, mitral insufficiency, aortic stenosis, and aortic insufficiency and their physiological basis.Comprehend congenital heart diseases like Patent Ductus arteriosus and Tetralogy of Fallot.Outline neural and humoral factors that influence their rate and significance of “overdrive suppression” and “ectopic pacemaker”.Discuss current of injury and describe how it alters the ST segment of the ECG.Analyze the alteration in conduction responsible for most common arrhythmias:Discuss the basis of common cardiac arrhythmias and relate with ECG changes.Explain the mechanism of myocardial injury during MI and its complications.Explain the ECG changes in case of ischemia and differentiate them from changes in infarction.Differentiate between anterior wall MI, lateral wall MI, inferior wall MI and Posterior wall MI based on the leads involved.Enlist the types of abnormal heart sounds (murmurs)Correlate the systolic and diastolic murmurs with valvular heart diseases like stenosis and regurgitationExplain the mechanism of myocardial injury during MIExplain the ECG changes in case of ischemia and differentiate them from changes in infarction.Correlate the ECG changes from the onset of MI to its progression and identification of changes of old MI.Differentiate between anterior wall MI, lateral wall MI, inferior wall MI and Posterior wall MI based on the leads involvedDiscuss the basis of common cardiac arrhythmias, process that produce them and their clinical significance.Employ the concept of sinus arrhythmia and its clinical significance.Compare between first degree, second degree and third degree heart blocks based on pathophysiology and ECG changes.Describe the basis of overdrive suppression and Stokes Adams attacksAssess changes in ECG and cardiac function during common abnormalities in ionic composition of body fluids.Differentiate between fibrillation and flutter based on ECG findingsDescribe the significance of defibrillation in emergency cardiac situationsElucidate the significance of cardiac biomarkers in Cardiac Ischemia & Infarction
  • Vascular PhysiologyLearning objectivesRecognize the location of vasomotor center.Enlist the different parts of vasomotor center and their functionsInterpret the Law of Laplace.Describe how it applies to ventricular function in the normal and volume overloaded (failing) ventricle.Extrapolate the relationship between pressure, flow, and resistance in the vasculature.Apply this relationship to the arteries, arterioles, capillaries, venules, and veins.Apply Poiseuille's law to understand the flow in distensible blood vessels.Correlate vascular resistance and conductance of blood vessels with the association of flow in series versus parallel on total resistance.Compare turbulent and laminar flow, the concept of pressure gradient, resistance to blood flow and its significance.Compare the physiologic anatomy of different types of blood vessels and their importance.Discuss the Physiology of vascular compliance, changes in compliance of blood vessels with age & comparison b/w the compliance of arteries versus veins.Identify the origin of arterial pressure pulse and its propagation to the peripheral arteries.Describe the factors damping the arterial pulse and abnormalities of arterial pulse.Correlate the right atrial pressure with the factors affecting venous return to heartCorrelate the venous resistance with Venous valves and muscle pump and gravitational forces with reference to varicose veinsDescribe how the theory of metabolic regulation of blood flow accounts for active hyperemia and reactive hyperemia.Identify the role of PO2, PCO2, pH, adenosine, and K+ in the metabolic control of blood flow to specific tissues.Diagram the synthetic pathway for nitric oxide (EDRF, endothelial derived relaxing factor), including substrate and the interplay between endothelium and vascular smooth muscle.Describe the role of angiogenesis in providing a long term match of tissue blood flow and metabolic need.Identify the cell membrane receptors and second messenger systems mediating the contraction of vascular smooth muscle by norepinephrine, angiotensin II, and vasopressin.Identify the cell membrane receptors and second messenger systems mediating the relaxation of vascular smooth muscle by nitric oxide, bradykinin, prostaglandins, and histamine.Describe the involvement of endothelial cells in the regulation of vascular diameter and inflammatory responses.Describe triple responseExplain the determinants of cardiac output i.e. stroke volume output and Heart rate and factors affecting them.Appreciate the mechanics of low & high cardiac outputs along with their effects on heart.Comprehend the factors affecting stroke volume, heart rate and total peripheral resistance.Understand Fick’s principle for the measurement of cardiac output.Understand the concept of “mean systemic filling pressure,” its normal value, and how various factors can alter its value.Define venous return.Understand the concept of “resistance to venous return” and know what factors determine its value theoretically, what factors are most important in practice.Construct a venous return curve.Predict how changes in right atrial pressure and mean systemic filling pressure effect the venous returnUnderstand the principles underlying cardiac output measurements using the Fick, dye dilution, and thermos-dilution methods.Contrast the local and neural control of cerebral blood flow and discuss the relative importance of O2, CO2, and pH in regulating cerebral blood flow.Describe the structural components of the blood brain barrier and how this barrier impedes the movement of gases, proteins, and lipids from the blood to neurons.Contrast the mechanisms of the two major types of stroke, hemorrhagic and occlusive strokeDescribe blood pressure measurement with a catheter and transducer and explain the components of blood pressure waveform.Contrast the direct and indirect estimation of blood pressure with a sphygmomanometer.Given systolic and diastolic blood pressures, calculate the pulse pressure and the mean arterial pressure.Describe how arterial systolic, diastolic, mean, and pulse pressure are affected by changes in stroke volume heart rate arterial compliance total peripheral resistanceComprehend the determinants of arterial pressure, factors affecting and mechanisms regulating blood pressure on short and long term basis.Understand mean arterial pressure and its significance.Contrast the sympathetic and parasympathetic nervous system control of heart rate, contractility, total peripheral resistance, and venous capacitanceExplain the sequence of receptor, afferent, CNS integration, and efferent events in the baroreceptor reflex, CNS ischemic response, chemoreceptor reflex, and Cushing reaction after an acute change in arterial blood pressure.Explain the sequence of events mediated by cardiopulmonary volume receptors that occur after an acute increase or decrease in arterial blood pressure.Include receptor response, afferent, CNS integration, efferent to the heart, kidney, hypothalamus, and vasculature.Explain the role of renin-angiotensin- aldosterone mechanism with the help of a flowsheet diagram in regulation of BP at intermediate termExplain the significance of pressure diuresis and pressure natriuresis in long term regulation of BPContrast the relative contribution of short- and long-term mechanisms in blood pressure and blood volume regulation.Examine the Radial Pulse and comment on rate, rhythm and characterRecord the Blood Pressure of a Subject using palpatory and Auscultatory MethodRecord the effects of posture and Exercise on Blood Pressure
  • Microcirculation, Lymphatics & Edema Learning objectivesDescribe the principles of capillary dynamics, structure of interstitium, Starling’s forces for fluid exchange across the capillary membrane and factors affecting thereof.Recognize the concept of starling’s equilibrium, and how the interstitial space is kept dryExplain the mechanism of formation of interstitial fluid, its composition and factors creating starling’s disequilibrium leading to the development of edema.Describe how histamine alters the permeability of the post capillary venules, and how the loss of albumin into the interstitial space promotes localized edema.Explain how edema develops in response to venous obstruction, lymphatic obstruction, increased capillary permeability, heart failure, tissue injury or allergic reaction, and malnutrition.Identify Types of edema, their pathophysiology and safety factors preventing edema formationSummarize different types of edema, and safety factors preventing edema formation.
  • Heart Failure & ShockLearning objectivesDifferentiate between the factors causing hyper-effective and hypo effective heart.Differentiate the mechanisms underlying compensated and uncompensated heart failure.Explain stages of development of shock.Differentiate compensated and uncompensated shockDifferentiate between right and left heart failure based on their pathophysiology and clinical manifestation.Outline the physiology of treatment of cardiac failureOutline the etiology, presentation, and management of hypovolemic, cardiogenic, anaphylactic, neurogenic, and septic shock.
  • Physiology PracticalsLearning objectivesDemonstrate the use of stethoscopeIdentify various parts of sphygmomanometer and stethoscopeDemonstrate the palpatory & auscultatory methods of recording blood pressureRecord the arterial blood pressure by properly placing the cuff 2.5 cm above the cubital fossa and placing the stethoscope on the brachial artery on the medial side of biceps tendon.Recognize the 4 types of Korotokoff sounds, their physiological basis and relevance to systolic and diastolic blood pressure ATTITUDEPractice the art of taking consent from the subject/patient prior to performance of procedure.Communicate the procedure effectively to the patientIdentify factors/indications for CPRPerform CPR according to American Heart Association guidelinesPractice the art of giving compressions on both adult and infant manikinsDemonstrate the use of Ambu bag with maskDemonstrate the three stages of response of skin (its micro vessels) to blunt mechanical injuryProficiently elicit local axon reflex by carefully applying a stroke on the skinPractice the procedure to record ECG by placing appropriate chest and limb leads on appropriate points and by adjusting the speed and calibration of the ECG machineProperly position the patient observing the required precautions during the recording of ECGObtain a 12 lead ECG recording with a long lead II for measurement of heart rate and identification of irregular rhythmIdentify normal ECG waves, complexes, segments and intervalsAssess cardiac axis, rhythm, origin of cardiac impulse (pace maker) and calculate heart rate from ECGCategorize the conditions affecting the ECG recordingIdentify bradycardia, tachycardia, and MI by examining the ECG ATTITUDEPractice the art of taking consent and communicating with the patient prior to conducting ECGExplain the procedure, reassure and communicate the precautions to be taken by the patientRecord the Radial artery pulse by placing three fingers on radial side of semi-pronated arm and counting for one minute.Observe the volume, rhythm and character of the pulseCompare the radial pulse with the carotid and femoral pulses and note any delayPalpate the carotid and dorsalis pedis pulses ATTITUDEIntroduce yourself to the subject/patient prior to performance of procedure and take consentExplain the procedure of conducting arterial pulse measurement to the patientProperly expose and position a subject and identify the different cardiac areas for auscultation of mitral, tricuspid, pulmonary and aortic valvesDemonstrate the auscultation of heart sounds by proper use of stethoscopeDifferentiate between first and second heart soundsAppraise the physiological basis of various heart soundsDemonstrate the location and palpation of apex beat on precordiumRecognize the displacement of apex beat and its relevance to diseases of heartBy adjusting position of subject’s head and neckRecord the arterial blood pressure by properly placing the cuff 2.5 cm above the cubital fossa and placing the stethoscope on the brachial artery on the medial side of biceps tendon.Record the effects of changing posture and performing standard exercise on blood pressure ATTITUDEPractice the art of taking consent from the subject/patient prior to performance of procedure.Communicate the procedure effectively to the patient
Medical Biochemistry6 listed topics
  • Lipid Structure, Digestion & AbsorptionLearning objectivesDefine lipids and enumerate their biomedical functionsDescribe lipid classification with examples & biochemical significance including nutritional significance of lipidsExplain the structure, chemistry, classification and biochemical functions of Fatty acids along with their nutritional roleDescribe the chemistry, functions & biochemical significance of Glycolipids, Phospholipids, Waxes and Steroids e.g Cholesterol along with their functionsExplain rancidity of fats, lipid peroxidation and its biochemical significanceAnalyze the results of Rancidity of FatsGive an overview of the digestion & absorption of LipidsCorrelate the digestion and absorption of lipids with clinical disordersExpalin the disorders related to essential fatty acids deficiency
  • Fatty Acid, Triglyceride & Ketone Body MetabolismLearning objectivesDescribe the biosynthesis of fatty acids, their regulation and related disordersExplain the mobilization and Oxidation of fatty acids along with types of oxidation (beta, alpha, omega & branched chain fatty acids), bioenergetics, regulation and related disordersElaborate the oxidation of fatty acids with odd number of carbon atoms and oxidation of unsaturated fatty acidsExplain Triglyceride metabolism (Lipogenesis & Lipolysis)Explain the metabolism of ketone bodies and correlate their utilization and clinical significance in body
  • Cholesterol, Lipoproteins & EicosanoidsLearning objectivesExplain the steps of Cholesterol synthesis, regulation along with functions and fate in the bodyDiscuss the synthesis, regulation and biochemical functions of Bile Acids and Bile SaltsElaborate enterohepatic circulation of bile and bile saltsDiscuss the metabolism of lipoproteins (VLDL, LDL, HDL, and chylomicrons) with respect to their transport, functions, and importance in health and disease.Discuss Apo lipoproteins and their role in lipoprotein metabolismDescribe the metabolism of Glycolipids and its related metabolic disordersExplain the classification, synthesis, biochemical functions and clinical importance of Eicosanoids
  • Cardiovascular Biochemistry - Clinical RelevanceLearning objectivesDescribe the metabolic disorders of lipid metabolismExplain Hypercholesterolemia in relation with pathophysiology of Atherosclerosis
  • Plasma Proteins & Immunoglobulins Learning objectivesDescribe the structure, classification, and biochemical functions of plasma proteins and immunoglobulins.Describe the clinical disorders associated with plasma proteins and immunoglobulins:EdemaMalnutritionMultiple Myeloma
  • Medical Biochemistry PracticalsLearning objectivesAnalyze the results of rancidity of fats experiment.Estimate and clinically interpret serum cholesterol, serum triglycerides, LDH, CK, and Trop T.Interpret a fasting lipid profile.Estimate and clinically interpret plasma proteins.