Mednotes

L02 CVS CVS Module Convenor Introduction

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tagscvs, lecture
aliasesCVS Module Convenor Introduction

7 min read

Overview

This lecture introduces the CVS (cardiovascular system) module: which disciplines contribute to it, its aims and objectives, the epidemiology and staged pathophysiology of atherosclerotic cardiovascular disease, how the module is assessed (integrated cases, eCASES, SAQs), and the anatomy practical programme, including coronary artery anatomy.

Module structure and objectives

Contributing disciplines: Anatomy, Histology, Physiology, Pharmacology, Biochemistry, Infection & Immunology, Pathology, Clinical Skills, Clinical Demos, Public Health, Early Professional Experience, Hauora Māori, Blood.

Aims: develop core understanding of basic cardiovascular structure and function, and begin developing an understanding of the clinical and social impact of cardiovascular diseases.

Nine module-wide objectives are posted on Moodle; three are printed on the slide:

  • Describe the normal structure and function of the organs of the cardiovascular system at a metabolic, cellular and organ level, including the heart, aorta (elastic and muscular), arteries, arterioles, capillaries, venules, veins and lymphatics.
  • Explain the principles underlying preventive measures and therapeutic interventions used to prevent or modify the course of cardiovascular diseases.
  • Describe the impact cardiovascular disease and its treatment has on an individual’s experience of illness, psychological state, level of functioning, and social interactions.

(Objectives 2-6 and 9 are not shown on the slide; they are posted separately on Moodle.)

Key pathophysiological concepts for the module:

  1. Occlusive vascular disease / atherosclerosis
  2. Dilating arterial disease / aneurysm
  3. Diseases of the myocardium
  4. Valvular heart disease
  5. Cardiac arrhythmias
  6. Venous disease
  7. Blood pressure regulation
  8. Lifestyle / risk factors for CVS disease
  9. Genetics / congenital heart disease
  10. Psychosocial impact of CVS disease

Epidemiology of cardiovascular disease

Causes of death, men (Europe, 2008): coronary heart disease 21%, other CVD 11%, stroke 11% (all CVD 42% combined, 2014 figure); other cancer 11%, injuries and poisoning 12%, all other causes 17%, respiratory disease 7%, lung cancer 6%, colorectal cancer 2%, stomach cancer 2%.

Causes of death, women (Europe, 2008): coronary heart disease 22%, stroke 17%, other CVD 15% (all CVD 51% combined, 2014 figure). [slide does not give the remaining segment values for women]

Age-standardised CVD death rates fell by about 10% over the preceding 15 years, but people are dying of CVD at an older age. [slide does not elaborate further on this trend]

Atherosclerosis: stages and remodelling

Atherosclerosis timeline (Pepine CJ, Am J Cardiol 1998): fatty streak -> intermediate lesion -> atheroma -> fibrous plaque -> complicated lesion / rupture, with the lipid core/plaque growing larger and more occlusive at each stage.

Positive remodelling: outward (adventitial) expansion of the vessel wall, shown occurring at the fibrous plaque / complicated lesion stage.

Assessment structure

Integrated cases in the module: Case 6 Bruising, Case 7 Fainting, Case 8 Palpitations, Case 9 Chest Pain.

eCASES structure:

  • Tutorial ONE: patients, clinicians, science, medical practice, discussion forum, plus an IDL session on wider contexts (a resources panel on this slide, referencing New Zealand rheumatic fever guidelines/prevalence documents, is largely illegible in the source).
  • Tutorial TWO: in class with a tutor, using the learning from Tutorial ONE and the IDL.

Example SAQ case: a 59-year-old man presents to the Emergency Department with severe chest pain, having recently arrived in New Zealand, started a new stressful job, and living alone. History: father died at 61 of a “heart attack”; stopped smoking 2 years ago; knows he should eat better and has been meaning to get his cholesterol checked; BMI 29, BP 140/95. Diagnosis: myocardial infarction; students are expected to know the major causes of MI, principally coronary artery disease (atherosclerosis).

The "integrated assessment" slide states students should know key MI treatment options, illustrated with markers on two coronary-specimen photos, but the slide gives no text/legend explaining what the markers denote.

SAQ format: typically 5 questions of 8 minutes each, drawn from anatomy, physiology, pathology, pharmacology, psychological medicine, infection & immunology, genetics, clinical biochemistry, and clinical cases/demonstrations.

Anatomy practicals and coronary artery anatomy

Prescribed texts: Gray’s Anatomy for Students, 4th edition (2nd or 3rd also fine), Drake et al; Wheater’s Functional Histology, 5th edition, Young & Heath.

Anatomy is best learnt with models and prosections; practicals are guided study sessions. The pre-lab task for Anatomy Lab 1 is a fill-in-the-blank heart anatomy worksheet (arch of aorta, pulmonary artery branches, coronary sulcus, small/great cardiac veins, anterior interventricular sulcus, etc.), completed by students during the practical.

Normal anatomic variation in coronary artery branching is shown on injected heart specimens (anterior and posterior views), colour-coded: LAD = red, LCx = green, RCA = blue.

Labelled coronary artery branches (anatomy practical diagram):

  • From the left coronary artery: sinu-atrial nodal branch, circumflex branch (giving the left marginal branch), anterior interventricular branch (giving the diagonal branch).
  • From the right coronary artery: marginal branch.
  • Posterior interventricular branch: labelled on the diagram as arising from the circumflex branch of the left coronary artery.

Two of the diagram's leader-line labels are cut off at the slide edge in the source; they are transcribed above using the parallel wording of the legible left-hand labels, so the exact printed text is not fully confirmed.

The capillary network totals approximately 96,500 km in length, with a total surface area of approximately 3000 m².

Reminder: much cardiovascular anatomy content is taught in other modules of the course, specifically Regional Clinical Anatomy, Respiratory, Renal, and Nervous System.

Self-test

  1. What are the two overall aims of the CVS module?
  2. List the ten key pathophysiological concepts the CVS module covers.
  3. Describe the trend in age-standardised cardiovascular death rates over the last 15 years, and how this relates to the proportion of deaths still attributed to CVD.
  4. Describe the five stages of the atherosclerosis timeline, in order.
  5. What does “positive remodelling” refer to, and at which stage of the atherosclerosis timeline is it shown occurring?
  6. A 59-year-old man presents to the ED with severe chest pain. His father died of a heart attack at 61, he stopped smoking 2 years ago, has never had his cholesterol checked, and has a BMI of 29 and BP of 140/95. What is the diagnosis, and what is its major underlying cause?
  7. Distinguish the roles of Tutorial ONE and Tutorial TWO within the eCASES structure.
  8. Describe the format of CVS module SAQ assessment: number of questions, time per question, and subject areas drawn from.
  9. On the coronary artery variation slide, which colour represents the LAD, the LCx, and the RCA?
  10. List the branches of the left and right coronary arteries shown in the anatomy practical diagram.
  11. What is the approximate total length and total surface area of the body’s capillary network?
  12. Why does the module note that not all cardiovascular anatomy is taught within the CVS module, and which other modules cover the remainder?

Answers

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