Факультет фундаментальной медицины

1. History taking and clinical examination - history taking, range and meaning of words used by patients to describe their symptoms; several symptoms of cardiovascular disease and features that differentiate them from non-cardiovascular conditions; cardiovascular risk factors derived from the patient's history and the importance of global cardiovascular risk assessment; names, pharmacology, and side-effects of the drugs prescribed to cardiovascular patients; clinical manifestations and treatment of the co-morbidities often associated with cardiovascular disease; clinical manifestations and treatment of inherited cardiovascular diseases and the principles of family counseling. Clinical examination: blood pressure (BP) measurement: principles and limitations of its diagnostic and prognostic values, keeping in mind the high variability of clinic BP; characteristics of the normal and abnormal arterial pulse, heart rate, and rhythm; the normal and abnormal precordial impulse; heart auscultation in relation to the cardiac cycle in health and disease; right atrial pressure (jugular venous pressure); palpation and auscultation of arteries. Significance of abnormal arterial pulses and vascular bruits at various sites; ankle-brachial index (ABI) as an indication of advanced peripheral arterial disease; the venous system; clinical signs of under-perfusion and fluid retention; features on general examination caused by cardiovascular disease (lungs, liver, skin, and limbs).
2. Electrocardiography - the cellular and molecular mechanisms involved in the electrical activity of the heart (the anatomy and physiology of the conduction system; electrical vectors throughout the cardiac cycle; normal ECG and how it derives from electrical vectors; common artifacts and lead reversal ECGs; the characteristic appearances of, and explanation for, the ECG in patients with: heart chamber hypertrophy, ischemia and infarction, 15- or 18-lead ECGs performed with an alternate precordial lead placement to assess posterior- or right-sided disease, conduction disturbances (left bundle branch block, right bundle branch block, hemi-fascicular block, other types of intraventricular conduction delay, AV-block, tachycardias and bradycardias, pre-excitation, chanellopathies, QT abnormalities (short QT, long QT), Brugada ECG pattern, early repolarization, other repolarization disturbances, electrolyte abnormalities, anti-arrhythmic and other drugs, hypothermia, pericarditis, pericardial effusion, myocarditis, arrhythmogenic cardiomyopathy, pacemaker, ICD, and CRT devices and their dysfunction). Long-term ambulatory ECG - indications and limitation.
3. Exercise ECG testing - main indications in evaluation of ischemia, treatment response, functional capacity, inducible arrhythmias, non-invasive hemodynamic response to exercise (e.g. chronotropic response, BP response). Contraindications, criteria for stopping the test, complications and their management.
4. Cardiopulmonary exercise testing - main indications, evaluation of exercise tolerance, differentiation between cardiovascular and pulmonary etiology of exercise intolerance, anaerobic threshold and aerobic capacity, VE/VCO2 slope, evaluation of patients with cardiovascular diseases, functional evaluation and prognosis in patients with heart failure, selection for cardiac transplantation, monitoring cardiac rehabilitation.
5. Non-invasive imaging in general - assessment of cardiac structure and function, cardiac chamber size and wall thickness, left ventricular (LV) mass, ventricular and atrial volumes, measurement of LV and right ventricular (RV) systolic function, assessment of LV and RV diastolic function, assessment of valvular stenosis, assessment of valvular regurgitation, assessment of coronary artery disease, including calcification of coronary arteries (+calcium score), non-invasive angiogram, evaluation of the ischemic myocardium, including regional wall motion abnormalities, scar, stunning, hibernation, perfusion, and viability, myocardial disease, pericardial disease, cardiac tumors/masses, congenital heart disease, estimation of shunt size and consequences, thoracic and abdominal aortic diseases, diseases of the pulmonary circulation, the effects of surgical and interventional procedures. Use of non-invasive imaging modalities to assess vascular anatomy and function of carotid and vertebral arteries (cervical arteries); thoracic and abdominal aorta; peripheral arteries; lower limb venous system. Principles of stress testing as applied in cardiac imaging, including treadmill and bicycle exercise; vasodilator stress (dipyridamole, adenosine, and related agents); sympathomimetic stress (dobutamine). Radiation exposure with different imaging techniques and principles of radiation protection.
6. Echocardiography - M-mode; two- and three-dimensional (2D and 3D) modes; Doppler imaging (blood flow, tissue); ultrasound examination of arteries and veins; contrast echocardiography; transesophageal echocardiography (TEE); deformation imaging (speckle-tracking- and Doppler-based strain analysis); stress-echo modalities (exercise and/or pharmacological echo). Global left ventricular (LV) and right ventricular (RV) systolic and diastolic function; regional LV function, including ischemic regional wall motion abnormalities and their implications for the presence of scar, stunning, hibernation, perfusion, and viability; LV mass, scaling for body size, and hypertrophy; cardiac chambers anatomy, size, function; primary and secondary cardiomyopathies (dilated, hypertrophic, restrictive, arrhythmogenic); valvular morphology and function, including stenosis and regurgitation, multivalvular diseases; valve repair, valve prostheses, percutaneous valve implantation; endocarditis; pericardial disease (including cardiac tamponade); cardiac masses (tumors, thrombi, vegetations, foreign bodies); congenital heart disease before and after surgical correction; shunt lesions; pulmonary hypertension; non-invasive hemodynamics, including cardiac output, LV filling pressures, pulmonary artery pressure, and right atrial pressures; liver congestion and venous flow, respirophasic changes of the vena cava; pathology to anticipate and to screen for in emergency echocardiograph.
7. Vascular ultrasound - carotid intima-media thickness and plaques; stenosis of the carotid, vertebral, abdominal, and lower limb arteries; thoracic and abdominal aortic diseases; venous insufficiency.
8. Cardiac magnetic resonance - basic CMR physics; CMR safety and safety of medical devices in CMR; CMR contrast agents: indications and safety; CMR evaluation of cardiac anatomy (including dark and bright blood techniques); cardiac function (including cine and myocardial tagging methods); tissue characterization (including contrast-enhanced techniques); CMR stress imaging (myocardial perfusion and dobutamine stress CMR); blood flow assessment with flow-velocity encoded CMR; MR angiography. CMR for ischemic heart disease (IHD); diagnosis and management of chronic IHD, ischemia testing with myocardial perfusion and dobutamine stress CMR; assessment with late-gadolinium-enhanced (LGE) CMR; coronary imaging; diagnosis and management of acute IHD; infarct size and area at risk in acute coronary syndromes (ACS) with late-gadolinium enhancement and T2-weighted CMR; LV and RV function post-myocardial infarction; microvascular obstruction and intramyocardial hemorrhage; myocardial disease; diagnosis and prognostication in inherited cardiomyopathies; diagnosis and prognostication in myocarditis; cardiac involvement in systemic disease/secondary cardiomyopathies; diagnosis and prognostication in acute and chronic heart failure; assessment of transplant cardiomyopathy; pericardial disease; normal anatomy and diagnosis of pericardial disease; assessment of functional effects of pericardial disease; morphology and pathology of the thoracic and abdominal aorta, including aneurysm and dissection; morphology and pathology of the pulmonary vessels; morphology and pathology of the cervical arteries and of the peripheral circulation; morphology and pathology of the systemic veins; assessment of valve morphology; quantification of valve stenosis; quantification of valve regurgitation; LV and RV dimensions and function; cardiac and pericardial masses/tumors; evaluation of congenital heart disease, quantification of shunt volumes and incidental (non-cardiovascular) findings.
9. Cardiac X-ray computed tomography - techniques, cardiac X-ray CT without contrast enhancement; coronary calcium score; cardiac X-ray CT with contrast enhancement; coronary artery disease; cardiac morphology; angiography of the great arteries and veins. Indications - coronary artery disease; coronary calcium score; CT angiography of the coronary arteries to assess degree of coronary stenosis; bypass graft disease; visualization of plaque characteristics; coronary anomalies; cardiac (non-coronary) pathology: congenital, traumatic, degenerative, atherosclerotic (infarcts/LV aneurysms, etc.), masses; interventional guidance: e.g. transcatheter valve implantation, pulmonary vein isolation; ventricular function; prosthetic heart valve dysfunction; quantification of opening and closing angles; visualization of thrombus and pannus; endocarditis of native heart valves and prosthetic heart valves; visualization of valvular vegetations; assessment of annular abscesses and mycotic aneurysms and relationship to coronary arteries; congenital heart disease diseases of the great arteries and great veins (congenital anomalies, aortic aneurysms, false aneurysms, aortic dissection, periaortic abscesses, aortic arch abnormalities; diseases of the cervical arteries and of the peripheral arteries.
10. Nuclear techniques - basic principles of radionuclide imaging as applied to the cardiovascular system, including radio-isotopes, radiopharmaceuticals, gamma cameras, image acquisition, reconstruction, display, and interpretation; single-photon emission computed tomography perfusion scintigraphy (SPECT); gated SPECT (perfusion and LV function); rest imaging; stress imaging (exercise and pharmacological stress with vasodilators and sympathomimetic agents); 2-day and 1-day protocols; positron emission tomography (PET): myocardial perfusion, glucose metabolism, and inflammation imaging; hybrid techniques (PET-CT and SPECT-CT) for attenuation; corrected imaging and for combined anatomical and functional imaging; radionuclide ventriculography using equilibrium planar and SPECT imaging, and first-pass planar, phase, and amplitude imaging of regional function; imaging of sympathetic innervation; imaging of pulmonary embolism, quantification of pulmonary perfusion and right-to-left shunting; leucocyte imaging for myocardial abscesses and infection; imaging of myocardial sarcoidosis. Diagnosis of chest pain syndromes; management of known and suspected coronary artery disease including detection, localization, and quantification of myocardial ischemia and scar; assessment of prognosis in stable coronary artery disease, in ACS and before non-cardiac surgery; assessment of LV dysfunction and heart failure, including global and regional LV function, abnormalities of myocardial motion and thickening, viability, stunning, hibernation, and innervation; monitoring of LV function before and during cardiotoxic chemotherapy; detection and quantification of left-to-right and right-to-left shunting; detection of cardiac infection and inflammation.
11. Invasive imaging - cardiac catheterization and angiography: radiation physics, exposure, and safety regulations; nephrotoxic effects of contrast agents, their prevention, and management; radiological anatomy of the heart, aorta, large vessels, and coronary arteries, as well as that of the femoral, radial, and brachial arteries used for vascular access during catheterization; collection of hemodynamic and oximetric data, and how to use the measurements to calculate cardiac output, vascular resistances, valve areas, and shunts; interpretation of pressure waveforms, hemodynamic and oximetric data; trans-septal cardiac catheterization; basic principles and indications for intracoronary ultrasound (intravascular ultrasound, IVUS), Doppler, coronary artery pressure measurements (FFR), and optical coherence tomography; complications of cardiac catheterization and angiography and their management.
12. Genetics - assessment of patients with inherited or familial cardiovascular disease; integrating genetics and epigenetics into the global evaluation of risk in common cardiovascular disease; incidence and prevalence of inherited cardiovascular disorders; principles of Mendelian monogenic human diseases: autosomal dominant, autosomal recessive and X-linked; mitochondrial patterns of inheritance; polygenic cardiovascular diseases; major monogenic cardiovascular diseases - cardiomyopathies; familial aortopathies; familial arrhythmias; trisomies, in particular trisomy 21; familial dyslipidemias.
13. Clinical pharmacology - classification, mode of action, and dosage of cardiovascular drugs with emphasis on anti-arrhythmic drugs (including class I-IV); anticoagulants, antiplatelet drugs, and fibrinolytics; beta- and alpha-adrenergic receptor blockers; calcium antagonists; diuretics; inhibitors of the renin-angiotensin-aldosterone system; inotropic drugs; lipid-lowering drugs; other anti-ischemic drugs (nitrates, potassium channel blockers, hemodynamically neutral antianginal agents); sinus node inhibitors; vasodilators. Pharmacokinetics, pharmacodynamics, pharmacogenetics, indications, contraindications, interactions, adverse effects, and toxicity of cardiovascular drugs; individually tailored choice of drug or combination of drugs according to the patient's age, profile, co-morbidities, genetic background, and ethnicity; cardiovascular side-effects of non-cardiovascular drugs; interpretation of diagnostic tests to assess drug efficacy and safety (laboratory tests, ECG, hemodynamic monitoring, and echo).
14. Cardiovascular prevention and cardiovascular risk factors, assessment, and management - epidemiology of cardiovascular disease in the local community: incidence, prevalence, survival; risk factors in the local community; risk assessment in primary prevention: multifactorial risk interaction and use of risk scoring charts; the impact of lifestyle on people at risk of, and patients with, cardiovascular disease; the potential of lifestyle changes to prevent and ameliorate cardiovascular disease: diet and nutrition, toxic habits (smoking, alcohol and others), physical activity; emerging risk factors (social, economic, stress, depression, and personality type); treatment/prevention strategies for major risk factors and changes in lifestyle, including corresponding pharmacologic therapies; the comprehensive approach required for multiple risk factors.
15. Arterial hypertension - definition and classification of hypertension; pathophysiology of hypertension: contribution of cardiac output, peripheral artery resistance, and age-related stiffening of the great arteries in the genesis of primary hypertension; central BP and its relation to brachial BP; etiology and pathophysiology of secondary hypertension (renovascular, renal, hormonal, estrogen induced, and other causes); interaction between BP regulation and sleep apnea; white-coat hypertension, masked hypertension and implications for measurement of BP and therapeutic decision-making; factors influencing prognosis of hypertension; target organ damage and complications of hypertension for the brain, the kidneys, and the great arteries; lifestyle measures for prevention and treatment of hypertension; pharmacological properties, indications and side-effects of the various classes of antihypertensive drugs; individually tailored choice of antihypertensive drug or combination of drugs according to the patient's age, profile, co-morbidities, genetic background, and ethnicity; interventional techniques for BP control (e.g. renal artery stenosis dilatation, renal artery denervation); targets for BP lowering; definition and management of refractory hypertension; definition and management of malignant hypertension.
16. Acute coronary syndromes - diagnostic criteria for ACS and myocardial infarction; classification of myocardial infarction; pathophysiology of ACS, including plaque rupture or erosion, thrombosis, vasospasm, immunity (innate and acquired) and cell necrosis. Impact at the level of epicardial coronary arteries, smaller arteries, the micro-circulation, and the myocardium; knowledge of non-atherosclerotic causes of ACS (e.g. variant angina, coronary dissection, tako-tsubo cardiomyopathy, coronary embolism); events that precipitate ACS; dominant clinical features of ACS; diagnostic process in patients with chest pain with suspicion of unstable angina, NSTE-ACS or STE-ACS; diagnostic techniques including ECG, troponin and other biomarkers, echocardiography and other imaging modalities; risk scores in patients with ACS; monitoring (ECG and hemodynamic monitoring); treatment of ACS: pre- and early hospital pharmacological therapy. Indications for interventional therapy based on clinical judgment and available risk scores; properties, effects, indications, contraindications, and secondary effects of analgesics, anti-ischemic drugs, anticoagulants, fibrinolytics, platelet inhibitors, statins, and other drugs for secondary prevention - use and complications of antithrombotic drugs in combination; PCI techniques, balloon techniques, stents; role and treatment of co-morbidities; early and late complications of ACS and their treatment.
17. Chronic ischemic heart disease - epidemiology of chronic IHD and its risk factors; molecular and cellular biology of IHD; coronary physiology; pathophysiology of ischemia: plaque formation, clotting, innate and acquired immunological mechanisms, vasospasm; effects of myocardial ischemia on the myocardium, including stunning, hibernation, and viability; events that precipitate an angina attack; prognosis of chronic IHD; clinical assessment of known or suspected chronic IHD, including differential diagnosis of chest pain and other symptoms and signs. Non-invasive test interpretation based on Bayes' law; indications for, and information derived from, diagnostic procedures including ECG, stress test in its different modalities (with or without imaging, exercise, and stress drugs) and coronary angiography; exercise physiology; management of chronic IHD, including lifestyle measures and pharmacological management; indications for coronary revascularization including PCI, stenting, and CABG; participants in, and role of, the Heart Team; knowledge of alternative interventions for chronic refractory angina (e.g. external counterpulsation, spinal denervation, spinal cord stimulation).
18. Myocardial diseases - epidemiology and classification of dilated, hypertrophic, restrictive, arrhythmogenic, and unclassified cardiomyopathies; pathophysiology including genetics, diseases causing cardiomyopathies, clinical features, and diagnostic criteria of cardiomyopathies; medical and invasive (surgical, electrophysiological, and interventional) management of cardiomyopathies: indications, contraindications, and possible adverse effects; prognostic factors. Myocarditis as an inflammatory disease, its causes, and its consecutive phases (acute, sub-acute, chronic); clinical features, imaging techniques (in particular CMR), pathology, and diagnostic criteria for infective and non-infective myocarditis; treatment of patients with myocarditis and its complications.
19. Pericardial diseases - classification and definition of acute pericarditis; relapsing pericarditis; chronic pericarditis; pericardial effusion and cardiac tamponade; constrictive and effusive-constrictive pericarditis. Epidemiology, pathophysiology, and etiology of pericarditis, including infective, inflammatory, and neoplastic disorders; relevant investigations: non-invasive and invasive, including interpretation of laboratory findings; differential diagnosis of constrictive pericarditis from restrictive cardiomyopathy; indications for pericardiocentesis; drug therapy for controlling pericardial inflammation; management of pericarditis and its complications; the transient nature of constrictive physiology in some cases.
20. Oncology and the heart - symptoms and signs of cardiac tumors, including systemic and embolic manifestations; classification, diagnosis, and therapy of primary and metastatic cardiac tumors; effects of tumors on coagulation and the occurrence of thromboembolism; obstruction to blood flow induced by proliferative processes (e.g. vena cava syndrome, atrial myxoma, pulmonary artery compression); effects of thoracic radiotherapy on the pericardium, myocardium, conducting system, and coronary arteries; cardiac toxicity associated with cancer therapy: e.g. anthracyclines, trastuzumab, and protein kinase targeted therapeutics; other adverse effects of chemotherapeutic drugs: myocardial ischemia; thrombosis, and embolism; altered BP; rhythm and conduction disturbances: bradycardia and heart block, tachycardia, arrhythmias; complications of permanent venous access devices; strategies for preventing adverse effects of chemotherapeutic drugs (e.g. statins).
21. Congenital heart disease in adult patients - physiology of the fetal and transitional circulations; etiology of congenital heart disease, including the developmental anatomy of the heart and vasculature; commonly associated genetic syndromes; anatomy of the heart, veins, and great vessels; their major congenital malformations and the principles of nomenclature; pathophysiology, natural history, and complications of valve and outflow tract lesions; septal defects; patent ductus arteriosus; Eisenmenger syndrome; coarctation of the aorta; Ebsteins's anomaly; aortic and pulmonary artery malformations; venous anomalies; transposition of the great arteries (complete and congenitally corrected); tetralogy of Fallot; functionally univentricular hearts and the Fontan circulation; congenital malformations of coronary arteries; cyanotic congenital heart disease and secondary erythrocytosis; pulmonary hypertension in congenital heart disease. Arrhythmias and conduction disturbances; pathophysiology, natural history, and complications of palliative and corrective surgery and interventions; physical signs of congenital heart disease and its complications. Prevention of infective endocarditis (IE); hazards of pregnancy, contraception, intercurrent illness, and non-cardiac surgery in patients with congenital heart disease.
22. Pregnancy and heart disease - physiological, hemodynamic, hemostatic, and metabolic alterations during pregnancy, the normal echocardiogram during pregnancy and puerperium; complications during pregnancy and puerperium in women without known cardiovascular disease: thrombo-embolism; hypertensive disorders (pre-/eclampsia); ischemic coronary events including ACS; spontaneous coronary dissection, aortic, or vascular dissection; arrhythmia; peripartum cardiomyopathy. For patients with known or suspected cardiovascular disease who are contemplating pregnancy are pregnant or post-partum: conditions for which pregnancy is contra-indicated (and those which justify early termination); indications for genetic counseling; conditions associated with a high risk of pregnancy-related cardiac complications for which intervention before considering pregnancy is appropriate; appropriate follow-up during pregnancy and post-partum; conditions requiring medical therapy during pregnancy; situations in which cardiac intervention may be required during pregnancy; management of anticoagulant therapy, with special attention to patients with valve prostheses; endocarditis during pregnancy; modalities of delivery and their major indications. Modalities for fetal assessment and diagnosis of genetic malformations. Cardiovascular pharmacology during pregnancy and lactation. Efficacy, risks, and contraindications associated with the various contraceptive methods according to the nature of the underlying heart disease.
23. Valvular heart disease - hemodynamics of VHD; pathophysiology: effects of VHD on the heart and on the circulation; natural history of VHD; strengths and limitations of diagnostic techniques, in particular echocardiography, and the value of additional procedures such fluoroscopy, X-ray CT, magnetic resonance imaging, and invasive hemodynamic assessment; values and limitations of different risk scores applied to VHD; indications, benefits, and risks of medical therapy, surgical and percutaneous interventions for VHD; indications for and management of anticoagulant therapy; role of concomitant coronary heart disease in VHD and its impact on surgical management; follow-up and medical management of native VHD; follow-up and management of repaired valves, bioprostheses, mechanical prosthetic valves, and percutaneously repaired and implanted valves.
24. Infective endocarditis - epidemiology of endocarditis in relation to the ageing population, to surgical interventions, and to the increasing prevalence of prosthetic cardiac implants; clinical features of different forms of endocarditis, including native valve, right heart, prosthetic valve (early and late after surgery), catheter and cardiac device-related infection (pacemaker, ICD); classification of IE according to the mode of acquisition; active or recurrent (relapse, re-infection); pathology, pathophysiology, and microbiology; symptoms and signs; laboratory investigations including microbiological results and their limitations; cardiac imaging including trans-esophageal echocardiography, magnetic resonance imaging, and PET computer tomography; medical management and monitoring; surgical management; complications and their management.
25. Heart failure - definition of heart failure; pathophysiology of heart failure, systolic and diastolic dysfunction; epidemiology and prognosis of heart failure with reduced and preserved ejection fraction (HFREF and HFPEF); precipitating factors of heart failure; AHA stages of heart failure (A-D), Weber-Janicki classes of heart failure (peakVO2); international classification of functional limitation (NYHA class); diagnostic procedures in the patient with known or suspected HF including chest X-ray, echo-Doppler, natriuretic peptides, cardiac X-ray CT and CMR, stress (including cardiopulmonary exercise) testing, cardiac catheterization; importance of co-morbidities for prognosis of HF, including anemia, renal impairment, depression, chronic obstructive pulmonary disease, and cachexia; prognostic evaluation of the heart failure patient; medical management of acute and chronic HF; device management of HF: cardiac resynchronization therapy, implantable cardioverter defibrillator (ICD), advanced supportive therapy, including (non-invasive) ventilation, ultrafiltration, and dialysis techniques; interventional therapies such as conservative surgical and percutaneous procedures (including coronary revascularization and percutaneous interventions on the mitral valve), assist devices, artificial heart, and transplantation; impact of coronary revascularization on the prognosis of HF patients; the role of exercise training programs in HF patients; complications of HF; impact of optimized follow-up on prognosis of patients with HF.
26. Pulmonary arterial hypertension - pulmonary hypertension and its pathophysiological classification; clinical classification and its rationale; epidemiology of pulmonary hypertension, in particular pulmonary arterial hypertension (incidence, prevalence, etiology, genetics, high-risk groups); pathology and pathophysiology of different types of pulmonary hypertension; clinical features of different etiologies of pulmonary hypertension; diagnostic criteria of pulmonary hypertension; prognostic markers; medical, surgical, and interventional management of pulmonary hypertension, including indications, contraindications, and adverse effects. Specifically disease targeted therapies and indications for pulmonary endarterectomy; complications of pulmonary hypertension and their management.
27. Physical activity and sport in primary and secondary prevention - exercise and sports physiology; benefits of exercise training; safety issues in exercise and sport; diagnostic criteria and appropriate investigations in athletes with cardiovascular disease; risk factors for and mechanisms of sudden cardiac death (SCD) during and after strenuous exercise; specific population challenges and exercise programs in appropriate settings; recommendations for professional and recreational sports participation; SCD in patients, athletes, and in the population at large, and mechanisms of action of illicit drugs.
28. Arrhythmias - classification and definition of bradycardias; tachycardias; supraventricular arrhythmias including atrial fibrillation and flutter; ventricular arrhythmias. Epidemiology, pathophysiology, diagnosis, and clinical features of arrhythmias and conduction disturbances; inherited arrhythmogenic diseases; prognosis including risk evaluation; principles of electrocardiography and electrophysiology, and relevant findings in different arrhythmias; high-risk features in the resting ECG such as long QT, short QT, Brugada ECG pattern, arrhythmogenic cardiomyopathy, and cathecholaminergic ventricular tachycardia; pharmacology of anti-arrhythmic drugs and knowledge of pro-arrhythmic effects of cardiovascular and other drugs and substances; prevention of thrombo-embolic complications of atrial fibrillation and flutter; invasive and device management of arrhythmias, including catheter ablation, and pacemaker, ICD, and surgical therapy; importance of co-existing structural heart diseases, including coronary artery disease, in relation to the outcome and management of arrhythmias.
29. Atrial fibrillation and flutter - epidemiology, pathophysiology, and prognosis of AF; classification of AF; diagnosis, clinical features, and impact on quality of life; pre-disposing conditions; importance of co-existing structural heart diseases on the outcome, and their implications for the management of AF; diagnostic procedures tailored to the individual need; diagnosis and prevention of atrial thrombosis and embolic complications, use of embolic risk scores and bleeding risk scores. indications, contraindications, side-effects, and complications of antithrombotic therapy (including vitamin-K antagonists, thrombin receptor antagonists, factor Xa antagonists, and low-molecular-weight heparins); rhythm vs. rate control therapy; anti-arrhythmic drug therapy; pharmacological cardioversion; prevention of recurrences; pharmacological control of ventricular rate; direct current (DC) cardioversion; Pacemaker and ICD therapy; catheter ablation of AF; surgical ablation of AF and occlusion of the left atrial appendage; catheter ablation of the AV node; atrial appendage occlusion devices.
30. Syncope - the epidemiology and prevalence of different causes of syncope; t pathophysiology of syncope; causes of syncope and other forms of transient loss of consciousness; risk stratification of patients with syncope and indications for hospitalization; diagnostic evaluation; treatments (device based, pharmacological or physical maneuvers) for neurally mediated (reflex) syncope; orthostatic hypotension; cardiac arrhythmias (tachy and brady); structural cardiac or cardiopulmonary disease.
31. Sudden cardiac death and resuscitation - definition of SCD; epidemiology, etiology, pathology, pathophysiology, and clinical presentation of pre-disposing conditions; diagnostic work-up and risk stratification of survivors; selection of appropriate long-term management options including pharmacological and device-based therapies; current recommendations for primary and secondary prevention of SCD; identification, risk stratification, and management of individuals at elevated risk, including family members of SCD patients. Causes of cardiorespiratory arrest, identification of patients at risk, and early implementation of corrective treatment of reversible causes; methods and guidelines of basic and advanced life support, including airway management, appropriate drug use, defibrillation, and pacing; indications for not starting resuscitation or ceasing an initiated attempt; pharmacology, actions, indications, and contraindications of the main drugs used in the management of a cardiac arrest.
32. Diseases of the aorta and trauma to the aorta and heart - epidemiology, etiology, pathology, genetics, pathophysiology, and clinical presentations of aortic disease, aortic root disease, and trauma to the aorta and heart including: aneurysm of the thoracic aorta; classification of aortic dissection; Leriche syndrome; aortic atherosclerosis types I-IV; inflammatory aortic disease; genetic conditions associated with aortic syndromes; trauma of the heart including contusion and ACS; trauma of the vessels including acute aortic dissection and aortic rupture. Strengths and limitations of different imaging modalities; appropriate medical, interventional, and surgical management strategies.
33. Peripheral artery disease - epidemiology and pathology of PAD; diagnosis and assessment of PAD, including the ABI and various imaging modalities; general treatment modalities including smoking cessation, lifestyle modification, supervised exercise training program, antiplatelet and anti-thrombotic drugs, lipid-lowering drugs, and antihypertensive therapies in patients with PAD; indications for invasive (interventional and surgical) management and their relative merits in different situations; prognostic stratification of PAD; acute and critical limb ischemia management.
34. Thrombo-embolic venous disease - epidemiology of deep vein thrombosis; risk factors for deep vein thrombosis inherited thrombophilia (e.g. factor V Leiden and prothrombin gene mutations); acquired thrombophilia (e.g. major surgery, trauma, immobilization, lupus anticoagulant, and elevated levels of antiphospholipid antibodies, malignancy, pregnancy, oral contraceptives, and myeloproliferative disorders). Pathophysiology of pulmonary embolism - increased pulmonary vascular resistance and ventilation-perfusion mismatch. Clinical presentation of superficial and deep vein thrombosis; clinical presentation of pulmonary embolism; diagnosis of deep vein thrombosis; management of superficial venous thrombosis; deep vein thrombosis. Treatment of acute pulmonary embolism by anticoagulant therapy; thrombolytic therapy; embolectomy. Management of chronic thrombo-embolic pulmonary hypertension, including thrombo-endarterectomy; preventive measures for DVT/pulmonary embolism: compression stockings; prophylactic anticoagulant therapy; caval filter.
35. Acute cardiovascular care - the early warning signs and symptoms of impending critical illness; causes of cardiorespiratory arrest, identification of patients at risk, and early implementation of corrective treatment of reversible causes; algorithms of basic (BLS) and advanced life support (ACLS), including the indications for not starting resuscitation or ceasing an initiated attempt. Criteria for admission and discharge from ICU; epidemiology, pathophysiology, diagnosis and management of cardiac emergencies, including ACS, acute heart failure, cardiogenic shock, life-threatening arrhythmias, cardiac arrest and resuscitation, pericardial tamponade, pulmonary embolism, acute valve and aortic disease; detailed and specialized cardiovascular support - causes, diagnosis, consequences, and treatment of circulatory failure and shock; indications, limitations, complications, and interpretation of non-invasive and invasive hemodynamic monitoring; pharmacology, indications, and contraindications of therapy used to support the circulation (fluids, inotropic, and vasoactive drugs); indications for mechanical circulatory assist devices (ECMO, IABP, and other assist devices); indications, contraindications, and complications of arterial and central venous access; recognition and management of basic and complex arrhythmias, including arrhythmias during resuscitation. Principles of respiratory support - respiratory physiology and pathophysiology: gas exchange, O2 and CO2 transport, hypoxia, hypo- and hyper-capnea; interpretation of arterial and venous blood gas samples; causes, prevention, and management of respiratory insufficiency emergency airway management; principles of oxygen therapy and selection of oxygen administration devices; knowledge of the indications, selection, and management of different methods of invasive and non-invasive mechanical ventilation (including the general principles of mechanical ventilation and heart -lung interactions); effects of mechanical ventilation on the circulation; pathogenesis, diagnosis, prevention, and principles of therapy for acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Principles of fluid, electrolyte, acid-base, and renal support renal pathophysiology, regulation of fluid, electrolyte, and acid-base balance; causes, diagnosis, prevention, and general principles of management of renal failure (acute, chronic, and acute on chronic); general knowledge of renal replacement therapies (hemofiltration and dialysis); treatment strategies for abnormalities of fluid, electrolyte, acid-base balance; indications, contraindications, and complications of fluid therapy; identification and prevention of the use or dose adjustments of nephrotoxic drugs in patients with renal impairment or failure. Principles of metabolic and gastrointestinal support - blood glucose control homeostasis: pathophysiology, indications for and monitoring of therapy; basic principles of gastrointestinal physiology, gut motility; assessment and management of nutritional status and basal energy requirements; prevention of stress ulceration. Principles of prevention and treatment of infection epidemiology and strategies for infection prevention in the ICU; indications for microbiological sampling and interpretation of microbiological test results; selection, indications, complications, interactions, and monitoring of common antimicrobial drugs; basic knowledge of sepsis, septic shock, and systemic inflammatory response syndrome. Other principles of support - causes, signs and symptoms, consequences, and methods of assessment of impaired neurological function; pain assessment and control (appropriate analgesia); drug therapy and assessment methods for sedation; drug therapy and assessment methods for pain.