Subject: PATHOPHYSIOLOGY
Place: Department of General and Experimental Pathology, room 371
Division: FACULTY OF MEDICINE
YEAR: 3

CLASS no: 4

Pathophysiology of the cardiovascular system – part 1

Goal: to explain etiology, pathogenesis, manifestations and consequences of selected diseases of the cardiovascular system

Time: 4 hours

Didactic tools: multimedia presentation

Before the classes students should revise anatomy, histology and physiology of the cardiovascular system. Organisation of the circulatory and lymphatic systems.
Hemodynamics of the circulatory system. Control of blood and lymphatic flow.

Topics :

1. HYPERTENSION: classification, pathogenesis and consequences.
2. ATHEROSCLEROSIS: epidemiology, risk factors, natural history, consequences.
   The role of endothelial injury, inflammation and dyslipidemia.
3. CORONARY HEART DISEASE: Principles of Coronary Circulation, Coronary Atherosclerosis and the Pathogenesis of Coronary Artery Disease.
   - Chronic (Stable) Ischemic Heart Disease (classification, pathogenesis, consequences)
   - Acute Coronary Syndromes and Myocardial Infarction (classification, pathogenesis, consequences)
4. VASCULITIS: Kawasaki Disease, Giant cell temporal arteritis.
5. PERIPHERAL ARTERY DISEASE: pathogenesis and consequences
6. ANEURYSM: types, pathogenesis, consequences.
7. DISORDERS OF CARDIAC RHYTHM AND CONDUCTION
   Mechanisms and types of arrhythmias and conduction disorders. Consequences of arrhythmias. Adams-Stokes syndrome.

References:
Porth's Pathophysiology: Concepts of Altered Health States - Tommie L Norris; Wolters Kluwer; 10^th Edition, International, (November 3, 2018), chapters: 26, 28.
Color Atlas of Pathophysiology - Stefan Silbernagl, Florian Lang,  Thieme; 3rd Edition, 2016.

Diseases:
Sick sinus syndrome.
Atrial fibrillation and atrial flutter.

Junctional tachycardia.
Ventricular tachycardia.
Wolff-Parkinson-White syndrome.
Atrio-ventricular blocks.
Long QT syndrome.
Atherosclerosis and its clinical forms.
Ischemic heart disease.
Stable angina.
Unstable angina.
Myocardial infarction.

Problems:
DISORDERS OF IMPULSE GENERATION AND IMPULSE CONDUCTION

Mechanisms of tachyarrhythmia formation.

Mechanisms of bradyarrhythmia formation.

Pathogenesis of disorders of the automatism of stimulus-generating centers.

Pathogenesis of pathological automatism.

Pathogenesis and examples of automatism of ectopic centers.

Mechanisms and examples of triggered automatism:

- early afterdepolarizations,

- late afterdepolarizations.

Pathogenesis of the re-entry phenomenon.

The morphologic background of reentrant tachycardias.

Pathogenesis of the preexcitation syndrome.

Pathogenesis of conduction disorders:
- atrioventricular block (I, II and III degree),
- sinoatrial block (I, II and III degree),
- intraventricular block.

ATHEROSCLEROSIS

Etiopathogenesis of atherosclerosis.

Cellular basis in the pathogenesis of atherosclerosis.

Consequences of atherosclerotic plaque rupture.

Clinical picture of atherosclerosis depending on the location of atherosclerotic lesions.

Complications of atherosclerosis.

ISCHEMIC HEART DISEASE

Etiopathogenesis of ischemic heart disease.

Etiopathogenesis of stable and acute coronary syndromes with the emphasis on the involvement of the thrombotic events.

Mechanisms of coronary artery obstruction.

Symptoms of ischemic heart disease.

Mechanisms of anginal pain.

Cellular sequelae of ischemia.

Myocardial stunning.

Myocardial hibernation.

Clinical picture of myocardial ischemia depending on the location of stenosis in the coronary circulation.

MYOCARDIAL INFARCTION

Pathogenesis of myocardial infarction.

The mechanism of cell death in myocardial infarction.

The importance of ST segment elevation in the pathogenesis of myocardial infarction.

Subendocardial vs transmural myocardial infarction.

Dynamics of myocardial damage in the course of acute myocardial infarction.

Biochemical markers of myocardial damage in the course of acute myocardial infarction.

Evolution of ECG changes in the course of myocardial infarction.

Early and late complications of myocardial infarction.

Cardiac tamponade.

Pathogenesis of post-infarction heart remodelling and its consequences.