Cardiovascular System

Block Book

Faculty of Medicine
Pelita Harapan University
Karawaci – Tangerang
2014/2015
 AUTHOR & Co-AUTHOR

dr. Evi, Master in Clinical Cardiology

dr. Sunanto Ng., Sp.JP, PhD
dr. Vito Damay, Sp JP

Contributors:
Lecturer and Tutors
1. Prof. dr. Wahyuni Atmodjo., PAK ,PhD
2. dr. Otte J.R, Sp JP (K)
3. dr. Jeffrey, Sp JP
4. dr. Radityo, Sp.JP
5. dr. Royman Simanjuntak.,Sp. BTKV
6. Dr. dr. Rusli, Sp. Rad
7. dr. Jan Tambajong., PHK
8. dr. Darti Wibisono, Sp.PA
9. Dr. dr. Nicolaski Lumbuun., Sp.FK
10. dr. T.Haryanto., Sp.PK
11. Dr. dr. Ira Andaningsih, Sp.JP
12. Dr. dr. Antonia A. Lukito., Sp.JP (K)
13. dr. Sunanto Ng., Sp.JP, Ph.D
14. dr. Evi
15. dr. Tirta Darmawan., MKes

Cardiovascular System/MEU FK-UPH Page 2

 OVERVIEW

The cardiovascular block will present an integrated case-based view of the anatomy,
histology, physiology, and cell biology of the cardiovascular system. This block will emphasize
electrophysiology of the heart, biochemistry of cardiac muscle, hemodynamics of the circulation,
structure/function of smooth muscle, microcirculation, and the overall regulation and control of the
cardiovascular system. State-of-the-art information on gene therapeutic approaches to
cardiovascular disease will be presented.
The Cardiovascular Block is designed to provide an integrated basic and clinical scientific
understanding of the underlying pathophysiology and treatment of major cardiovascular diseases.
The block begins with a mini-block of material focused on the pharmacology of the autonomic
nervous system that serves as an introduction to the cardiovascular material.
All topics include a discussion of treatment modalities, including a complete review of
pharmacologic interventions as well as other medical and/or surgical interventions. In addition, a
series of cardiovascular pathology and histopathology laboratories are included in the
Cardiovascular Block.

Lippo Karawaci, August 08th, 2014

Block Coordinator Cardiovascular system

Evi, dr. Master in Clinical Cardiology

Cardiovascular System/MEU FK-UPH Page 3

 List of Content

Chapter I. Course Information

Chapter II. Standard of Medical Competencies
Chapter III. Teaching and Learning Method
Chapter IV. Departments
Chapter V. Week Objectives
Chapter VI. List of Disease
Chapter VII. References
Chapter VIII. Assessment
Chapter IX. Timetable
Chapter X. Approval

Cardiovascular System/MEU FK-UPH Page 4

 CHAPTER I
COURSE INFO

o Block : Cardiovascular
o Semester : III
o Credits :5
o Duration : 5 weeks
o Started : September 22, 2014
o Ended : October 24, 2014
o Coordinator : Evi, dr . Master in Clinical Cardiology

Description:
The Cardiovascular Block provides a basic overview of an integrated and clinical scientific
understanding of the underlying pathophysiology processes and treatment of major cardiovascular
diseases, including case representation. The purpose of the cardiovascular block is for the student to be
able to learn about the development of the heart and the consequences of mal development, normal
physiology of the heart, regulation of blood vessels and the consequences of abnormal regulation,
determine pathophysiology of ischemic heart disease, assess cardiac electrical function and
dysfunction, identify and define clinical approach and management of heart failure.

Cardiovascular System/MEU FK-UPH Page 5

 CHAPTER II
STANDARD OF MEDICAL COMPETENCIES

Effective Communication
 Core competency
Able to explore and exchange information verbally and non-verbally with patients.
 The graduate is able to:
1. Establish rapport with the patient and his/her family.
 Greet the patient.
 Make the patient feel comfortable.
 Show empathy and trustworthiness.
 Listen actively
2. Collect information.
 Able to use open-ended and closed questions in acquiring information.
 Ask for clarification from the patient about any of his/her statements.
 Use clinical reasoning in exploring the history of the present illness, family
history, and history of past illness.
 Conduct data exploration logically and efficiently.
 Not give education and explanation prematurely while collecting
information.
3. Understand the patient’s perspective.
 Respect the patient’s belief in everything related to his/her illness.
 Explore the patient’s needs, worries, and hopes.
 Respond professionally to the patient’s verbal and non-verbal language.
 Use polite and understandable language which is appropriate to the
patient’s age and level of education.
4. Give explanations and information.
 Anticipate and reduce the patient’s feeling of fright and stress before physical
examination.
 Warn the patient when physical examination and clinical procedures may cause
pain or discomfort.

Cardiovascular System/MEU FK-UPH Page 6

Scientific basis of medical knowledge
 Core competency.
Identify, explain, and plan a scientific approach to health problem-solving, based on
current medical and health science, to get an optimal result.
 The graduate is able to:
Apply the concepts and principles of biomedical, clinical, and behavioural science,
and public health, appropriate to the delivery of primary health care.
Summarize an appropriate interpretation of the history, physical examination,
and laboratory tests for cardiovascular disorders.
Explain the cardiovascular disorders in terms of the principles of the basic medical
sciences, pathogenesis and pathophysiology.
Explain the molecular and cellular aspects of the cardiovascular disorders, based
on an understanding of the normal mechanisms of the human body.
Explain the physiological and the molecular goals of treatment in cardiovascular
disorders.
Explain the rational management of the d cardiovascular disorders, based on
clinical-epidemiology, pharmacology, physiology, diet, exercise, and behavioural
change.
Justify the chosen intervention based on pharmacology, physiology, exercise and
behavioural change in cardiovascular disorders.
Explain the possibility of drug interactions and side effects.
Explain the benefit of dietary therapy in the management of cardiovascular
disorders.
Summarize an appropriate interpretation of the history, physical examination, and
laboratory tests of cardiovascular disorders.
Explain the clinical and laboratory data to determine the diagnosis of cardiovascular
disorders.

Cardiovascular System/MEU FK-UPH Page 7

 CHAPTER III
TEACHING AND LEARNING METHOD

Lecture : 6 hours/week
Tutorial and Plenary : 7 hours/week
Laboratory practice : 4 hours /week
Clinical skill : 4 hours/week
Clinical exposure : 3 hours/week
University compulsory course : 2 hours/week
Self directed learning : 12 hours /week

Cardiovascular System/MEU FK-UPH Page 8

 CHAPTER IV
DEPARTMENT

Department of Anatomy
Department of Histology
Department of Biochemistry
Department of Physiology
Department of Anatomical Pathology
Department of Pharmacology
Department of Clinical Pathology.
Department of Radiology
Department of Cardiovascular medicine

Cardiovascular System/MEU FK-UPH Page 9

 CHAPTER V
OBJECTIVES

WEEK 1
Theme : Embriology and Anatomy of the Heart
Week Chair : Evi, dr
Week objectives :
Students should be able to:
Describe anatomical structure of the heart and circulatory system
Describe histological structure of the heart
Describe embryology of the heart
Describe development of the heart and consequences of mal development
Overview of congenital heart disease
Elaborate key points for basic cardio-thorax imaging

Lecture 1
Topic : Anatomy of the Heart
Lecturer : Prof. Wahyuni L. Atmodjo, dr., PAK, Ph.D
Objective
Students should be able to:
Describe potition of the heart in thoracic cage
Describe anatomical structure of the Heart
Describe the circulation system (systemic circuit and pulmonary circuit)
Described anatomy of main coronary arteries and its perfusion area of the heart

Lecture 2 : 50 minutes
Topic : Histology
Lecturer : Jan Tambajong, dr, PHK
Objective
Students should be able to:
Describe the histology structure of the heart: endocardium, myocardium, pericardium and
heart valves
Describe the histology of blood and lymph vessels

Cardiovascular System/MEU FK-UPH Page 10

 Lecture 3 and 4
Topic : Embryology of the Heart
Lecturer : Radityo, dr, Sp.JP
Objective
Students should be able to:
Explain the primitive heart tube and the division of embryonic heart tube
Describe cardiac looping and rotation
Describe atrial and ventricular septation development
Describe outflow tract development
Describe heart valves development
Explain circulation pattern before birth (fetal circulation)
Describe malformation of heart development

Lecture 5
Topic : Overview of congenital heart disease
Lecturer : Radityo, dr, Sp.JP (K)
Objective
Students should be able to:
Recognize the incidence of congenital heart disease
Describe type and classification of congenital heart disease
- acyanotic and cyanotic type
Overview of hemodynamic, sign and symptom, management of prevalent congenital heart
disease : ASD, VSD, TOF, PDA

Lecture 6
Topic : Radiographic Imaging of Cardiovascular System
Lecturer : Subagya, dr, Sp. Rad.
Objective
Students should be able to:
interpret of normal cardio-thorax X-Ray
interpret thorax X-Ray associated with congenital heart disease

Cardiovascular System/MEU FK-UPH Page 11

LABORATORY
LABORATORY 1 : Anatomy of the heart
Instructor : Bernard Hutabarat, dr.,PAK
Prof. Wahyuni L. Atmodjo, dr., PAK, Ph.D
Lab assistant : Deisy Budiono dr
Objectives
To be able to identify:
heart chamber
heart valve
heart wall and septum
outflow tract

LABORATORY 2 : Histology of heart

Instructor : Jan Tambayong dr, PHK,
Objectives
To be able to :
Identify the histology of : -endocardium
-myocardium
-pericardium

Cardiovascular System/MEU FK-UPH Page 12

WEEK 2
Theme : Hemodynamic of Cardiovascular System
Week Chair : Evi, dr
Objectives :
Students should be able to;
Describe basic principle of cardiac hemodynamic
Interpret cardiac cycle (Wiggers Diagram) and heart sound
Describe basic principle of vessels hemodynamic
Define clinical approach and management of hypertension
Describe pharmacodynamics of anti-hypertensive drugs.
Describe pathological changes of heart and blood vessels

Lecture 1
Topic : Principle of Cardiac Hemodynamic
Lecturer : Sunanto, dr, Sp.JP, PhD
Objective
Students should be able to:
Describe mechanism of cardiac contraction and relaxation
Describe pressure and volume changes during the cardiac cycle (Wiggers Diagram) and related
heart sound
Describe cardiac hemodynamic and body compensation:
- venous return - preload
- Stroke Volume (SV) - afterload
- Heart Rate (HR) - LV End Diastolic and End Systolic Pressure
- Cardiac Output (CO) - contractility (Frank-Starling Law)

Lecture 2
Topic : Cardiac hemodynamic disturbance
Lecturer : Sunanto, dr, Sp.JP, PhD
Objective
Students should be able to:
Describe hemodynamic disturbance and related heart murmur due to valvular problem :

Cardiovascular System/MEU FK-UPH Page 13

 - Aortic stenosis-regurgitation - mitral stenosis-regurgitation
- Pulmonal stenosis-regurgitation - tricuspid stenosis-regurgitation
Describe hemodynamic disturbance due to myocardial problem :
- Dilated cardiomyopathy - hyperthrophic obstructive cardiomyopathy
- Restrictive cardiomyopathy

Lecture 3
Topic : Pharmacology of Anti-Hypertensive drugs
Lecturer : Nicolaski Lumbuun., dr, Sp.FK
Objective
Students should be able to:
Describe the Pharmacology of Anti Hypertension Drugs;
- Diuretics
- Beta Blockers
- Calcium Channel Blockers
- Angiotensin Converting Enzyme (ACE) inhibitors
- Angiotensin Receptor Blockers (ARB)
- Aldosterone Antagonists
- Alpha Blockers
- Direct Vasodilators

Lecture 4
Topic : Principle of Vessel Hemodynamic
Lecturer : Ira Andaningsih, dr. Sp.JP
Objective
Students should be able to:
Describe function of vascular endothelium and smooth muscle
Describe control factors of blood pressure and blod flow :
- Role of the cardiovascular center
- Neural factors: baroreceptor reflexes and chemoreceptor reflexes
- Hormonal factors: Renin-Angiotensin-Aldosterone (RAA) system, Epinephrine and
Norepinephrine, Antidiuretic Hormone (ADH), Atrial Natriuretic Peptide (ANP)
- Autoregulation: physical changes, vasodilating and vasoconstricting chemicals

Cardiovascular System/MEU FK-UPH Page 14

 Lecture 5
Topic : Blood Pressure
Lecturer : Ira Andaningsih, dr. Sp.JP
Objective
Students should be able to:
Describe systolic and diastolic pressure
Define hypertension and its grading
Describe classification of hypertension (primary and secondary, emergency and urgency,
pulmonary hypertension, gestational hypertension)
Describe management and complication of hypertension

Lecture 6
Topic : Anatomical Pathology
Lecturer : Darti Wibisono, dr,Sp.PA
Objective
Students should be able to:
Explain the difference between arterio amd venous blockage
Explain process of arteriogenesis and related neoplasm
Recognize pathological changes of cardiomyopathy

Cardiovascular System/MEU FK-UPH Page 15

LABORATORY
LABORATORY 1 : Anatomy of the heart
Instructor : Bernard Hutabarat, dr.,PAK
Prof. Wahyuni L. Atmodjo, dr., PAK, Ph.D
Lab assistant : Deisy Budiono dr.
Objectives
To be able to identify:
Blood vessels
coronary arteries and its supply areas

LABORATORY 2 : Histology of the heart

Instructor : Jan Tambayong dr, PHK
Lab assistant :
Objectives :
To be able to identify:
the histology of blood and lymph vessels :
o aorta/large artery
o medium and small artery
o capillaries
o veins
o venules
o lymphatics

Cardiovascular System/MEU FK-UPH Page 16

WEEK 3
Theme : Cardiac electrical function and dysfunction
Week Chair : Evi, dr.
Objectives :
Students should be able to;
Describe anatomy of cardiac conduction
Explain basic concepts of normal electrophysiology and conduction
Describe the principles of electrical conduction abnormalities
Define clinical approach and management of arrhythmia
Define diagnosis tool of cardiovascular diseases
Describe the pharmacodynamics aspect of anti arrhythmia drugs
Perform ECG examination
Interpret normal and abnormal ECG results

LECTURE
Lecture 1
Topic : Electrophysiology of the heart
Lecturer : Otte JR, dr, Sp.JP
Objective
Students should be able to:
Describe the anatomy of cardiac electrical system
- SA node, AV node
- Bundle of His
- Purkinje Fibers
Explain basic concepts of Normal Electrophysiology and Conduction
Describe transmission of cardiac impulse
- Describe phases and ion movement
- Describe relative and absolute refractory periods
- Describe conduction velocity
Describe the relationship between electrical (action potential) and mechanical activities in
myocardium (The Process of Myocardial Excitation-Contraction Coupling)

Cardiovascular System/MEU FK-UPH Page 17

 Lecture 2 and 3
Topic : Arrhythmia and conduction disturbance
Lecturer : Antonia, dr. Sp JP
Objective
Student should be able to;
Describe basic concept of atrial arrhythmia :
- Premature Atrial Contraction
- Supra Ventricular tachycardia
- Atrial fluter
- Atrial fibrillation
Describe basic concept of ventricular arrhythmia;
- Premature Ventricular Contraction
- Ventricular tachycardia
- Ventricular fibrillation
Describe the abnormal conduction of Cardiac Electrical System;
- RBBB
- LBBB
- AV Block
- WPW
Cardiac arrest and sudden death

Lecture 4
Topic : Anti-arrhytmic drugs
Lecturer : Tirta., dr
Objective
Students should be able to:
Describe the pharmacodynamics aspect of anti arrhythmia drugs;
- Class I, II, III, and IV anti arrhythmia
- Adenosine
- Digoxin
- Atropin
- Mg and K with respect to dysrhythmia

Cardiovascular System/MEU FK-UPH Page 18

 Lecture 5
Topic : ECG abnormalities in extra cardiac condition
Lecturer : Antonia, dr. Sp JP
Objective
Students should be able to:
Define ECG abnormalities in extra cardiac condition : COPD, Cor Pulmonale, pulmonary
embolism, electrolyte imbalance
Define ECG changes in LVH, RVH, pericarditis, cardiac tamponade

Lecture 6
Topic : Diagnosis tool of cardiovascular diseases
Lecturer : Vito, dr. Sp JP
Objective
Students should be able to:
Define the diagnostic tool for cardiac & vascular abnormalities
- Treadmill test
- Holter monitoring
- ABPM (Ambulatory Blood Pressure Monitoring)
- Echocardiography + Doppler Vascular?
- Coronary angiography- vascular angiography
- CT scanning / MRI
- Electrophysiology test

Cardiovascular System/MEU FK-UPH Page 19

LABORATORY

LABORATORY 1 :
Instructor : Sunanto, dr, Sp.JP
Lab assistant : Vito, dr.Sp.JP , Evi, dr
Objective : ECG
Students should be able to;
Interpreting normal ECG
Interpreting atrial arrhythmia :
- Premature Atrial Contraction
- Supra Ventricular tachycardia
- Atrial fluter
- Atrial fibrillation

LABORATORY 2 :
Instructor : Darti Wibisono, dr,Sp.PA, Suga T. dr. Sp.PA, Kistiandono dr. Sp.PA
Objective : Pathological change of heart and blood vessels
Students should be able to:
Recognize pathological change of cardiomyopathy
Recognize pathological changes that occur during artery and venous blockage

Cardiovascular System/MEU FK-UPH Page 20

WEEK 4
Theme : Ischemic Heart Disease
Week Chair : Evi, dr.
Objectives :
Students should be able to:
Describe physiology and pathophysiology of ischemic heart disease
Define clinical approach and management of Ischemic Heart Disease
Define the role of ECG in diagnosis of Ischemic Heart Disease
Define the role of cardiac enzymes in diagnosis of Acute Myocardial Infarction
Define metabolic regulation of lipid
Define the pharmacology of the drugs used in management of Ischemic Heart Disease
Demonstrate simple lipid examination
Interpret cardiac enzymes [CK, CKMB, Trop I/T] examination
Perform ECG examination
Interpret ECG results on ACS

LECTURE
Lecture 1:
Topic : Physiology and Pathophysiology of Ischemic Heart Disease
Lecturer : Jeffrey, dr. Sp.JP
Objective
Students should be able to:
Explain basic principles of the cardiac oxygen supply and demand
Describe the role of heart rate and diastolic time in coronary blood flow
Explain the Pathophysiology of stable angina and Acute Coronary Syndrome
Describe complication of Myocardial infarction (ventricular dysfunction, cardiogenic shock,
arrythmia )

Cardiovascular System/MEU FK-UPH Page 21

 Lecture 2
Topic : Initial management for acute coronary syndrome
Lecturer : Jeffrey, dr. Sp.JP
Objective
Students should be able to;
Clinical approach in Acute Coronary Syndrome
Define ECG changes in Acute Coronary Syndrome
Give initial management for Acute Coronary Syndrome in the Emergency Department

Lecture 3
Topic : Anatomical Pathology
Lecturer : Darti Wibisono, dr,Sp.PA
Objective
Students should be able to:
Explain the difference between atherosclerosis and arteriosclerosis
Compare histologic appearance between normal wall and infarct wall of the heart

Lecture 4
Topic : Role of enzyme examination for supporting diagnosis of MCI
Lecturer : T. Haryanto, dr. Sp.PK
Objective
Students should be able to :
Define the various biomarker of Ischemic heart disease
- CK - LDH
- CKMB - HBDH
- Troponin T Hs - CRP-Hs
- Troponin I - BNP
Describe the role and mechanism of cardiac enzymes
Define the kinetic release of cardiac enzyme during ischemia/infarct

Cardiovascular System/MEU FK-UPH Page 22

 Lecture 5
Topic : Role of lipid abnormality as risk factors for Coronary Heart Disease
Lecturer : T.Haryanto,dr. Sp.PK
Objective
Students should be able to;
Describe basic concepts of lipid metabolism
Describe role of lipid abnormality in pathogenesis of atherosclerosis
Describe lipid profile test in management of Coronary heart disease

Lecture 6
Topic : Pharmacology
Lecturer : Nicolaski Lumbuun., dr. Sp.FK
Objective
Students should be able to;
Define pharmacology of the drugs used in management of Ischemic Heart Disease :
- Nitrate - Lipid lowering agent
- Thrombolytics - ACEI/ ARB
- Anti platelet - B blocker
- Anti coagulant - Morphin

Cardiovascular System/MEU FK-UPH Page 23

LABORATORY 1 :
Instructor : Sunanto, dr, Sp.JP
Lab assistant : Vito, dr.Sp.JP , Evi, dr
Objective
Students should be able to;
Perform ECG examination on model (manekin or friend)
Interpreting normal ECG
Interpreting acute coronary syndrome on ECG

LABORATORY 2 :
Instructor : T Haryanto , dr, Sp.PK
Lab assistant :
Objective
Student should be able to;
Demonstrate Total Cholesterol examination
Demonstrate Trygliceride examination
Interpret cardiac enzymes [CK, CKMB, Trop I/T] examination in groups

Cardiovascular System/MEU FK-UPH Page 24

WEEK 5
Theme : Heart as a Pump
Week Chair : Evi, dr.
Objectives :
Students should be able to:
Describe the pathophysiology of heart failure
Define clinical approach and management of heart failure
Describe basic principles and the role of haemostasis in cardiovascular event
Pharmacology of the drugs used in management of heart failure
Describe the pathological changes of heart and vessel’s abnormalities
Overview of other vascular and heart disease
Interpret ventricular arrythmia ECG

Lecture 1 and 2
Topic : Pathophysiology of Heart Failure
Lecturer : Sunanto, dr.Sp.JP
Objective
Students should be able to:
Describe the definition, classification ( acute and chronic, left and right), causes and classes of
heart failure
Describe pathophysiology of heart failure :
o neurohormonal system : RAAS and sympathetic system
o left ventricle remodeling in heart failure
Describe the compensatory mechanism in heart failure
- Autonomic Nervous System
- The kidney in heart failure:
a. Sodium retention
b. Renin angiotensin and aldotserone mechanism
- Atrial Natriuretic Peptides Factors
- Arginine vasopressin factor
- Describe the pulmonary function and pulmonary edema in heart failure

Cardiovascular System/MEU FK-UPH Page 25

 Lecture 3
Topic : Clinical Assessment and management of Heart Failure
Lecturer : Sunanto, dr. Sp JP
Objective
students to be able to :
1. Explain sign and symptom of heart failure : acute and chronic
heart failure, right and left heart failure
2. Describe classification of severity of heart failure : NYHA class
(chronic), KILLIP class ( acute )
3. Describe heart failure related chest x-ray
4. Overview biomarkers of heart failure : NT pro BNP
5. Overview the role of advanced imaging : echocardiography
and other imaging
6. Define management in acute heart failure and chronic heart
failure.

Lecture 4
Topic : Pharmacology of the drugs in heart failure
Lecturer : Nicolaski Lumbuun., dr, Sp.FK
Objective
Students should be able to:
Explain the pharmacology aspects of drugs used in management of heart failure;
- Angiotensin Converting Enzyme- Inhibitor
- Diuretics
- Angiotensin II-Receptor blocker
- Digoxin
- Beta-Blockers
- Aldosterone antagonists

Cardiovascular System/MEU FK-UPH Page 26

 Lecture 5
Topic : Overview of other heart disease
Lecturer : Evi, dr.
Objective
Students should be able to:
Overview of other heart disease: rheumatic fever, rheumatic heart disease, infective
endocarditis, myocarditis and pericarditis

Lecture 6
Topic : Overview of other vascular disease
Lecturer : Vito, dr. Sp JP
Objective
Students should be able to:
Overview of arterial disease: aortic aneurism, aortic dissection, coarctation of aorta, arterial
thrombosis, arterial emboli, Buerger’s disease, claudicatio, subclavian steal syndrome,
Raynaud’s disease
Overview of vein disease: deep vein thrombosis, thrombophlebitis, varicess, vein emboli,
chronic vein insufficiency, lymphangitis and lymphedema

Cardiovascular System/MEU FK-UPH Page 27

LABORATORY

LABORATORY 1 :
Instructor : Darti Wibisono, dr,Sp.PA, Suga T. dr. Sp.PA, Kistiandono dr. Sp.PA
Objective
Students should be able to:
Compare Atherosclerotic vessels and arteriosclerotic vessels
Compare histologic appearance between normal wall and infarct wall of the heart

LABORATORY 2 :
Instructor : Sunanto, dr, Sp.JP
Lab assistant : Vito, dr.Sp.JP , Evi, dr
Objective : ECG
Students should be able to;
Interpreting ventricular arrhythmia;
- Premature Ventricular Contraction
- Ventricular tachycardia
- Ventricular fibrillation
Interpreting abnormal pathway of Cardiac Electrical System;
- RBBB
- LBBB
- AV Block
- WPW
Cardiac arrest and sudden death

Cardiovascular System/MEU FK-UPH Page 28

 CHAPTER VI
LIST OF DISEASES (KKI)

Level of competencies 1
Able to recognize and apply the sign and symptoms to establish a diagnosis when reviewing
literature. Able to recognize clinical manifestation and how to get further information. This level indicates
overview level. Doctor can refer the patient soon after recognizing the illness.

Level of competencies 2
Able to establish a diagnosis depend on physical examination and the other examination ordered
by the doctor such as simple laboratory studies or X-Ray imaging. Doctor can refer the patient as soon
as possible to specialist for further treatment.

Level of competencies 3a.

Able to make a clinical diagnosis depend on physical examination and the other
examination ordered by the doctor such as simple laboratory studies or X-Ray imaging. Doctor can
decide and give initial therapy before referring the patient to specialist. Not an emergency case.

Level of competencies 3b.

Able to make a clinical diagnosis depend on physical examination and the other examination
ordered by the doctor such as simple laboratory studies or X-Ray imaging. Doctor can decide and give
initial therapy before refer the patient to specialist. In case of emergency.

Level of competencies 4
Able to make clinical a diagnosis depend on physical examination and the other examination
ordered by the doctor such as simple laboratory studies or X-Ray imaging. Doctor can decide and give
initial therapy before refer the patient to specialist. Doctor can decide and manage the problem by
himself completely

Cardiovascular System/MEU FK-UPH Page 29

 KARDIOVASCULAR
Gangguan dan Kelainan pada Jantung:
1. Kelainan jantung congenital (Ventricular Septal Defect, Atrial Septal Defect, Patent Ductus Arterio-
sus,Tetralogy of Fallot) 2
2. Radang pada dinding jantung (Endokarditis, Miokarditis, Perikarditis) 2
3. Syok (septik, hipovolemik, kardiogenik, neurogenik) 3B
4. Angina pektoris 3B
5. Infark miokard 3B
6. Gagal jantung akut 3B
7. Gagal jantung kronik 3A
8. Cardiorespiratory arrest 3B
9. Kelainan katup jantung: Mitral stenosis, Mitralregurgitation, Aortic stenosis, Aortic regurgitation,
dan Penyakit katup jantung lainnya 2
10. Takikardi: supraventrikular, ventricular 3B
11. Fibrilasi atrial 3A
12. Fibrilasi ventrikular 3B
13. Atrial flutter 3B
14. Ekstrasistol supraventrikular, ventricular 3A
15. Bundle Branch Block 2
16. Aritmia lainnya 2
17. Kardiomiopati 2
18. Kor pulmonale akut 3B
19. Kor pulmonale kronik 3A

Gangguan Aorta dan Arteri:

20. Hipertensi esensial 4A
21. Hipertensi sekunder 3A
22. Hipertensi pulmoner 1
23. Penyakit Raynaud 2
24. Trombosis arteri 2
25. Koarktasio aorta 1
26. Penyakit Buerger's (Thromboangiitis Obliterans) 2
27. Emboli arteri 1
28. Aterosklerosis 1
29. Subclavian steal syndrome 1
30. Aneurisma Aorta 1
31. Aneurisma diseksi 1
32. Klaudikasio 2
33. Penyakit jantung reumatik 2

Vena dan Pembuluh Limfe:

34. Tromboflebitis 3A
35. Limfangitis 3A
36. Varises (primer, sekunder) 2
37. Obstructed venous return 2
38. Trombosis vena dalam 2
39. Emboli vena 2
40. Limfedema (primer, sekunder) 3A
41. Insufisiensi vena kronik 3A
Cardiovascular System/MEU FK-UPH Page 30
 CHAPTER VII
REFERENCES

1. Anatomy
Anatomy for students, Gray's 1st edition. Elsevier 2005.
Clinical Anatomy, 3rd ed; Ernest W. April, Williams & Wilkins, 1997
Clinical Oriented Anatomy, 4th ed. Keith L. Moore
Netter Atlas of Human Anatomy. Netter, F. H., 4th ed. Saunders, 2006.
Medical Embryology, Langman

2. Biochemistry
Harper’s Illustrated Biochemistry. Murray, R. K., Granner, D. K., Mayes, P. A., Rodwell, V.
W., 27th ed. McGraw Hill, 2006.
Lehninger Principles of Biochemistry. Nelson, Dav, 4th ed. W. H. Free, 2005.

3. Histology
Basic Histology. L.C. Junquira, J. Carneiro, R.O. Kelley, 9th ed., Prentice Hall Int., 2000.
Color Textbook of Histology. L.P. Gardner and J.L. Hiati, 2nd ed., Saunders, 2001.

4. Physiology
Human Physiology, From Cells to Systems. Sherwood, L., 5th ed. Thomson, 2004.
Review of Medical Physiology. Ganong, W., 22nd ed. McGraw Hill, 2005.
Textbook of Medical Physiology. Guyton, A., 10th ed. Saunders, 2000.

5. Pharmacology
Basic and Clinical Pharmacology, Katzung, 10th ed, 2006.
Melmon and Morelli’s Clinical Pharmacology. Carruthers, S., 4th ed. McGraw Hill,
2000.

6. Clinical Pathology
Pathology. O’Connor, D., 2nd ed. Mosby, 2003.
The Science of Laboratory Diagnosis. Burnett, Da, 2nd ed. John Wiley, 2005.

Cardiovascular System/MEU FK-UPH Page 31

 7. Anatomical Pathology
Pathologic Basis of Disease. Mitchell, R. N., Kumar, V., Abbas, A. K., Fausto, N., 7 th ed.
Saunders, 2006.
Pathology Illustrated. Macfarlane, 5th ed. Churchill, 2000.

8. Microbiology
Medical Microbiology. Jawetz, melnick, Adelberg’s, 24th ed. McGraw Hill, 2007.
Principles and practice of Infectious Diseases, Mandell, Douglas and Bennetts

9. Radiology
Lecture Notes: Radiologi. Patel, P. R., 2nd ed. Erlangga, 2007.
Radiologi Diagnostik. Staf pengajar Subbagian radiodiagnostik, Bagian Radiologi
Fakultas Kedokteran Universitas Indonesia, 6th ed. FKUI, 1999.

10. Cardiology
Heart Disease I & II, A Textbook of Cardiovascular Medicine Braunwald, W.B.Saunders
Company
The Heart, William Hurst, 13th ed, Mc Graw Hill
Clinical Cardiology, M.Sokolov/M.B. Mellroy, Lange Medical Publications
Braunswald’s Heart Disease: International Edition, Single volume, Zipes, 9th ed.
Drugs for the Heart: Textbook with Online Updates, Opie, 8th ed.
Textbook of Critical Care, Fink, 5th ed.
Exercises of the Heart, Froelicher, 5th ed.
Nada’s Pediatric Cardiology, Keane, 2nd ed
Textbook of Clinical Echocardiography, Otto, 3rd ed.
Electrocardiography: In Chemical Practice Adult, Chou.

Cardiovascular System/MEU FK-UPH Page 32

 CHAPTER VIII
ASSESSMENT

I. Attendance requirements
Problem Based learning is an important and integral component of the UPH curriculum. This
instructional method emphasizes cooperative behavior and small group learning which for many
students, is a new way of learning. Consequently for groups to function successfully, regular full
attendance at tutorials is essential.
Attendance expectations as requirements and prerequisites to sit the examinations:
a. 100% for PBL tutorials and Clinical Skills sessions.
b. 70 % for all other activities.
c. Exemptions permitted with Doctor’s certificate, event of Family crisis, disaster or
extraordinary reason with prior permission from tutor. Further criteria according to UPH
criteria for exemption.

II. Assessment of Student Performance

The system will include assessment of block learning, mandatory courses, assessment of clinical skills
and a comprehensive “end of year” knowledge based examination. Each component will be given a
relative value in calculating a Cumulative Score.
a. Assessment will be conducted for learning in each block and will include:
i. Knowledge based MCQ.
ii. Objective structured Practical Examination (OSPE).
iii. Tutorial performance.
b. Clinical skills learning will be assessed at the end of each semester using the international
standard Objective Structured Clinical Examination (OSCE).
c. A comprehensive knowledge based examination (MCQ) will be conducted at the year end.
This will cover content from all components of the 2 previous semesters.
d. The Cumulative Score calculated based on the components will be the final score and
required for a successful Pass for the YEAR .
e. The Cut-off score for Pass will be determined by recognized standard setting processes.

Cardiovascular System/MEU FK-UPH Page 33

1. PBL Tutorial performance
Students will be assessed at the end of the block on the following performance in tutorial
sessions as:
a. Preparation.
b. Participation.
c. Professional Behavior.
All of performance above will be valued with the score as follows:
F (Fail) 50
P- (Need improvement) 60
P (Meet expectation) 75

2. Knowledge Assessment
Student’s applied knowledge will be assessed at the end of each block using:
a. Multiple Choice Questions (MCQ)
b. Objective Structure Practical Examination (OSPE)

3. Clinical Skills Assessment

Student’s applied clinical skills will be assessed at the end of semester using:
a. Objective Structure Clinical Examination (OSCE)

Standard setting
All assessment process such as MCQ, OSPE, OSCE, Extended matching are subjected to a
rigorous standard setting process. Methods such as Angoff, modified Angoff and Hofstee will be
used.

III. Relative values

1. At the end of the block, the relative value of the block consists of each component as follows:
Component Percentage
1. PBL tutorials 25 %
2. MCQ 55 %
3. OSPE 20 %

Cardiovascular System/MEU FK-UPH Page 34

 2. At the end of the year, the relative value of Cumulative Score consists of the relative value as
follows:
Component Percentage
1. MCQ comprehensive
(items will cover knowledge from all blocks within the year) 20 %
2. OSCE (compile value within the year) 20 %
3. Blocks (compile value within the year) 45 %
4. Longitudinal Course 15%

3. Standardization of Scores:
Passing grade at UPH is 60.00% (C) and will be determined through recognized Standards
Setting processes. Relationship to the Grading system and GPA is as indicated in the table.

GRADE RANGE SCALE

A 90,00 - 100 4,00
A– 85,00 – 89,99 3,70
B+ 80,00 – 84,99 3,30
B 75,00 – 79,99 3,00
B– 70,00 – 74,99 2,70
C+ 65,00 – 69,99 2,30
C 60,00 – 64,99 2,00 (PASS)
C– 55,00 – 59,99 1,50
F 00,00 – 54,99 0,00

Cardiovascular System/MEU FK-UPH Page 35

 CHAPTER IX
SCHEDULE
Block coordinator : Evi Lie,dr
Batch 2013
ROOM 301
Week I Development of the Heart Week Chair: Evi, dr.
22-Sep 23-Sep 24-Sep 25-Sep 26-Sep
Time Monday Tuesday Wednesday Thursday Friday
Christian
07.15 - 08.05 PBL PBL PBL
Worldview 2/
Character Devel-
08.10 - 09.00 Discussion 1 Clinical exposure II, Discussion 2 Discussion 3
opment
Anatomy,
09.05 - 09.55 Small Group Self learning
Wahyuni Leadership
10.00 - 10.50 Histology, JT Field Christian Worldview
10.55 - 11.45 lunch break lunch break 2 Radiology, Subagia Self learning
11.50 - 12.40 Lab practice Clinical Skill II Faith activity
Clinical Skill II
12.45 - 13.35 Anatomy Evi
Embriology, Radityo
13.40 - 14.30 & Plenary, Evi
14.35 - 15.25 Histology CHD, Radityo
15.30 - 16.20

Week II Regulation of Blood Vessel Week Chair: Evi, dr.

29-Sep 30-Sep 1-Oct 2-Oct 3-Oct
Time Monday Tuesday Wednesday Thursday Friday
Christian
07.15 - 08.05 PBL PBL PBL
Worldview 2/
Character Devel-
08.10 - 09.00 Discussion 1 Clinical exposure II, Discussion 2 Discussion 3
opment
Cardiac Hemody-
09.05 - 09.55 Small Group Self learning
namic
Leadership
10.00 - 10.50 Sunanto Field PA, Darti
Christian Worldview
2
10.55 - 11.45 lunch break lunch break Self learning

11.50 - 12.40 Lab practice Clinical Skill II Faith activity

Clinical Skill II
Vessels Hemody-
12.45 - 13.35 Anatomy Evi
namic
13.40 - 14.30 & Pharmacology, NL Ira

14.35 - 15.25 Histology Plenary, Ira

15.30 - 16.20

Cardiovascular System/MEU FK-UPH Page 36

 Cardiac electrical function and dys-
Week III Week Chair: Evi, dr.
function
6-Oct 7-Oct 8-Oct 9-Oct 10-Oct
Time Monday Tuesday Wednesday Thursday Friday
Christian
07.15 - 08.05 PBL PBL PBL
Worldview 2/
Character Devel-
08.10 - 09.00 Discussion 1 Clinical exposure II, Discussion 2 Discussion 3
opment
09.05 - 09.55 Self learning Small Group
Leadership
10.00 - 10.50 Field
Christian Worldview
2
10.55 - 11.45 lunch break lunch break

11.50 - 12.40 Lab practice Clinical Skill II Faith activity

Clinical Skill II
12.45 - 13.35 Interpreting Evi
Arrythmia, Antonia
Electrophysiology,
13.40 - 14.30 ECG Plenary, Otte
Otte
Diagnostic tool,
14.35 - 15.25 Sunanto, Vito&Evi Pharmacology, Tirta
Vito
extracardiac ECG
15.30 - 16.20 abnormalities, An-
tonia
16.25 - 17.15

Week IV Ischemic Heart Disease Week Chair: Evi, dr.

13-Oct 14-Oct 15-Oct 16-Oct 17-Oct
Time Monday Tuesday Wednesday Thursday Friday
Christian
07.15 - 08.05 PBL PBL PBL
Worldview 2/
Character Devel-
08.10 - 09.00 Discussion 1 Clinical exposure II, Discussion 2 Discussion 3
opment
Pathophysiology
09.05 - 09.55 Small Group Self learning PA, Darti
ACS, Jeffrey
Leadership
Management of
10.00 - 10.50 Field Plenary, Sunanto
ACS, Jeffrey Christian Worldview
2
10.55 - 11.45 lunch break lunch break Pharmacology, NL

11.50 - 12.40 Lab practice Clinical Skill II Faith activity

Clinical Skill II
Interpreting ECG Cardiac Enzyme,
12.45 - 13.35 Evi
Su&Evi Haryanto
Lipid profile, Haryan-
13.40 - 14.30 &
to
14.35 - 15.25 Path clin

15.30 - 16.20

Cardiovascular System/MEU FK-UPH Page 37

 Week V Heart as a pump Week Chair: Evi, dr.
20-Oct 21-Oct 22-Oct 23-Oct 24-Oct
Time Monday Tuesday Wednesday Thursday Friday
Christian
07.15 - 08.05 PBL PBL PBL
Worldview 2/
Character Devel-
08.10 - 09.00 Discussion 1 Clinical exposure II, Discussion 2 Discussion 3
opment
Pathophysiology
09.05 - 09.55 Small Group Self learning Plenary, Sunanto
of
Leadership
Overview of vascu-
10.00 - 10.50 CHF,Sunanto Field
Christian Worldview lar disease, Vito
2 Overview of heart
10.55 - 11.45 lunch break lunch break Self learning
disease, Evi
11.50 - 12.40 Lab practice Clinical Skill II Pharmacology, NL Faith activity
Clinical Skill II
12.45 - 13.35 Pathology Evi
Clin.assesment of
13.40 - 14.30 Anatomy
HF, Sunanto
14.35 - 15.25 Darti

15.30 - 16.20

Cardiovascular System/MEU FK-UPH Page 38