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Cardiopulmonary System - #23360


Heart Sounds

Cardiovascular System

Chapter 1-5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 11

 

 
William Elkington, DC
3.0
90.0
3.0
2.0 + 1 hr Independent Study

This course focuses on disorders of the cardiovascular and respiratory systems, and the role that doctors of chiropractic can play in helping patients to restore and maintain healthy functions of these organ systems.
Please select from the list on the right.

The Institution-wide learning goals define the common ground that unites the programs within the university. They are purposefully broad so that the various colleges and schools can continue to develop their unique identities through varying ways in which the goals are met.

  1. Effective Communication
    Graduates will demonstrate effective verbal, non-verbal, and written communication skills in a wide variety of contexts, including collaborative activities.
  2. Self Directed and Lifelong Learning
    Graduates will be aware of the limits of one’s personal knowledge and experience and have an intellectual interest in scholarly and creative endeavors. Graduates will actively set appropriate learning goals, pursue them, and apply the knowledge gained.
  3. Ethical Reasoning
    Graduates will demonstrate a willingness to recognize the values of others while maintaining one’s own integrity, and act ethically and professionally in all endeavors.
  4. Individuals, Communities and Cultures
    Graduates will demonstrate awareness and sensitivity to the cultural and health practices of individuals and communities. Graduates will be able to identify appropriate health related resources.
  5. Service to the Community
    Graduates will understand and value the benefits of service to the community.
  6. Influence of Mind, Body and Spirit on Health
    Graduates will recognize the inter-relationship of the mind, body and spirit and the influence of extrinsic factors on an individual’s health.
  7. Critical Thought and Knowledge Acquisition
    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
  8. Competence in one's Discipline
    Graduates will demonstrate competence of appropriate depth and scope for one's discipline.

Course Objectives
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  1. Describe the normal anatomy and healthy functioning of the respiratory and cardiovascular systems and their component parts.
  2. List the risk factors for major cardiovascular and respiratory system diseases and, where applicable, describe methods for risk factor modification.
  3. Describe current understanding of the epidemiology, pathophysiology and natural history of common cardiovascular and respiratory diseases.
  4. Recognize and describe the typical clinical manifestations of common cardiovascular and respiratory diseases.
  5. Describe and/or perform an appropriate diagnostic work up of patients presenting with clinical manifestations of cardiovascular or respiratory disease, including history, physical examination, imaging, lab, and otherr diagnostic procedures.
  6. Perform the appropriate and necessary cardiovascular and pulmonary screening components of pre-sports and pre-work physical examinations.
  7. Describe appropriate chiropractic and/or medical (or other) treatment of common cardiovascular and respiratory diseases.
  8. Recognize and describe situations in which patients presenting with particular cardiovascular or respiratory manifestations should be referred for emergency or other medical care.
  9. Perform manual chiropractic methods appropriate to the care of patients with cardiovascular and respiratory conditions.
  10. Educate patients regarding specific lifestyle/self-care measures that can help prevent or treat cardiovascular and respiratory diseases.
  11. Describe the impact of respiratory and cardiovascular diseases on the general health, well-being and quality of life of the patient, and conversely, how emotional, social, economic factors and lifestyle choices can impart cardiovascular and respiratory system health.
Materials
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A. Required Text(s):
Mayo Clinic Heart Book, 2nd Edition, 2001, Morrow

B. Recommended Text(s):

Clinical Manifestations of Respiratory Disease, 5th Edition, by Terry DesJardins
Heart Sounds Auscultation CD. A Guide to Physical Diagnosis and History Taking, 8th Edition, Bates/Bickley (or equivalent PDX test)
Recommended resources:
CardioPulmonary System course notes (available in the bookstore)
Merck Manual (latest edition)
Relevant Bates PDX videotapes (on reserve)
Study guides for quizzes and exams, recent articles, and significant course note updates will be handed out in class.


C. Required Materials for Lab:

1. peak flow meter (available in the bookstore)

2.stethoscope (Littmann Cardiology recommended)

3. blood pressure cuff

4. tape measure

5. skin marking pencil

6.ophthalmoscope

7. pen light
Assignments
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  1. Read the required textbook, course notes, and handout materials.
  2. Attend and actively participate in labs and lecture discussions.
  3. Prepare, especially for labs, using course notes, study guides (included in course notes), web sites, and Bates CD and other audiovisual resources pertaining to examination of the cardiovascular and respiratory systems and heart and lung sounds.
  4. Utilize this course syllabus as a study guide: you will be competent if you are able to explain - or do - all things listed on the syllabus.
  5. Cardiovascular Risk Factor Project: each student will perform a cardiovascular risk factor assessment and modification plan for a person 50 years of age or older.
Attendance
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Attendance is required and taken in labs.
Grading Criteria
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  1. Quizzes: two; about 35 points each; mostly fill-in-the-blank
  2. Midterm written exam: 100 points; multiple choice test items, including heart sounds identification
  3. Practical 1: Pass/Fail (must pass in order to pass the course)
  4. Practical 2: Pass/Fail (must pass in order to pass the course)
  5. Final written exam: 100 points; multiple choice test items, including heart and lung sounds identification
  6. Cardiovascular Risk Factor Project: 10 points
  7. Pulmonary Function Test: no points; must turn in spirometry and peak flow meter worksheet with correct figures and interpretation

    Note: For all quizzes and exams, the student is responsible for material covered in lectures and labs up to the date of the quiz or exam, including course notes, handouts, and textbook/CD ROM assignments.

Guaranteed grades are as follows:

A = 92 - 100% of Total Possible Points
B = 86 - 91%
C = 80 - 85%
D = 74 - 79%
F = < 74% of total points
Course Competencies
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-

COGNITIVE DOMAIN


Students will be able to construct and follow a rational diagnostic process in evaluating patients who present with the following respiratory symptoms:

a. cough l. hoarseness/loss of voice
b. sneezing m. chest pain
c. nasal congestion n. palpitations
d. rhinorrhea (runny nose) o. edema in the extremities, face or abdomen (ascites); pitting edema
e. dyspnea/shortness of breath, dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea

p. general fatigue &/or weaknesss
f. snoring q. sudden changes in vision, strength, coordination, speech, or sensation
g. hemoptysis
r. lightheadedness, syncope
h. wheezing s. cyanosis or otehr abnormal skin color; skin sores, ulcerations
i. crackles t. nausea/vomiting; diaphoresis
j. sputum production u. referred pain to: arm, back, shoulder, jaw, etc.
k. sore throat v. weakness, fatigability, or paresthesias in the extremities

In addition, students will be able to recognize and describe the significance of the following non-specific symptoms which may be present in cardiovascular and respiratory conditions as well as in conditions related to other body systems.

a. altered mental status, coma h. digit clubbing
b. anorexia, weight loss or gain i. anxiety
c. fever, chills, diaphoresis, night sweats j. weakness
d. headache k. general fatigue
e. muscle aches l. hyperventilation
f. skin changes m. altered urine volume/flow
g. malaise n. abdominal pain

Students will be able to explain the clinical utility and indications for the following laboratory, imaging and other diagnostic tests in patients with suspected cardiovascular and/or respiratory disease:

a. pulmonary function tests, including spirometry and peak flow meter q. urinalysis
b. pilocarpine iontophoresis (sweat test) r. blood oxygen saturation and pulse oximetry
c. Mantoux test s. electrocardiography and stress ECG
d. sputum cultures, throat, and blood cultures t. Holter monitor
e. allergy tests (skin and RAST) u. echocardiography and stress echocardiography
f. rapid antigen/antibody tests v. Doppler ultrasonography
g. antistreptolysin O (ASO) titers w. cardia enzymes: CPK, troponin I & T, myoglobin, LDH
h. CBC with differential x. blood lipid profile: total cholesterol, LDL, triglycerides, HDL, lipoprotein A
i. blood chemistry y. cardia chtherterization and angiography
j. ventilation/perfusion scanning z. fluoroscopy
k. alpha 1-antitrypsin assay aa. prothrombin time and INR
l. polysomnography (oximetry, EEG, ECG, thermistor, etc) bb. check x-ray
m. lecithin: sphingomyelin (L:S) ratio cc. electron beam computer tomography
n. check x-rays, sinus x-rays dd. nuclear scanning
o. nasal smears ee. biopsy
p. IgE assay ff. electrophysiology studies


Conditions:

Students will be able to make case management decisions regarding common respiratory conditions based on their understanding of the following information regarding each condition. (See key on following page for description of codes.)

RESPIRATORY CONDITIONS

Clinical Condition
Etiol. & Epidem.
Pathophysiology
Nat.History & course
Exam & DX
RX/Mgmt
ARDS
2
1
2
1,2
6
Asthma
3
3
3
1,2,3,4,5,7
1,3,4,5,6,8
Bronchiolitis
2
2
2
1,2,3,4,5,7
1,6
COPD
3
3
3
1,2,3,4,5,6,7
1,3,4,5,6
Cystic Fibrosis
3
3
3
1,2,3,7
1,3,5,6
IRDS
3
3
3
1,2,3,5,7
6
Lung Cancer
3
2
2
1,2,3,6
6
Pneumoconiosis
0
0
0
NA
NA
Pneumonia
3
2
2
1,2,3,6
1,3,5,6
Pulmonary Embolism
3
2
2
1,2,3,6,7
1,3,4,5,6
Tracheobronchitis
3
2
2
1,2,3,6
1,3,6
Tuberculosis
3
2
2
1,2,3,5,6
3,6


CARDIOVASCULAR CONDITIONS

Clinical Condition
Etiol. & Epidem.
Pathophysiology
Nat.History & course
Exam & DX
RX/Mgmt
Angina: stable/unstable, varient 3 3 3 1,2,3,6,7 3,4,5,6
Aortic aneurysm 2 2 2 1,2,3,6 6
Aortic dissection 2 2 2 1,2,3,6 6
Aortic regurgitation 2 2 3 1,2,3,6 6
Aortic stenosis 2 2 3 1,2, 3, 6 6
Arrhythmias (see individual arrhythmias)          
Atherosclerosis 3 3 3 1,2,3,5,6,7 1,3,4,5,6
Atrial bradycardias & tachycardias          
Atrial fibrillation 3 3 3 1,2,3,6,7 3,6
Berry aneurysm 2 2 2 1,6 6
Buerger's disease 2 2 2 1,2,3  
Cardiomyopathy: dilated; hypertrophic; restrictive 2 2 2 1,2,3,5,6 2,3,4,5,6
Carotid artery disease 2 2 2 1,2,3,6 1,3,4,5,6
Cerebrovascular accident 2 2 2 1,2,3 1,3,4,5,6
Congenital heart disease 2 2 2 1,2,3 6
Congestive heart failure 3 3 3 1,2,,5,6,7 2,3,4,5,6,7,8
Cor Pulmonale 2 2 2 1,2,3 6
Coronary artery disease 3 3 3 1,2,3,5,6,7 1,3,4,5,6
Deep Vein Thrombosis 3 3 3 1,2,3,6,7 1,3,4,5,6
Dyslipidemia 3 3 3 1,2,3,5,6,7 1,2,3,4,5,6
Endocarditis 2 2 2 1,2,3,5,6, 6
Heart block 2 2 2 1,2,3,5,6 4,5,6
Hypertension and pre-hypertension 3 3 3 1,2,3 1,3,4,5,6,8
Kawasaki Syndrome 2 2 2 1,2,3 6,8
Long Q-T Syndrome 2 2 2 1,2,3,7 4,5,6
Metabolic Snydrome 2 2 2 1,2,3,5 3,4,5,6,8
Mitral prolapse 2 2 2 1,2,3,6 4,5,6
Mitral regurgitation 2 3 3 1,2,3,6 6
Mitral stenosis 2 3 3 1,2,3,6 6
Myocardia Infarction 3 3 3 1,2,3,5,6,7 2,3,4,5,6,7,8
Myocarditis 2 2 2 1,2,3,5,6 6
Pericarditis & cardia tamponade 1 2 1 1,2,3,6 6
Peripheral vascular disease: arterial; venous          
Pulmonary Embolism 2 2 2 1,2,3,5,6,7 6,7.8
Raynaud's phenomenon 2 2 2 1,2,3 1,5
Rheumatic heart disease 1 1 1 1,2,3,5 5,6
Takayasu's arteritis 1 1 1 1,2,3 6
Temporal arteritis 2 2 2 1,2,3 1,3,4,5,6
Transient ischemic attachs 2 2 2 1,2,3 1,3,4,5,6
Valve disorders 2 2 2 1,2,3,5,6 4,5,6
Ventricular fibrillation 2 2 2 1,2,3,7 4,5,6
Ventricul tachycardia 2 2 2 1,2,37 4,5,6
           

Elaboration of Coding Definitions Regarding the Conditions

The following codes refer to the depth of coverage for Etiology and Epidemiology; Pathophysiology, and; Natural History and Course:

0 No coverage or content
1 Introduction, without test items
2 Moderate class discussion and/or handout material, with test items
3 Extensive discussion and/or handout material, with test items

For Exam and Diagnosis, the following numbers indicate which aspects of exam and diagnosis of each condition are taught in this course:

1. Presenting SX: Presenting symptoms related to condition are discussed.
2. History findings: Relevant personal and family history are discussed.
3. Exam findings: General physical exam findings are discussed.
4. Chiro. Findings: Posture, subluxation, muscle tone and length, trigger pts .
5. Lab findings: Blood, urine, CSF . . .
6. Imaging findings: Normal, CT, CAT, MRI . . .
7. Special test findings: eg sweat test for cystic fibrosis, spirometry for asthma.

For Treatment/Management, the following numbers indicate which aspects of treatment and management of each condition are taught in this course:

1. Chiropractic: Adjustments, soft tissue techniques
2. PT: Physical therapy modalities of all types
3. Nutrition/Suppl: Diet and supplement recommendations
4. Exercise: Stretching, strengthening, aerobic exercise recommendations
5. Lifestyle Mgmt: Stress reduction, smoking cessation, allergen avoidance . . .
6. Medical: Drugs, antibiotics, surgical procedures, radiotherapy . . .
7. Other: Acupressure/puncture, massage, homeopathic or herbal Rx . . .
8. Guidelines: If published, do you refer to them regarding this condition?


PSYCHOMOTOR DOMAIN


Students will be able to conduct, in a patient presenting with cardiovascular or pulmonary disease manifestations, an appropriate physical examination using the following procedures:
  1. auscultation for abnormal breath and heart sounds, and for bruits of carotid and femoral arteries and the abdominal aorta
  2. chest percussion
  3. check for tactile fremitus, egophony, bronchophone and whispered pectoriloquy
  4. evaluation for the presence of thrills, heaves, enlarged and displaced PMI
  5. check for abnormal chest expansion
  6. peak flow meter testing
  7. spirometry
  8. check for tracheal deviation and fixation
  9. palpation for lymphadenopathy
  10. check for anterior cervical and superior rib fixations
  11. palpation of accessory respiratory muscles for hypertonicity and trigger points
  12. blood pressure evaluation: arms and legs; and to evaluate for orthostatic hypotension and coarctation of the aorta
  13. evaluation of arterial pulses: (carotid, temporal, brachiel, radial, femoral, popliteal, dorsalis pedis, and posterior tibial)
  14. take blood pressure correctly to screen for hypertension, orthostatic hypotension, coarctation of the aorta, and peripheral vascular disease
  15. palpation for abdominal aortic aneurysm


In addition, students will be able to seek and detect, during the visual inspection and listening and olfactory phase of the physical examination of a patient with cardiovascular or respiratory manifestations, the following signs:

  1. shortness of breath
  2. posture of dyspnea
  3. use of accessory muscles of respiration
  4. abnormal respiratory rate, rhythm and depth
  5. pursed lip breathing
  6. nasal flaring
  7. mouth breathing or nasal voice due to nasal obstruction
  8. asymmetry of the chest shape or motion during respiration
  9. barrel chest (increased anterior to posterior dimensions)
  10. Harrison's groove
  11. intercostal retraction
  12. paradoxical chest and sternum motion
  13. abnormal retraction/hollowing of the supraclaviculr space
  14. pallor, cyanosis, dependent rubor, and varicose veins
  15. patient's body habitus and overall level of conditioning
  16. respiratory splinting
  17. digit clubbing
  18. anisocoria, eyelid ptosis
  19. distended external jugular veins and facial edema
  20. abnormal tympanic membrane appearance using otoscope
  21. abnormal nasal mucosa and deviated septum using scope
  22. abnormal pharyngeal mucosa using light and tongue depressor
  23. audible wheezing or crackles, hoarseness, or raspy voice
  24. foul smelling breath
  25. edema, pitting edema, and ascites
  26. elevated jugular venous pressure


Students will be able to select and properly employ the following treatment techniques (either singly or in condition specific treatment "packages") to male and female patients who have cardiovascular or respiratory disease:

  1. prone, supine and sitting adjustments for superior first rib
  2. prone drop piece adjustment for anterior fixations of C5-7
  3. stretching, PNF, and trigger point techniques for resp. acc. muscles
  4. suboccipital muscle release
  5. hip-rib technique
  6. upper thoracic percussion (for asthma attacks)
  7. cervical lymph stripping
  8. thoracic, arm and sacral lymphatic pump techniques
  9. acupressure formulas for asthma, sinusitis, otitis media
  10. levator scapula release
  11. diaphragm release
  12. Heimlich maneuver with victim seated, standing, supine; and self save
  13. Fossa of Rosenmuller technique
  14. ear pump
  15. ear ossicle adjusments
  16. sinus pump
  17. general thoracic mobilization
  18. cervical stairstepping
  19. cervical sway and nod
  20. upper thoracic adjustments and mobilization techniques

    In addition, students will be able to advise and instruct patients regarding the following home care concepts and activities as they apply to specificcardiovascular and respiratory conditions:
  1. pectoralis major, SCM and scalene stretches
  2. kyphosis stretch using a pillow under the back
  3. spine and thorax stretches (cobra, cat, and crouch)
  4. humidification
  5. HEPA filters and other ways to reduce mold, dander and house dust exposure in the home
  6. nutrition and supplementation
  7. aerobic exercise
  8. the use of certain herbal remedies
  9. erector spinae, rhomboid and pec major strengthening exercises using free weights and select gym equipment


AFFECTIVE DOMAIN


Students will demonstrate integrity, sensitivity, respect, courtesy, compassion and professionalism at all times, both in lectures and labs, and will be able to apply the history, physical examination and treatment techniques learned in this course to any patient while demonstrating those same qualities.
Weekly Calendar of Learning Objectives
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Week Dates Topics/Learning objectives
Week 1 --

Lec. Introduction: review of course syllabus; goals; CV epidemiology; review cardiovascular anat/phys; ECG
Reading: Mayo ch 1-5 (CV anat/phys); Mayo ch 6 (CV SX)
Lab: Intro: goals, conduct; anat/phys; heart ausc loc
Reading for lab: Mayo ch 10 (CV HS & physical exam)

Week 2 --

Lec: SX of CV dd; red flags; types of CV dd
Reading: Mayo ch 7 (types of CV dd)
Lab: heart ausc; CV exam: inspect; vitals: BP, HR, RR
Week 3 --

Lec: CV risk factors, congenital heart dd
Reading:
Mayo ch 7, 8-9 (CV risk factors & how of modify them)
Lab:
heart ausc; BP; pulses; periph vasc exam
Week 4 --

Lec: quiz #1
atherosclerosis, CAD, angina, MI, stroke, TIA,
peripheral artery disease - diagnosis, medical RX
Reading: Mayo ch 7, 11, 12, 13, 15
Lab: heart ausc; BP (ortho hypo and coarctation); risk factors
Week 5 --

Lec: vein disorders, PE, aneurysms, cardiomyopathies, pericardial dd
Reading: Mayo ch 7, 11, 12, 13, 18, 19
Lab: ECG; review for Practical Exam #1
Week 6 --

Lec: arrhythmias, infections, valve dd; heart failure
Reading: Mayo ch 7, 11, 13, 14, 17
Lab: Practical Exam #1 (wk 6 or 7)
Week 7 --

Midterms

Week 8 --

Lec: Respiratory epidemiology; review of resp. anat/phys; terminology, concepts; SX of resp dd; red flags; types of resp dd; risk factors; pulmonary function testing

Reading: course notes for lecture; labs one and two

Lab: lung anatomy, lung sounds, exam procedures; demonstration of pulmonary function testing
Week 9 --

Lec: finish PFT; Obstructive disorders: asthma; COPD

Reading: course notes and study guides for lecture; labs three and four

Lab: lung sounds, exam procedures, pulmonary function testing
Week 10 --

Lec: finish obstructive disorcers; pneumothorax; pulmonary embolism

Reading: course notes and study guides for lecture; lab five

Lab: treatment techniques
Week 11 --

Lec: quiz #2
L ower resp infections: acute bronchitis, influenza, pneumonia

Reading: course notes and study guides for lecture; lab notes regarding treatment techniques

Lab: treatment techniques
Week 12 --

Lec: finish lower resp infections: bronchiolitis, tuberculosis; lung cancer

Reading:course notes and study guides for lecture; lab notes regarding treatment techniques

Lab: treatment techniques
Week 13 --

Lec: cystic fibrosis; IRDS; ARDS

Reading:course notes and study guides for lecture; lab notes regarding treatment techniques

Lab: Practical Exam #2
Week 14 -- Final Exams As Scheduled
Week 15 -- Final Exams As Scheduled
Please Note
This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
Maintained by Northwestern College of Chiropractic
Last updated: 14 December, 2006
 

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