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Cardiovascular/Pulmonary: Case 1

O. Daimler and D. Harris

Week 1 - June 22-26

Boards and Beyond - Required

Enrichment

Required 19

Textbook Assignments

Article Assignments

Weekly Objectives

Normal Physiology

Cardiopulmonary Anatomy
  1. Describe the various pleura and the significance of their different sensory innervations.
  2. Diagram the basic anatomy of the lung, being able to demonstrate features found at the hilar, lobar, and segmental level.
  3. Demonstrate the lymphatic drainage of the lungs and differentiate the right vs left side.
  4. Review the anatomy of the lungs, airways, and vasculature.
  5. Explain the role of diaphragm and intercostal muscles in breathing mechanics.
  6. Diagram the normal blood flow through the heart.
  7. Differentiate atrial and ventricular anatomy 
  8. Describe the anatomical relationship of the pleural and pericardial cavities.
  9. Describe the anatomical relationship of the heart to adjacent thoracic structures.
  10. Describe the foramen ovale and ductus arteriosus and changes that occur at birth.
  11. Distinguish the anatomical features of each cardiac chamber and valve.
  12. Diagram the normal coronary artery and venous distribution pattern, including types of dominance patterns.
  13. Describe the cardiac conduction system and its blood supply.
  14. Review the neural input to the heart.
  15. Recognize the origin of heart sounds
Pulmonary Mechanics
  1. Describe the mechanical forces that control lung volume and chest wall.
  2. Differentiate mechanisms of airway obstruction.
  3. Identify methods for measuring pulmonary function.
Pulmonary Circulation
  1. Describe the pathogenesis of primary pulmonary hypertension
  2. Identify cardiovascular consequences of pulmonary hypertension.
  3. Differentiate primary pulmonary hypertension from secondary pulmonary hypertension.
Cardiovascular Physiology
  1. Delineate the etiologies explain the pathogenesis of acute cardiogenic shock.
  2. Recognize common clinical presentations and treatment regimens for acute cardiogenic shock.
  3. Apply principles of cardiac physiology to recognize the value of cardiac catheterization (Swan-Ganz catheterization).
  4. Recognize how the basic interpretation of cardiac pressures can inform the clinical scenario.
  5. Regulation of Cardiac Output
Regulation of Cardiac Output
  1. Illustrate in detail the changes in left ventricular pressure, aortic pressure, and left atrial pressure during one cardiac cycle (Wigger’s Diagram).
  2. Diagram the relationships between venous and arterial pressure
  3. Diagram the venous return curve, cardiac function curve, vascular function curve, and pressure-volume loops.
  4. Describe how changes in contractility, venous pressure, arterial pressure, compliance, sympathetic activity, blood volume, and peripheral resistance affect the cardiac function curve, vascular function curve, and pressure-volume loop.
  5. Analyze the effect of complex changes such as exercise to overall cardiac function.
Alveolar Ventilation and Gas Transport
  1. Differentiate minute ventilation from alveolar ventilation.
  2. Describe the relationship between PCO2 and alveolar ventilation.
  3. xplain the oxygen-hemoglobin dissociation curve.
  4. Differentiate the concepts of oxygen tension, hemoglobin saturation, oxygen content, and oxygen delivery
  5. Identify factors that influence venous PO2 and venous oxygen saturation.
  6. Describe the P50 for hemoglobin, and list factors that shift the oxy-hemoglobin dissociation curve left and right.
  7. Describe mechanisms of arterial hypoxemia.
  8. Develop a working understanding of the alveolar gas equation, describing the A-a gradient for oxygen.
  9. Differentiate conditions associated with normal A-a gradient for oxygen from those with widened A-a gradient for oxygen.
  10. Identify consequences of inadequate oxygen delivery to tissue.
Informed Consent
  1. Describe the essential steps in ethical human research
  2. Describe the informed consent and what it means.
  3. Describe the process of obtaining informed consent.
Chest X-Ray
  1. Describe the ABCDE approach to chest X-ray interpretation, using this approach to identify intrathoracic structures on the X-ray.
Electrocardiography (ECG)
  1. Describe the physiologic basis of ECG.
  2. Describe what the different ECG waves represent.
  3. Explain the key features of a normal ECG, including P wave morphology, PR interval, QRS axis, QRS duration, and QT interval.
  4. Review examples of how pathology can result in ECG abnormalities, specifically left atrial enlargement, heart block, right bundle branch block, and ST-segment elevation MI.
Echocardiograph (ECHO) and Coronary Angiography
  1. Describe the physiologic basis of ECHO.
  2. Identify major structures of ECHO views.
  3. Cite examples of major abnormalities that can be detected by ECHO.
  4. Explain the physiologic basis of cardiac catheterization and coronary angiography.