Truth gains more from the errors of those who think for themselves than from those who do not suffer themselves to think.
- John Stuart Mill
There is but a handful of medical disciplines in which understanding of basic physiology is critical to recognising the clinical manifestations of disease. Cardiology is a paramount example of such a symbiosis. This multimedia, interactive e-learning resource makes no apology for being less than all-inclusive. Rather, its major aim is to enable the learner to conceptualise an approach to the clinical diagnosis and management of cardiac patients based on sound principles of applied physiology. Contained herein are ten chapters – each offering a unique challenge to apply these principles in the setting of individual case scenarios covering a wide array of cardiac conditions.
The chapters should flow smoothly. Each begins with a brief story of the clinical presentation. A decision point is then reached - represented in the form of multiple options – directions, if you will, on how to proceed. Each of your responses, whether correct or not, is positively reinforced with feedback designed to illustrate how applied physiology facilitates the diagnosis and rationalises an approach to management - always mindful of the patient’s anticipated reaction, needs and preferences. Your clinical responsibility never wavers as your patient stumbles through a branching network of different circumstances, each posing a different set of options. The narrative is occasionally highlighted with animated images - a visual framework to help understand the mechanisms of disease processes and how they manifest clinically.
You should have fun.
Produced under the auspices of The Division of Cardiology, The Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University and The Population Health Research Institute Hamilton Health Sciences
Clinical Applications of Cardiovascular Physiology
This introductory chapter deals with some fundamental principles of normal cardiovascular physiology and their adaptations to changing physiologic circumstances in a patient who has suffered haemorrhagic shock.
A Case of Angina Pectoris
Included, in this chapter, are mechanisms of angina, coronary physiology, determinants of myocardial oxygen consumption, description and indications for coronary angiography and rationale for therapy based on anatomico-pathophysiologic principles.
A Case of Acute Myocardial Infarction
This chapter describes coronary atherosclerosis, risk factors and their modulation, the clinical presentation and objectives of management based on the underlying pathology with or without ongoing ischemia.
A Case of Effort Dyspnea
A case of Congestive Heart Failure due to a non-ischemic dilated Cardiomyopathy. Emphasis given to the pathophysiology of left ventricular dysfunction, types of heart failure and how they present, systemic manifestations of heart failure, diagnostic criteria and the rationale underlying management strategies.
Differential Diagnosis of a Systolic Murmur
A case of diastolic dysfunction due to Hypertrophic Cardiomyopathy. This chapter offers an opportunity to define the differences between systolic and diastolic dysfunction in terms of classical concepts of cardiac physiology. Included are descriptions of the clinical presentations, diagnostic maneuvers and principles of management.
Mitral Valve Disease – Unplugged
Mitral valve disease in all its manifestation is discussed in this chapter. Both mitral stenosis and varying forms of mitral regurgitation are described in terms of pathophysiology, clinical presentations (including acute pulmonary edema), diagnosis and management.
A Case of Aortic Valve Disease
This is a case of Aortic Stenosis, its pathology, different modes of clinical presentation, complications, diagnosis and management. Included is a description of infective endocarditis and the development of aortic valve insufficiency and how the latter presents with a different clinical and pathophysiologic syndrome.
A Case Exhibit of Cardiac Dysrhythmias
This chapter describes dysrhythmias in all its manifestations. It begins with a case who presents innocently with occasional ventricular ectopic beats but through a series of iatrogenic misadventures the poor fellow elicits every dysrhythmia imaginable. The different rhythm distrubances are described in terms of their ECG diagnosis as well as the underlying pathologic substrate.
A Case of Congenital Heart Disease
A case of Tetralogy of Fallot is described in terms of clinical presentation, embryology, pathophysiology, diagnosis and management. Other common Congenital Heart Disorders are also described briefly especially in terms of how and why they differ in their presentations.
3 Short Cases of Pericardial Disease
Three short cases of Pericardial Disease are described. The different clinical presentations of these conditions (acute, compressive and constrictive) are described and compared with reference to specific etiologies and pathophysiologic mechanisms.