Learning Objectives By Lesson1-Cardiac Output & Shunts
- Describe how to determine cardiac index
- Define normal cardiac output and resting cardiac index values
- Identify invasive and non-invasive means to measure cardiac output
- Define and apply Fick's principle to determine cardiac output
- Describe and apply the indicator dilutation method to determine cardiac output
- Identify factors that can reduce the accuracy of the indicator dilution method in determining cardiac output
- Describe and apply the thermodilution method to determine cardiac output
- Identify factors that can reduce the accuracy of the thermodilution method in determining cardiac output
- Describe the screening and diagnostic approach for the evaluation of an intracardiac shunt
- Describe how an intracardiac shunt is expressed
- Describe how to determine pulmonary blood flow, systemic blood flow, and mixed venous saturation (Flamm formula)
- Describe how to interpret the Qp/Qs ratio in the context of intracardiac shunts
- Describe what is meant by the effective circulating blood flow
- Calculate effective circulating blood flow in the setting of a bidrectional intracardiac shunt
2-Circulatory Regulation
- Describe what mean arterial pressure represents
- Describe the short- and long-term circulatory control systems
- Explain the purpose of the baroreceptor reflex and its response to arterial stretch and hypotension
3-Coronary Physiology
- Identify the vessels of coronary arterial and venous circulation
- List the determinants of oxygen demand
- Describe the pressure gradients between different myocardial layers
- Describe the phasic changes that occur in coronary blood flow
- Explain why the subendocardium is the most susceptible layer to ischemia
- Describe the therapeutic strategy for patients with reduced coronary flow reserve
4-Drug Effects on Circulatory Function
- Review the determinants and regulation of circulatory function
- Describe the circulatory effect of various drugs (phenylephrine, prazosin, isoproterenol, propranolol, norepinephrine, and dopamine) on systemic vascular resistance, contractility, preload, stroke volume, and heart rate
5-Mechanisms of Arrhythmia
- Idenitfy three main mechanisms of arrhythmia
- Describe what is meant by enhanced automaticity and how it can precipitate arrhythmias
- Describe what is meant by triggered activity and how it can precipitate arrhythmias
- Describe the difference between early and delayed after depolarizatons and how they can precipitate arrhythmias
- Describe what is meant by reentry and how it can precipitate arrhythmias
6-Basic Approach to Arrhythmias
- Identify various causes of ventricular arrhythmias
- Describe initial therapies to consider for different ventricular arrhythmias
- Describe a basic classification for wide complex tachycardia differentiation and initial therapies to consider
- Describe general therapeutic considerations for atrial fibrillation management when a rhythm control strategy is favored
7-Antiarrhythmic Pharmacology Basics
- Identify different components of the normal contractile cardiomyocyte action potential
- Describe the relationship of events on the normal actional potential to those on the surface ECG
- Describe the Vaughn-Williams classification of antiarrhythmic agents
- Describe the effects of various antiarrhythmic drug classes on the action potential and surface ECG
8-Who Gets an AICD?
- Become familiar with the primary prevention automatic implanatable cardioverter defibrillator (AICD) clinical trials for ischemic and non-ischemic cardiomyopathy
- Describe the primary prevention strategy for sudden cardiac death in the context of ischemic and non-ischemic cardiomyopathy
- Describe an approach to determine who gets an automatic implanatable cardioverter defibrillator (AICD) for primary prevention of sudden cardiac death
- Identify clinical conditions in which automatic implanatable cardioverter defibrillator (AICD) should be considered in the context of normal left ventricular ejection fraction
Contributors: Nandan Anavekar, MBBCh; Mahmoud Ismayl, MD; Khalid Saeed Al-Asad, MD; Adnan Halboni, MD; Adolfo Martinez Salazar, MD; Anthony Kashou, MD
Last updated: January 2023.
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