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Cardiovascular Pathophysiology

Spring 2008

Electrocardiogram - the graphic record of the heart's integrated action currents obtained with the electrocardiograph displayed as voltage changes over time. (Adapted by Tufts OCW.)

Highlights of this Course

The Introduction to Cardiovascular Pathophysiology course provides the students with two main objectives.  It delineates the material students are expected to understand and have recalled from the basic cardiac physiology lectures and it  expands on the discussion of the hemodynamic perturbations of cardiac function.

Course Description

In the second year Introduction to Cardiovascular Pathophysiology course, students will be introduced to the pathophysiologic basis for common cardiovascular diseases. This includes the basics of  hemodynamic perturbations and congenital and arrhythmic disorders of the heart. Students are also introduced to the spectrum of coronary disease and cardiomyopathies as well as the basics of vascular diseases. By the end of the course, students are familiar with common cardiovascular entities. The course will allow them to embark on a broader  future understanding of the diagnosis and management of cardiovascular diseases.

Popular Content

  • Introduction to Electrocardiography
  • Anti Arrhythmic Agents
  • Monophasic Action Potential (Cardiac Muscle Cell)
  • Cardiogenic Shock (Post Extensive Myocardial Infarction)
  • Hypovolemic Shock (Hemorrhage, Dehydration)


  • The student will learn the following:

    Basic Anatomy

    • Identify the cardiac chambers, valves and blood supply to the myocardium
    • Identify the Great Vessels (aorta, superior and inferior vena cava, pulmonary artery)
    • Identify how an impulse is generated in the sinus node and the route it travels to get to the ventricles 

    Excitation Contraction Coupling

    • Describe the constituents of the cardiomyocyte
    • Describe the microcellular steps leading to contraction
    • Define excitation contraction coupling 

    The Cardiac Cycle

    • Define systole and diastole
    • Identify the first and second heart sounds and the mechanism of their genesis
    • Define isovolumic contraction and iso volumic relaxation
    • Define the components of the cardiac cycle on the intracardiac pressure tracing; systole, diastole, isovolumic contraction and relaxation, S1, S2, S3 and S4
    • Describe the initiators of systole and diastole and the coupling between electrical activity and mechanical events in the heart
    • Define the components of atrial activity during the cardiac cycle, the a and v waves, the x and y descent
    • Describe S3 and S4 and their genesis 

    Cardiac Output

    • Define cardiac output and stroke volume
    • Recognize the determinants of cardiac output and stroke volume 
    • Understand what preload is and its relationship with the cardiac output 
    • Understand what inotropy is and how to recognize different inotropies on the Frank-Starling curve and on the pressure-volume loops 
    • Understand what end diastolic and end systolic volumes are and what stroke volume is 
    • Understand what afterload is 
    • Define what left ventricular ejection fraction is 
    • Describe the pressure volume loop 
    • Identify critical points of the cardiac cycle on the pressure volume loop  

    Intra Cardiac Pressures

    • Define the significance of the left ventricular end-diastolic pressure
    • Describe the classical hemodynamic picture in aortic and mitral stenosis 

    Systemic and Pulmonary Pressure and Resistance

    • Calculate mean pulmonary and systemic pressures
    • Define cardiac output and cardiac index
    • Define the determinants of blood pressure
    • Distinguish between different causes of hypotension (shock), cardiogenic, hypovolemic and hypotension secondary to inappropriate vasodilation (anaphylaxis, sepsis, vasodilators) 

    The Genesis and Conduction of Cardiac Rhythm

    • Define automaticity
    • Define resting and threshold potentials
    • Describe impulse conduction from the atrium to the ventricle
    • Define the determinants of resting membrane potential
    • Define the changes that occur across the membrane when an impulse is conducted
    • Define the components of the myocardial monophasic action potential
    • Identify the channels responsible for the genesis of the MAP  

    Coronary Artery Disease 

    Coronary Perfusion

    • Define the determinants of myocardial O2 demand
    • Describe the determinants of coronary perfusion
    • Define the “double product”
    • Identify endothelial vasodilators and vasoconstrictors
    • Define the degree of epicardial narrowing to result in ischemia
    • Define coronary reserve and factors limiting it 


    • Define the steps towards formation of atherosclerotic plaques
    • Stable vs, unstable plaque
    • Identify risk factors for atherosclerosis
    • Describe consequences of atherosclerosis 

    Coronary Artery Ischemia

    • Identify the factors determining the size of myocardial ischemia
    • Define collateral circulation and ischemic preconditioning
    • Define the consequences of impaired coronary perfusion to the myocardium
    • Distinguish stunned from hibernating myocardium  

    Coronary Syndromes

    • Distinguish between the different types of coronary syndromes, stable vs. acute
    • Distinguish between the different acute coronary syndromes
    • Distinguish acute myocardial infarction from the other coronary syndromes
    • Define the criteria required to diagnose and acute myocardial infarction
    • Define the types of acute myocardial infarction; e.g. silent, ST-segment elevated vs. non ST-segment elevated MI
    • Describe the definitive treatments of myocardial infarction
    • Describe the adjunctive treatment of myocardial infarction
    • Describe the short and long term complications of a myocardial infarction
    • Describe the determinants of prognosis in patients with coronary artery disease and after a myocardial infarction 

    Congenital Heart Disease 


    • Identify the commonest types of congenital heart disease in different age groups
    • Distinguish cyanotic from acyanotic congenital heart disease 

    Consequences of Congenital Heart Disease

    • Identify the main complications of congenital heart disease
    • Describe the EisenmengerÂ’s syndrome and its consequences
    • Identify the risks particular to adults with congenital heart disease 

    Ventricular Septal Defect

    • Describe VSD
    • Describe the pathophysiologic changes
    • Recognize the hemodynamic changes of VSD using hemodynamic data
    • Determine the natural course of VSD and indications for surgical correction 

    Atrial Septal Defect

    • Identify the different types of ASD
    • Describe the pathophsiologic changes
    • Describe the characteristic auscultatory findings
    • Describe the indications for treatment 

    Patent Ductus Arteriosus

    • Describe the connections of PDA and their consequences
    • Describe the classical findings
    • Describe treatment 

    Coarctation of the Aorta

    • Describe coarctation of the aorta
    • Describe the consequences of coarctation
    • Describe the physical findings
    • Identify indications for surgery

    Tetralogy of Fallot

    • Identify the components of TOF
    • Describe the clinical presentation
    • Identify long-term consequences in treated patients 

    Complete (D-TGA) Transposition of the Great Arteries

    • Identify the abnormalities of D-TGA
    • Describe prognosis and management 

    Corrected (L-TGA) Transposition of the Great Arteries

    Introduction to Electrocardiography

    • Describe the different types of electrocardiographic leads.
    • Explain the definition of the P, QRS and T waves, the PR and QT intervals and the ST segment.
    • Correlate the components of the electrocardiogram with the cardiac cycle.
    • Define a normal PR, QRS and QT intervals.
    • Identify abnormalities seen in the PR interval (short in preexcitation, prolonged in first degree AV block)
    • Distinguish 2nd from 3rd degree AV block, Mobitz I (Wenckebach) from Mobitz II 2nd degree AV block.
    • Distinguish sinus node dysfunction, as a cause of bradycardia, from AV block
    • Identify the electrocardiographic features of atrial fibrillation.
    • Identify the electrocardiographic features of atrial flutter.
    • Identify the electrocardiographic features of paroxysmal supraventricular tachycardia.
    • Identify the electrocardiographic features of tachy-brady syndrome (sinus node dysfunction).
    • Identify the electrocardiographic features of preexcitation (short PR interval, delta wave).
    • Identify the electrocardiographic features of ventricular tachycardia (wide complex, regular tachycardia).
    • Identify the electrocardiographic features of ventricular fibrillation (irregular, low amplitude wide complex tachycardia).
    • Describe what an AED (automatic external defibrillator) does and the indication for its use.
      Session   Type Title  
      1 Lecture Introduction to Cardiovascular Pathophysiology  
      2 Lecture Coronary Artery Disease  
      3 Lecture Ischemic Heart Disease  
      4 Lecture Congenital Heart Disease  
      5 Lecture Valvular Heart Disease  
      6 Lecture Anti-Ischemic Therapy  
      7 Lecture Arrhythmias and ECGs, Therapy of Arrhythmias  
      8 Lecture Dyslipidemias and Lipid Lowering Agents  
      9 Lecture Clinico-Pathological Conference  
      10 Lecture Anti Arrhythmic Agents  
      11 Lecture Introduction to Electrocardiography  
      12 Lecture Heart Failure I and II  
      13 Lecture Gender Differences in Heart Failure  
      14 Lecture Vascular Diseases I and II  
      15 Lecture Review  
      16 Examination Final Exam   Tell A Friend