Преподаватель: профессор Maцкеплишвили Симoн Tеймypaзoвич
Lecturer: Professor Simon Matskeplishvili, MD, PhD, FESC, FACC

Занятия проходят по четвергам с 17:15 в аудитории 501
Первый семинар 12 февраля 2015 года

Занятия будут состоять из 2 секций - на русском и английском языках.

Программа курса:

В первой части - лекции по всем основным разделам современной кардиологии с обсуждением новых данных, полученных в результате клинических и экспериментальных исследований, новейших рекомендаций Российского кардиологического общества в сравнении с аналогичными рекомендациями Европейского кардиологического общества и Американской коллегии кардиологов, а также новостей кардиологии, не вошедших, по разным причинам, в данные рекомендации.
Особое внимание будет уделяться спорным вопросам, которые нередко становятся ведущими темами дискуссий на основных кардиологических конгрессах в России и за рубежом, с обсуждением возможных причин разногласий и поиском возможных ответов на подобные вопросы, а также интересным и необычным клиническим случаям в разных клиниках России, Европы и США.
Во второй части - онлайн лекции ведущих кардиологов мира с последующим обсуждением вопроса на английском языке, а также представление и "защита" слушателями докладов (реферат на 5-7 страниц, включая таблицы, графики и рисунки) по предварительно выбранной тематике.

Program of the course:

Completion of the elective course should equip the future doctor with knowledge, skills, behaviors and attitudes to act independently in the diagnosis, assessment, and management of cardiovascular diseases and emergencies.

The ability to apply this knowledge to clinical situations requires mastery of the indications and the performance and interpretation of cardiological investigations, treatments, and procedures. It may also demand a further knowledge and experience in the sub-specialties to ensure the appropriate referral for more advanced investigations and therapies.

The course will include interesting clinical cases and lectures from "legends of cardiology"  and leading cardiologists on general cardiology and additional knowledge of interventional cardiology, cardiovascular imaging (echocardiography, cardiac CT, CMR, nuclear and PET scan), cardiovascular intensive care, electrophysiology and device therapy, advanced heart failure and transplantation, cardiac rehabilitation and prevention, grown-up congenital heart disease (GUCH), genetic and regenerative cell treatment of cardiovascular diseases.

To complete the course, students should present a short synopsis (maximum 5-7 pages of text including tables, graphics and pictures) on one of the program topics and/or subtopics.

Темы лекций и семинаров:

1. Ишемическая болезнь сердца.
Анатомия коронарных артерий; физиология коронарного кровотока и коронарного резерва; физиология сокращения и расслабления сердца; патофизиология ишемии миокарда и определение ИБС; этиологические факторы ишемии миокарда; последствия ишемии миокарда; диагностика ишемии миокарда (от ЭКГ до стресс-эхокардиографии, МРТ, КТ, ПЭТ и ангиографии) - возможности, преимущества и недостатки каждого метода; принятие клинического решения по тактике обследования и лечения пациентов и оценка риска неблагоприятного исхода; лечение ишемии миокарда (фармакологическое, интервенционное, хирургическое, гибридное); альтернативные методы лечения ИБС (клеточная терапия, терапевтический ангиогенез, ударно-волновая терапия, неинвазивная контрпульсация и др.).

2. Острый коронарный синдром.
Патофизиология острой ишемии миокарда и определение ОКС; этиологические факторы острого коронарного синдрома; концепция нестабильной коронарной бляшки, последствия острого коронарного синдрома; диагностика ОКС (от ЭКГ и биохимических маркеров до стресс-эхокардиографии, МРТ, КТ, ПЭТ и ангиографии) - возможности, преимущества и недостатки каждого метода; принятие клинического решения по тактике обследования и лечения пациентов с ОКС (тромболитическое, интервенционное, терапевтическое); организационные принципы лечения ОКС.

3. Хроническая сердечная недостаточность.
Систолическая и диастолическая функция миокарда; патофизиология хронической сердечной недостаточности; этиологические факторы хронической сердечной недостаточности; диагностика ХСН (от ЭКГ и биомаркеров до стресс-эхокардиографии, МРТ, КТ, ПЭТ и биопсии миокарда) - возможности, преимущества и недостатки каждого метода; принятие клинического решения по тактике обследования и лечения пациентов и оценка риска неблагоприятного исхода; лечение ХСН (фармакологическое, интервенционное, хирургическое, гибридное); новые методы лечения ХСН (клеточная терапия, терапевтический ангиогенез, трансплантация сердца, искусственное сердце, интервенционные вмешательства на клапанах сердца, сердечная ресинхронизация и др.).

4. Клапанные пороки сердца.
Анатомия и физиология клапанов сердца; патология атриовентрикулярных клапанов, патология аортального и легочного клапанов (этиология, гемодинамические нарушения, последствия); диагностика клапанных пороков; принятие клинического решения о методе лечения клапанной патологии; лечение пороков клапанов сердца (терапевтическое, интервенционное, хирургическое).

5. Нарушения ритма и проводимости сердца.
Анатомия и физиология проводящей системы сердца; нарушения ритма сердца (классификация, этиология); нарушения проводимости; наиболее частые и клинически значимые нарушения ритма и проводимости сердца (фибрилляция предсердий, экстрасистолия, тахиаритмии, блокады внутрисердечного проведения и др.); диагностика аритмий; принципы и основные методы лечения аритмий.

6. Артериальная гипертензия.
Физиология поддержания артериального давления (системного и легочного); этиология и патогенез артериальной гипертензии (системной и легочной); классификация, диагностика и лечение артериальной гипертензии.

7. Заболевания миокарда.
Классификация кардиомиопатий; генетика кардиомиопатий; классификация миокардитов; диагностика и лечение заболевания миокарда и болезней накопления.

8. Врожденные пороки сердца.
Эмбриологическое развитие сердца; причины развития врожденных пороков сердца; основные ВПС (классификация, диагностика, лечение); ВПС у взрослых.

9. Частная кардиология.
Заболевания сердца в эндокринологии, ревматологии, онкологии, неврологии, гастроэнтерологии, урологии; болезни сердца у беременных.

10. Современные методы диагностики в кардиологии.
Основные оцениваемые показатели (анатомия, гемодинамика, функция, коронарные артерии, перфузия, метаболизм); эхокардиография, магнитно-резонансная томография, компьютерная томография, позитронно-эмисионная томография, ангиография, внутрисосудистые методики (ультразвук, оптическая когерентная томография, термография и т.д.); возможности, преимущества и недостатки каждого метода, алгоритм выбора в зависимости от патологии; безопасность диагностических процедур.

11. Молекулярно-генетическая кардиология.
Генетическая предрасположенность к заболеваниям сердечно-сосудистой системы; наследственные заболевания в кардиологии; генетика аритмий сердца; генетика заболеваний миокарда; клеточные технологии в кардиологии; геномные и постгеномные исследования в кардиологии.

Program of the course:

1.    History taking and clinical examination in cardiac patient.
Range and meaning of words used by patients to describe their symptoms; specific 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 examination: blood pressure measurement: principles and limitations of its diagnostic and prognostic values; 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; 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 cardiac disease. 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. 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, evaluation of the ischemic myocardium, including regional wall motion abnormalities, scar, stunning, hibernation, perfusion, and viability, myocardial disease, pericardial disease, cardiac tumors/masses. 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; primary and secondary cardiomyopathies (dilated, hypertrophic, restrictive, arrhythmogenic); valvular morphology and function, 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.

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; cardiac function; tissue characterization; CMR stress imaging; blood flow assessment with flow-velocity encoded CMR; MR angiography; 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; pericardial disease; morphology and pathology of the thoracic and abdominal aorta; morphology and pathology of the pulmonary vessels; morphology and pathology of the cervical arteries and of the peripheral circulation.

9.    Cardiac X-ray computed tomography.
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; 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; positron emission tomography (PET): myocardial perfusion, glucose metabolism, and inflammation imaging; hybrid techniques (PET-CT and SPECT-CT) for attenuation; leucocyte imaging for myocardial abscesses and infection; imaging of myocardial sarcoidosis.

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; 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. 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 of 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; 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); 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); diagnostic process in patients with chest pain; diagnostic techniques including ECG, troponin and other biomarkers, echocardiography and other imaging modalities; risk scores in patients with ACS; 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 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; management of chronic IHD, including lifestyle measures and pharmacological management; indications for coronary revascularization including PCI, stenting and CABG.

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. 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; 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); 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. 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. 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; 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; importance of co-morbidities for prognosis of HF; 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; interventional therapies; 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.
Pathophysiological classification; clinical classification and its rationale; epidemiology of pulmonary hypertension, in particular pulmonary arterial hypertension; diagnostic criteria of pulmonary hypertension; prognostic markers; medical, surgical, and interventional management of pulmonary hypertension.

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; pharmacology of anti-arrhythmic drugs and knowledge of pro-arrhythmic effects of cardiovascular and other drugs and substances; invasive and device 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; rhythm vs. rate control therapy; anti-arrhythmic drug therapy; pharmacological cardioversion; prevention of recurrences; pharmacological control of ventricular rate; Pacemaker and ICD therapy; catheter ablation of AF; surgical ablation of AF and occlusion of the left atrial appendage.

30.    Syncope.
Epidemiology and prevalence of different causes of syncope; 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 for neurally mediated syncope; orthostatic hypotension; cardiac arrhythmias; 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; causes of cardiorespiratory arrest, identification of patients at risk; methods and guidelines of basic and advanced life support; 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; 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 management.

34.    Thrombo-embolic venous disease.
Epidemiology of deep vein thrombosis; risk factors for deep vein thrombosis inherited thrombophilia; acquired thrombophilia; 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.
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; 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; diagnosis 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 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.