Cardiovascular System

Block Book

Faculty of Medicine
Pelita Harapan University

Karawaci – Tangerang

2015/2016
Editor (2015 ed)
Dr. Sunanto Ng, dr., SpJP, MSc

Authors
Dr. Ira Andaningsih, dr., SpJP, Dr. Antonia A. Lukito, dr., SpJP, Evi, dr., MSc,
Vito Damay, dr., SpJP, MKes, Dr. Sunanto Ng, dr., SpJP, MSc

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 Lecturers

Dr. Antonia A. Lukito, dr, SpJP Royman Simanjuntak, dr, SpBTKV

Darti Isbandiati, dr, SpPA
Dr. Ira Andaningsih, dr, SpJP
Ingrid Pardede, dr, SpJP
Jan Tambayong, dr, PHK
Dr. Nicolaski Lumbuun, dr, SpFK
Otte J. Rahman, dr, SpJP
Radityo Prakoso, dr, SpJP
Subagia Santosa, dr, SpRad
Dr. Sunanto Ng, dr, SpJP, MSc
T. Haryanto, dr, SpPK
Tirta D. Susanto, dr, MKes
Vito Damay, dr., SpJp, MKes
Prof. Wahyuni Lukita Atmodjo, dr, Ph.D

Lab Instructors
Anatomy Bernard SM Hutabarat, dr, PAK, Stefanus Sumali, dr, Deisy Budiono, dr.
Histology Jan Tambayong, dr, PHK
Anatomical Darti Wibisono, dr,Sp.PA, Suga T. dr. Sp.PA, Kistiandono dr. Sp.PA
Pathology
Clinical Pathology T Haryanto, dr, SpPK
ECG Vito Damay, dr, SpJP, MKes, Hendyono Lim, dr., Ingrid Pardede, dr., SpJP,
Dr. Sunanto Ng, dr., SpJP, MSc
Cardiac Imaging Hendyono Lim, dr., Vito Damay, dr, SpJP, MKes, Ingrid Pardede, dr., SpJP,
Dr. Sunanto Ng, dr., SpJP, MSc

Tutors
Eric Setiawan, dr Risa, dr Daisy W., dr
Liaw Mega, dr Intan, dr Victor, dr
Jeffry, dr Nesta, dr Fenny Ng, dr
Winfrey, dr Fenita, dr Frisca A., dr
Juliana P, dr Maissy, dr Clarissa S., dr
Vesta, dr Kristina O., dr Erika, dr
Devita H, dr Priscillia, dr Patricia T., dr
Jan Tambayong, dr, PHK Darti Isbandiati, dr, SpPA Deisy Budiono, dr

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 INTRODUCTION

Cardiovascular disease is a major health problem worldwide. It is an essential to introduce the

knowledge since early in the medical education. Therefore, cardiovascular block is introduced at the
third semester in the medical education of University Pelita Harapan. The block consists of five topics of
cardiovascular medicine including development of the heart, hemodynamic of the cardiovascular
system, cardiac electrophysiology, ischemic heart disease, and heart as a pump. Each topic will be
provided in one week.
This block book describes the learning objectives of topics and the methods. The learning objectives of
topics in cardiovascular block are based on cardiovascular topics in the national standard of
competencies (Standar Kompetensi Dokter Indonesia 2012). Methods will include problem-based
learning, clinical skills, laboratorium, and lecture. Problem-based learning will be the mainstream
methods, in which students have the authority to gain knowledge guided by the learning objectives and
tutors. Interactive learning is encouraged in this system.
Some development is made for the 2015 Block Book, including additional time for laboratorium practice
and a new lab of cardiac imaging.
Assessment will be done continuously throughout the course and by examination at the end of this
block, including multiple choice questions and objective structured practical examination (OSPE).
We hope that this block book will serve as an appropriate guideline for the student to achieve their
knowledge in cardiovascular medicine. Objective feedback are most welcome to improve the learning
process.

Banten, August 3rd 2015

Dr. Sunanto Ng, dr., SpJP, M.Sc

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 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. References
Chapter VII. Assessment
Chapter VIII. Timetable
Chapter IX. Approval

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 CHAPTER I
COURSE INFO

o Block : Cardiovascular
o Semester : III
o Credits :5
o Duration : 5 weeks
o Started : September 21st, 2015
o Ended : October 23rd, 2015
o Coordinator : Dr. Sunanto Ng, dr., SpJP, MSc

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.

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 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.

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 ▪ 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.

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 behavioral 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 behavioral
change.

• Justify the chosen intervention based on pharmacology, physiology, exercise and

behavioral 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.

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 • Explain the clinical and laboratory data to determine the diagnosis of cardiovascular
disorders.

List of Cardiovascular Disorders and Level of Competency

(The National Standard of Competency / Standar Kompetensi Dokter
Indonesia 2012)
No Disorders LoC
Cardiac Disorders
1 Congenital heart disease (Ventricular septal defect, atrial septal defect, patent 2
ductus arteriosus)
2 Infection of the heart (endocarditis, myocarditis, pericarditis) 2
3 Shock (septic, hypovolemic, cardiogenic, neurogenic) 3B
4 Angina pectoris 3B
5 Myocardial infarction 3B
6 Acute heart failure 3B
7 Chronic heart failure 3A
8 Cardiorespiratory arrest 3B
9 Abnormality of the valves: mitral stenosis, mitral regurgitation, aortic regurgitation, 2
aortic stenosis, and other cardiac valve disorders
10 Tachycardia: supraventricular, ventricular 3B
11 Atrial fibrillation 3A
12 Ventricular fibrillation 3B
13 Atrial flutter 3B
14 Supraventricular and ventricular extra systole 3A
15 Bundle branch block 2
16 Other arrhythmias 2
17 Cardiomyopathy 2
18 Acute cor pulmonale 3B
19 Chronic cor pulmonale 3A
Aortic and arterial disorders
20 Essential hypertension 4A
21 Secondary hypertension 3A
22 Pulmonary hypertension 1
23 Raynaud disease 2
24 Arterial thrombosis 2
25 Aortic coarctation 1
26 Buerger’s disease (Thromboangiits obliterans) 2
27 Arterial emboli 1
28 Atherosclerosis 1
29 Subclavian steal syndrome 1
30 Aortic aneurysm 1
31 Aortic dissection 1
32 Claudication 2
33 Rheumatic heart disease 2
Vein and lymphatic disorders
34 Thrombophlebitis 3A
35 Lymphangitis 3A
36 Varicose (primary, secondary) 2
37 Obstructed venous return 2

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38 Deep vein thrombosis 2
39 Vein emboli 2
40 Lymphedema (primary, secondary) 3A
41 Chronic vein insufficiency 3A

Level of competencies 1 - identify and explain

Graduate is able to recognize and to explain the clinical characteristics of a disease, and knows
how to explore further information on the disease, and furthermore is able to determine appropriate
referral for the patient. Graduate should be able to manage the patient after back from referral.

Level of competencies 2 - diagnose and refer

Graduate is able to establish clinical diagnosis and able to determine appropriate referral for
management. Graduate should be able to manage the patient after back from referral.

Level of competency 3 - diagnose, provide early treatment and refer

Level of competencies 3a - not emergency
Graduate is able to establish clinical diagnosis and provides initial management in a non-
emergency situation. Graduate is able to determine appropriate referral for further management.
Graduate should be able to manage the patient after back from referral.
Level of competencies 3b - emergency
Graduate is able to establish clinical diagnosis and provides initial management in an emergency
to save life or to prevent severe or permanent disability at the patient. Graduate is able to determine
appropriate referral for further management. Graduate should be able to manage the patient after back
from referral.

Level of competencies 4 - diagnose, provide comprehensive treatment

Graduate is able to establish clinical diagnosis and to provide comprehensive management.
Level of competency 4A - achieve on graduation as medical doctor
Level of competency 4B - achieve after finish the internship program and/or Continue Medical
Education (CME)

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 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

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 CHAPTER IV
DEPARTMENTS

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

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 CHAPTER V
WEEK OBJECTIVES

WEEK 1
Theme : Development of the Heart
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 position 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 Tambayong, 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

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 Lecture 3 and 4
Topic : Embryology of the Heart
Lecturer : Radityo Prakoso, dr, Sp.JP (K)
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 Prakoso, 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 : Subagia, 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

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LABORATORY
LAB ANATOMY : Anatomy of the Heart
Coordinator : Bernard SM Hutabarat, dr.,PAK
Instructor : Bernard SM Hutabarat, dr.,PAK, Stefanus Sumali, dr,Deisy Budiono,
dr
Objectives:
1 . To be able to identify external topographic of the heart
2. To be able to identifiy internal anatomy of the heart.

LAB HISTOLOGY : Histology of Heart

Instructor : Jan Tambayong dr, PHK
Objectives :
1. To be able to identify histology of endocardium, myocardium and pericardium
2. To be able to identify histology of the blood vessel, including the artery, vein and lymph.

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WEEK 2
Theme : Hemodynamic of Cardiovascular System
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 : Dr. Sunanto Ng, dr, SpJP, MSc
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 : Dr. Sunanto Ng, dr, SpJP, MSc
Objective
Students should be able to:
• Describe hemodynamic disturbance and related heart murmur due to valvular problem :
- Aortic stenosis-regurgitation - mitral stenosis-regurgitation
- Pulmonal stenosis-regurgitation - tricuspid stenosis-regurgitation
• Describe hemodynamic disturbance due to myocardial problem :

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 - Dilated cardiomyopathy - hyperthrophic obstructive cardiomyopathy
- Restrictive cardiomyopathy

Lecture 3
Topic : Pharmacology of Anti-Hypertensive drugs
Lecturer : Dr. 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 blood 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

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 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 anatomical pathology change of cardiovascular system

LABORATORY
LAB ANATOMY : Anatomy of the Heart
Coordinator : Bernard SM Hutabarat, dr.,PAK
Instructor : Bernard SM Hutabarat, dr.,PAK, Stefanus Sumali, dr,Deisy Budiono,
dr
Objectives:
1 . To be able to identify external topographic of the heart
2. To be able to identifiy internal anatomy of the heart.

LAB HISTOLOGY : Histology of Heart

Instructor : Jan Tambayong dr, PHK
Objectives :
1. To be able to identify histology of endocardium, myocardium and pericardium
2. To be able to identify histology of the blood vessel, including the artery, vein and lymph.

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WEEK 3
Theme : Cardiac Electrophysiology
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 : ECG Abnormalities in Extra Cardiac Condition
Lecturer : Dr. Antonia A. Lukito, 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 2
Topic : Electrophysiology of The Heart
Lecturer : Otte J. Rahman, 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

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 - 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)

Lecture 3 and 4
Topic : Arrhythmia and Conduction Disturbance
Lecturer : Dr. Antonia A. Lukito, 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
• Describe cardiac arrest and sudden death

Lecture 5
Topic : Anti-arrhytmic drugs
Lecturer : Tirta D. Susanto, dr, M.Kes
Objective
Students should be able to:
• Describe the pharmacodynamics aspect of anti arrhythmia drugs;

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 - Class I, II, III, and IV anti arrhythmia
- Adenosine
- Digoxin
- Atropin
- Mg and K with respect to dysrhythmia

Lecture 6
Topic : Diagnosis Tool of Cardiovascular Diseases
Lecturer : Ingrid Pardede, dr. Sp JP
Objective
Students should be able to:

Define the indication of adjunctive diagnostic tools in cardiovascular assessment, including:

-Cardiac imaging : Echocardiography, Vascular ultrasound, Multislice CT Scan, Cardiac MRI
-Stress test for ischemic evaluation: exercise stress test (treadmill test), dobutamine stress
echocardiography, Cardiac MRI
- Eletrophysiology study: Holter monitoring, Invasive electrophysiology study
-Other functional test: Ambulatory blood pressure monitoring, ankle-brachial index

LABORATORY
LAB ECG:
Coordinator : Vito Damay, dr., SpJP, MKes
Instructors : Vito Damay, dr, SpJP, MKes, Hendyono Lim, dr., Ingrid Pardede, dr., SpJP,
Dr. Sunanto Ng, dr., SpJP, MSc
Objective :
Students should be able to;
• Perform ECG recording
• Interprete normal ECG
• Interprete abnormal ECG: ECG in acute MCI, VT, AFib, and VES.
•

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LAB PA:
Coordinator : Darti Wibisono, dr,Sp.PA
Instructor : Darti Wibisono, dr,Sp.PA, Suga T. dr. Sp.PA, Kistiandono dr. Sp.PA
Objectiv :
Students should be able to identify anatomic pathological change of the heart and blood
vessels.

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WEEK 4
Theme : Ischemic Heart Disease
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: 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
Lecture 2
Topic: Role of lipid abnormality as risk factors for Coronary Heart Disease
Lecturer: T.Haryanto,dr. Sp.PK
Objective
Students should be able to;

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 • 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 3
Topic: Physiology and Pathophysiology of Ischemic Heart Disease
Lecturer : Vito Damay, dr. Sp.JP, MKes

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 )

Lecture 4
Topic: Initial management for acute coronary syndrome
Lecturer: Vito Damay, dr. Sp.JP, MKes
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 5
Topic : Pharmacology
Lecturer : Dr. 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

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 Lecture 6
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

LABORATORY
LAB ECG :
Coordinator : Vito Damay, dr., SpJP, MKes
Instructors : Vito Damay, dr, SpJP, MKes, Hendyono Lim, dr., Ingrid Pardede, dr., SpJP,
Dr. Sunanto Ng, dr., SpJP, MSc
Objective :
Students should be able to;
• Perform ECG recording
• Interprete normal ECG
• Interprete abnormal ECG: ECG in acute MCI, VT, AFib, and VES.

LAB PA :
Coordinator : Darti Wibisono, dr,Sp.PA
Instructor : Darti Wibisono, dr,Sp.PA, Suga T. dr. Sp.PA, Kistiandono dr. Sp.PA
Objective :
Students should be able to identify anatomic pathological change of the heart and blood
vessels.

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WEEK 5
Theme : Heart as a Pump
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 : Dr. Sunanto Ng, dr.Sp.JP, MSc
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 26ldosterone mechanism
- Atrial Natriuretic Peptides Factors
- Arginine vasopressin factor
- Describe the pulmonary function and pulmonary edema in heart failure

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 Lecture 3
Topic : Clinical Assessment and management of Heart Failure
Lecturer : Dr. Sunanto Ng, dr. SpJP, MSc
Objective
Students should be able to :
Explain sign and symptom of heart failure : acute and chronic heart failure, right and left heart
failure
Describe classification of severity of heart failure : NYHA class (chronic), KILLIP class ( acute )
Describe heart failure related chest x-ray
Overview biomarkers of heart failure : NT pro BNP
Overview the role of advanced imaging : echocardiography and other imaging
Define management in acute heart failure and chronic heart failure.

Lecture 4
Topic : Pharmacology of the drugs in heart failure
Lecturer : Dr. 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

Lecture 5
Topic : Overview of other vascular disease
Lecturer : Vito Damay, dr. Sp JP, MKes
Objective
Students should be able to:

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 • 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

Lecture 6
Topic : Overview of other heart disease
Lecturer : Sunanto Ng, dr., SpJP, M.Sc, Ph.D
Objective
Students should be able to:
• Overview of other heart disease: rheumatic fever, rheumatic heart disease, infective
endocarditis, myocarditis and pericarditis

LABORATORY
LAB CARDIAC IMAGING :
Coordinator : Hendyono, dr
Instructors : Hendyono, dr , Vito, dr.Sp.JP, MKes, Sunanto Ng, dr, SpJP, M.Sc, Ph.D &
Ingrid Pardede, SpJP
Objective : Cardiac Imaging
Students should be able to;
Interprete the X-ray of a normal heart
Interprete the X-ray of abnormal heart (cardiomegaly, congestion signs of heart failure,
and congenital heart disease)
Understand basic interpretation of echocardiography

LAB CLINICAL PATHOLOGY :

Instructor : T Haryanto, dr., SpPK
Objective :
Student should be able to:
Demonstrate total cholesterol examination
Demonstrate triglyceride examination
Interprete cardiac enzymes (CK, CKMB, Troponin T/I) examination

Cardiovascular System / MEU FK-UPH Page 28

 CHAPTER VI
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 29

 7. Anatomical Pathology
• Pathologic Basis of Disease. Mitchell, R. N., Kumar, V., Abbas, A. K., Fausto, N., 7th 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 30

 CHAPTER VII
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. 80 % 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 31

 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 32

 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 33

 CHAPTER VIII
SCHEDULE

Cardiovascular System / MEU FK-UPH Page 34

 CARDIOVASCULAR SYSTEM
ODD SEMESTER 2015/2016

Semester III Batch 2014

Block Coordinator : Dr. dr. Sunanto Ng, SpJP, MSc Room 201 GBFK

Week I Development of The Heart

Time Monday, 21-09-2015 Tuesday, 22-09-2015 Wednesday, 23-09-2015 Thursday, 24-09-2015 Friday, 25-09-2015
07.15 - 08.05
PBL/Tutorial PBL/Tutorial PBL/Tutorial
08.10 - 09.00 Clinical exposure II,
09.05 - 09.55 Lecture 1 : Wahyuni Small Group Plenary, Su
10.00 - 10.50 Lab Introduction for Week I Field Lab Introduction for Week II
Christian Worldview 2
10.55 - 11.45 Lecture 6 : Subagia

11.50 - 12.40 Lab Practice

Anatomy (Bernard) & Clinical Skill II Idul Adha Faith activity
12.45 - 13.35 Histology (Jan) Lecture 2 : Jan
13.40 - 14.30 Lab Practice Anatomy Lab Practice Anatomy
(Bernard) & Histology Lecture 3 & 4 : Radityo (Bernard) & Histology
14.35 - 15.25 (Jan) (Jan)
15.30 - 16.20 Lecture 5 : Radityo
16.25 - 17.15 Clinical Exposure II
17.25 - 18.10 (Lecture)

Lecture 1 : Anatomy of The Heart Lecture 5 : Overview of Congenital Herart Disease

Lecture 2 : Histology of The Heart Lecture 6 : Radiographic Imaging of Cardiovascular System
Lecture 3 & 4 : Embriology of The Heart

Lab I : Anatomy of the heart

Lab II : Histology of the heart

Week II Hemodynamic of Cardiovascular System

Time Monday, 28-09-2015 Tuesday, 29-09-2015 Wednesday, 30-09-2015 Thursday, 01-10-2015 Friday, 02-10-2015
07.15 - 08.05
PBL/Tutorial PBL/Tutorial Character Development PBL/Tutorial
08.10 - 09.00 Clinical exposure II,
09.05 - 09.55 Small Group Lecture 3 : Nico Christian Worldview 2 Plenary, Ira
Lecture 1 & 2 : Su
10.00 - 10.50 Field /Leadership Lab Introduction for Week III
Christian Worldview 2
10.55 - 11.45 Lecture 6 : Darti
11.50 - 12.40 Lab Practice
Anatomy (Bernard) & Clinical Skill II Clinical Skill II Faith activity
12.45 - 13.35 Histology (Jan) Lecture 4 : Ira
13.40 - 14.30 Lab Practice Anatomy Lecture 5 : Ira Lab Practice Anatomy
(Bernard) & Histology (Bernard) & Histology
14.35 - 15.25 (Jan) (Jan)
15.30 - 16.20
16.25 - 17.15 Clinical Exposure II
17.25 - 18.10 (Lecture)

Lecture 1 & 2 : Principle of Cardiac Hemodynamic System Lecture 4 : Principle of Vessel Hemodynamic
Cardiac Hemodynamic Disturbance Lecture 5 : Blood Pressure
Lecture 3 : Pharmacology of Anti-Hypertensive Drugs Lecture 6 : Anatomical Pathology

Lab I : Anatomy of The Heart

Lab II : Histology of The Heart

Cardiovascular System / MEU FK-UPH Page 35

 Week III Cardiac Electrical Function and Dysfunction
Time Monday, 05-10-2015 Tuesday, 06-10-2015 Wednesday, 07-10-2015 Thursday, 08-10-2015 Friday, 09-10-2015
07.15 - 08.05
PBL/Tutorial PBL/Tutorial Character Development PBL/Tutorial
08.10 - 09.00 Clinical exposure II,
09.05 - 09.55 Lecture 1 : Antonia Small Group Christian Worldview 2
10.00 - 10.50 Field /Leadership Lab Introduction for Week IV
Christian Worldview 2
10.55 - 11.45 Lecture 6 : Ingrid
Lab Practice
11.50 - 12.40 Interpreting
Clinical Skill II Clinical Skill II Faith activity
12.45 - 13.35 ECG (Su, Vito)
PA (Darti) Lecture 3 & 4 : Antonia
13.40 - 14.30 Lab Practice Interpreting Lab Practice Interpreting
ECG (Su, Vito), PA ECG (Su, Vito), PA
14.35 - 15.25 (Darti) Lecture 5, Tirta (Darti) Plenary, Otte
15.30 - 16.20 Lecture 2 : Otte
16.25 - 17.15 Clinical Exposure II
17.25 - 18.10 (Lecture)

Lecture 1 : ECG Abnormalities in Extra Cardiac Condition Lecture 6 : Diagnostic Tool of Cardiovascular Disease
Lecture 2 : Electrophysiology of The Heart Lecture 5 : Anti - Arrythmic Drugs
Lecture 3 & 4 : Arrythmia and Conduction Disturbance

Lab I : Interpreting ECG

Lab II : Pathological Change of Heart and Blood Vessels

Week IV Ischemic Heart Disease

Time Monday, 12-10-2015 Tuesday, 13-10-2015 Wednesday, 14-10-2015 Thursday, 15-10-2015 Friday, 16-10-2015
07.15 - 08.05
PBL/Tutorial Character Development PBL/Tutorial
08.10 - 09.00 Clinical exposure II,
09.05 - 09.55 Lecture 1 : Haryanto Small Group Christian Worldview 2 Lecture 5 : Nico
10.00 - 10.50 Lecture 2 : Haryanto Field /Leadership Lab Introduction for Week V

10.55 - 11.45 Lecture 6 : Darti

Lab Practice
11.50 - 12.40 Interpreting Islamic Hijriyah
Clinical Skill II Clinical Skill II Faith activity
12.45 - 13.35 ECG (Vito) & New Year
PA (Darti)
13.40 - 14.30 Lab Practice Interpreting Lab Practice Interpreting Plenary, Su
ECG (Su, Vito), PA ECG (Su, Vito), PA
14.35 - 15.25 Lecture 3 : Vito (Darti) (Darti)
15.30 - 16.20 Lecture 4 : Vito
16.25 - 17.15 Clinical Exposure II
17.25 - 18.10 (Lecture)

Lecture 1 : Role of Enzyme Examination for Supporting Diagnosis Lecture 4 : Initial Management for Acute Coronary Syndrome
of MCI
Role of Lipid Abnormality as Risk Factors for Coronary Role of Lipid Abnormality as Risk Factors for Coronary
Lecture 2 : Lecture 5 :
Heart Disease Heart Disease
Physiology & Pathophysiology of Ischemic Heart
Lecture 3 : Lecture 6 : Anatomical Pathology
Disease

Lab I : Interpreting ECG

Lab II : Pathology Anatomy

Cardiovascular System / MEU FK-UPH Page 36

 Week V Heart as A Pump
Time Monday, 19-10-2015 Tuesday, 20-10-2015 Wednesday, 21-10-2015 Thursday, 22-10-2015 Friday, 23-10-2015
07.15 - 08.05
PBL/Tutorial PBL/Tutorial Character Development PBL/Tutorial
08.10 - 09.00 Clinical exposure II,
09.05 - 09.55 Small Group Christian Worldview 2 Lecture 5 : Vito
Lecture 1 & 2 : Su
10.00 - 10.50 Field /Leadership Lecture 6 : Su
Christian Worldview 2
10.55 - 11.45 Plenary, Su
Lab Practice
11.50 - 12.40 Cardiac Imaging
Clinical Skill II Clinical Skill II Faith activity
12.45 - 13.35 (Hendyono) Lecture 3 : Su
Clin Path (Haryanto)
13.40 - 14.30 Lab Practice Cardiac Lecture 4 : Nico Lab Practice Cardiac
Imaging (Hendyono), Imaging (Hendyono),
14.35 - 15.25 Clin Path (Haryanto) Clin Path (Haryanto)
15.30 - 16.20
16.25 - 17.15 Clinical Exposure II
17.25 - 18.10 (Lecture)

Lecture 1 & 2 : Pathoplysiology of Heart Failure Lecture 4 : Pharmacology of The Drugs in Heart Failure
Lecture 3 : Clinical Assessment and Management of Heart Failure Lecture 5 : Overview of Other Vascular Disease
Lecture 6 : Overview of Other Heart Disease
Lab I : Cardiac Imaging
Lab II : Clinical Pathology

Cardiovascular System / MEU FK-UPH Page 37