PH 198.001 DeCal: Introduction to Fall 2019 Syllabus 1 Unit

Section Day/Time/Location: Wednesday, 6:00-7:00PM, Location: Barrows 175 ​

Main Course Email: [email protected] ​ ​

Facilitator Contact Information Daniel Han - [email protected] ​ Kathryn Li - [email protected] ​ ​ Mandeep Ladhar (Teaching Assistant) - [email protected] ​

Faculty Sponsor: Dr. John Swartzberg, MD, FACP - [email protected] ​

DeCal Information & Objectives Course Description and Objectives According to the CDC, more than 600,000 people in the United States die each year from heart-related diseases, making it the leading cause of death for both men and women. Cardiovascular disease is a result of the gradual buildup of plaque or fatty material within the arterial walls leading to heart attacks. However, most cardiovascular diseases are preventable by addressing risk factors such as poor and unhealthy diets, smoking, environmental hazards, and limited physical activity. The heart is one of the most vital organs required for human life and has very complex structures and mechanisms that enable blood circulation throughout the body. This DeCal aims to introduce interested students from all backgrounds the fundamentals of the heart. In particular, we will cover its respective anatomy and physiology, learn related diseases and their impacts on public health, and explore exciting on-going research fields. This weekly DeCal is 1 hour long and counts as 1 unit P/NP.

Teaching approaches/activities This course will be taught by all three student facilitators in an interactive style. Lectures, discussions, videos and activities will be used to reinforce course content. Typical classes will consist of a bi-weekly quiz and a final project. The final project will be divided into four pieces: topic proposal, annotated bibliography, written summary and a final presentation. These four pieces serve as checkpoints to ensure that the students are on track for their final project. The presentations will be conducted in the last section of class.

DeCal Policies & Requirements Expectations Students are expected to come to every section on time and prepared for the bi-weekly quizzes. Students should turn in their homework assignment via bCourses prior to coming to class. Any late assignments will be deducted 50% of the final assignment grade. Prerequisites This course has no prerequisites. Students of all backgrounds and all majors interested in learning more about the heart, its physiology and anatomical structures, and relevant diseases are encouraged to take this course.

Course Evaluations Students will answer a short course evaluation in the middle and end of the semester, which will be in the form of written feedback about how facilitators can improve the course.

Readings There will be weekly readings that are used as a supplement to the material covered in the course. Additional readings may be announced during lecture and all readings will be posted online via bCourses in a PDF format in the Files>Readings tab. Students are encouraged to ask questions about readings during lecture, so please come prepared with your questions to lecture. Please review the reading list at the end of the syllabus.

Assignments & Grades Attendance and Late Policy Lecture attendance is MANDATORY. If you cannot make lecture, you must email [email protected] 24 hours in advance with your reason for being absent to be considered ​ excused (valid reasons may be due to medical reasons, family emergencies, etc. and must provide proper documentation -- ie. a doctor’s note). Students arriving to lecture more than 15 minutes past the hour are considered tardy. Three tardies will count as an unexcused absence. Students are allowed TWO ​ unexcused absence.

Bi-weekly quizzes Quizzes will be given every 2 weeks based on lecture material and readings from the previous week and be in the form of multiple choice and/or fill in the blank. There will be a total of 6 quizzes. There will be ​ one drop-quiz allowed.

Final Project Students will form groups of no larger than 3 people and present on a topic that is related to lecture material we have covered throughout the semester. Final Project would challenge students by allowing them to research on the new scientific discoveries within the field of Cardiology by applying the concepts that students have learned throughout this course. Please include research paper titles, sources, dates, and link to your research papers.

Your final project will include 4 pieces: ● Proposal Topic (Due on 09/18) ​ ​ ○ Groups must submit a topic of their choice on bCourses ○ Students must convene with their group determine the topic of interest and find out one citation that describes their topic of interest. ○ Students are required to discuss their topic of choice with one of the facilitators. ○ Topics must be related to the field of Cardiology (i.e., structural malformations, diseases, research, etc.) ○ Provide a paragraph summary (5-6 sentences) on final project topic ● Annotated Bibliography (Due on 10/16) ​ ​ ○ Students must carefully read 4-5 citations (may include published articles, journals, and research papers) and write a one paragraph summary (5-6 sentences) per citation ● Presentation Transcript/Summary (Due on 11/06) ​ ​ ○ Must be 2-4 pages in length describing: ■ Outline of the format of Final Presentation ■ Analysis of Research Papers to the Topic of Interest ■ Description on the Epidemiology of disease(s) ■ Potential Effect of the topic of interest to the society and the field of Medicine ● Final Presentation (Present in-class on 12/04) ​ ​ ○ Have summary of all relevant research papers ○ Discuss any disease(s) and how it affects the overall public health ○ Be around 5-7 minutes long, points will be deducted if presentations are not within the recommended time limits ○ Have each individual in the group participate and speak during the presentation

Grade Breakdown ■ Attendance/Participation 35% ​ ​ ■ Topic Proposal 5% ​ ​ ■ Annotated Bibliography 10% ​ ​ ■ Presentation Transcript/Summary 10% ​ ​ ■ Final Presentation 25% ​ ​ ■ Weekly Quizzes 15% ​ ​

Course Calendar

Week Date Topic

1 9/4 Basic Course Overview, Cardiac Muscle and Structural Anatomy Due: Pre-Semester Survey

2 9/11 Heart Development & Innervations, Blood components (Hemoglobin), Blood Vessels, Blood Flow Due: Quiz 1

3 9/18 Cardiovascular System and Other Organ Systems Due: Topic Proposal

4 9/25 Heartbeats, Cardiac Action Potential & EKG Readings Due: Quiz 2 5 10/2 Branches of Cardiology & EKG Interpretations

6 10/9 Diagnosis Tests, Biomedical Devices, and Heart Procedures Due: Quiz 3

7 10/16 Hypertension & Due: Annotated Bibliography Mid-semester Evaluations

8 10/23 Congestive , Heart Attack, Cardiac Arrest Due: Quiz 4

9 10/30 Case Study: Atherosclerotic Cardiovascular Disease

10 11/6 Case Study: Congenital Heart Disease Due: Quiz 5 Presentation Transcript/Summary

11 11/13 Case Study: Heart, Infectious Diseases & Other Abnormalities Due: Quiz 6 Questions for CPPN

12 11/20 Cardiology Professional Panel Night

13 11/27 Thanksgiving Break NO CLASS

14 12/4 Final Group Presentation End of the Semester Course Evaluation

Reading List

Week 1: Overview of Cardiac Muscle, Heart Development, Structural Anatomy & Innervations ​

Anderson, Robert H et al. “Cardiac anatomy revisited” Journal of anatomy vol. 205,3 (2004): 159-77. ​ ​

Hill, M. C. & Martin, J. F. Heart muscle regeneration: the wonder of a Cardio-Cocktail. Cell Research 28, ​ ​ ​ ​ 503–504 (2018).

MacGrogan, D., Münch, J. & Pompa, J. L. de la. Notch and interacting signalling pathways in cardiac development, disease, and regeneration. Nature Reviews Cardiology 15, 685 (2018). ​ ​ ​ ​

R.M. Ali, L.T.A. Kury, K.-H.S. Yang, A. Qureshi, M. Rajesh, S. Galadari, Y.M. Shuba, F.C. Howarth, M. Oz, Effects of cannabidiol on contractions and calcium signaling in rat ventricular myocytes, Cell ​ Calcium (2015), http://dx.doi.org/10.1016/j.ceca.2015.02.001 ​ ​ Weinberger F, Mannhardt I, Eschenhagen T. Engineering cardiac muscle tissue: a maturating field of research. Circ. Res. 2017;120:1487–1500. doi: 10.1161/CIRCRESAHA.117.310738.

Week 2: Hemoglobin, Blood Vessels, Blood Flow ​

Epelman, S., Liu, P. P. & Mann, D. L. Role of innate and adaptive immune mechanisms in cardiac injury and repair. Nature Reviews Immunology 15, 117–129 (2015). ​ ​ ​ ​

Estes, E. H., et al. “The Anatomy and Blood Supply of the Papillary Muscles of the Left Ventricle.” American Heart Journal, vol. 71, no. 3, Mar. 1966, pp. 356–62. ​

Lee Gyeongsil et al. Association of Hemoglobin Concentration and Its Change With Cardiovascular and ​ ​ All Cause Mortality. Journal of the American Heart Association 7, e007723 - ​ ​ ​ ​

Liu, N. et al. Bone Marrow Is a Reservoir for Cardiac Resident Stem Cells. Scientific Reports 6, 28739 ​ ​ ​ ​ ​ ​ (2016).

Oka Toru, Akazawa Hiroshi, Naito Atsuhiko T. & Komuro Issei. Angiogenesis and Cardiac Hypertrophy. Circulation Research 114, 565–571 (2014). ​ ​ ​

Week 3: Cardiovascular System and Other Organ Systems ​

Baumann, M. et al. Prehypertensive Renin-Angiotensin-Aldosterone System Blockade in Spontaneously ​ ​ Hypertensive Rats Ameliorates the Loss of Long-Term Vascular Function. Hypertension Research 30, ​ ​ ​ ​ 853–861 (2007).

Hasan, W. Autonomic cardiac innervation. Organogenesis 9, 176–193 (2013). ​ ​ ​ ​

Hori, D., Yamaguchi, A. & Adachi, H. Coronary Artery Bypass Surgery in End-Stage Renal Disease Patients. Ann Vasc Dis 10, 79–87 (2017). ​ ​ ​ ​

Nehme, A. et al. Atlas of tissue renin-angiotensin-aldosterone system in human: A transcriptomic ​ ​ meta-analysis. Scientific Reports 5, 10035 (2015). ​ ​ ​ ​

Rosner, M. H. & Okusa, M. D. Acute Kidney Injury Associated with Cardiac Surgery. CJASN 1, 19–32 ​ ​ ​ ​ (2006).

Week 4: Mechanisms & EKG Readings ​

Lin, M.-H. et al. Development of a rapid and economic in vivo electrocardiogram platform for ​ ​ cardiovascular drug assay and electrophysiology research in adult zebrafish. Scientific Reports 8, 15986 ​ ​ ​ ​ (2018). Moorman Antoon F.M., de Jong Frits, Denyn Marylène M.F.J. & Lamers Wouter H. Development of the Cardiac Conduction System. Circulation Research 82, 629–644 (1998). ​ ​ ​ ​

Munshi, N. V. Gene Regulatory Networks in Cardiac Conduction System Development. Circ Res 110, ​ ​ ​ ​ 1525–1537 (2012).

Ueda, H., Miyawaki, M. & Hiraoka, H. High–normal blood pressure is associated with new-onset electrocardiographic left ventricular hypertrophy. Journal of Human Hypertension 29, 9–13 (2015). ​ ​ ​ ​

Xu, Y. et al. Locating the Human Cardiac Conduction System Using a 3D Model of Its Nutritious ​ ​ Arteries. Scientific Reports 7, 344 (2017). ​ ​ ​ ​

Week 5: Branches of Cardiology: Electrophysiology, Cardiogeriatrics, Echocardiography ​

Díaz-Navarro, R. & Villagran, F. Takotsubo and : value of cardiac magnetic resonance imaging for diagnostic confirmation: a case report. Eur Heart J - Case Rep ​ doi:10.1093/ehjcr/yty151 ​

Carrel, T. & Eberle, B. Candida Endocarditis after TAVR. New England Journal of Medicine 380, e1 ​ ​ ​ ​ (2019).

Li, Danshi, et al. “Effects of Experimental Heart Failure on Atrial Cellular and Ionic Electrophysiology.” Circulation, vol. 101, no. 22, June 2000, pp. 2631–38. circ.ahajournals.org, ​ ​ ​ doi:10.1161/01.CIR.101.22.2631.

Nguyen, Kim-Lien, et al. “The Crossroads of Geriatric Cardiology and Cardio-Oncology.” Current ​ Reports, vol. 4, no. 4, 2015, p. 327. www.ncbi.nlm.nih.gov, doi:10.1007/s13670-015-0147-4. ​ ​ ​

Marsan, Nina Ajmone, et al. “Real Time Three Dimensional Echocardiography Permits Quantification of - - Left Ventricular Mechanical Dyssynchrony and Predicts Acute Response to Cardiac Resynchronization Therapy.” Journal of Cardiovascular Electrophysiology, vol. 19, no. 4, Apr. 2008, pp. 392–99. ​ ​ onlinelibrary.wiley.com, doi:10.1111/j.1540-8167.2007.01056.x. ​

Week 6: Diagnostic Tests, Biomedical Devices & Heart Procedures ​

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery | Circulation. Available at: https://www.ahajournals.org/doi/10.1161/CIR.0b013e31823c074e. (Accessed: 30th January 2019)

Arora, S., Misenheimer, J. A. & Ramaraj, R. Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status. Texas Heart Institute Journal 44, 29–38 (2017). ​ ​ ​ ​

Cook, J. A. et al. The total artificial heart. J Thorac Dis 7, 2172–2180 (2015). ​ ​ ​ ​ ​ ​ Iribarne, A. et al. The golden age of minimally invasive cardiothoracic surgery: current and future ​ ​ perspectives. Future Cardiol 7, 333–346 (2011). ​ ​ ​ ​

Mancini, Donna M., et al. “Low Incidence of Myocardial Recovery After Left Ventricular Assist Device Implantation in Patients With Chronic Heart Failure.” Circulation, vol. 98, no. 22, Dec. 1998, pp. ​ ​ 2383–89. circ.ahajournals.org, doi:10.1161/01.CIR.98.22.2383. ​ ​

Olgin, J. E. et al. Wearable Cardioverter–Defibrillator after . New England Journal ​ ​ ​ of Medicine 379, 1205–1215 (2018). ​ ​ ​

SUN, R. et al. Advances in stem cell therapy for cardiovascular disease (Review). Int J Mol Med 38, ​ ​ ​ ​ ​ ​ 23–29 (2016).

Week 7: Hypertension & ​

Jennings Amy et al. Mediterranean-Style Diet Improves Systolic Blood Pressure and Arterial Stiffness in ​ ​ Older Adults. Hypertension 0, HYPERTENSIONAHA.118.12259. ​ ​ ​ ​

Khera, R. et al. Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for ​ ​ antihypertensive treatment in United States and China: nationally representative cross sectional study. BMJ 362, k2357 (2018). ​ ​ ​

Oparil Suzanne & Schmieder Roland E. New Approaches in the Treatment of Hypertension. Circulation ​ Research 116, 1074–1095 (2015). ​ ​ ​

Poynter, J. A. et al. Surgical Treatment of : The Time Is Now. The Annals of Thoracic Surgery 90, 2079–2086 (2010).

Whelton, P. K. et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA ​ ​ Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71, (2018). ​ ​ ​ ​

Wolf, P. A., et al. “Atrial Fibrillation as an Independent Risk Factor for Stroke: The Framingham Study.” Stroke, vol. 22, no. 8, Aug. 1991, pp. 983–88. stroke.ahajournals.org, doi:10.1161/01.STR.22.8.983. ​ ​ ​

Week 8: Stroke, Congestive Heart Failure, Heart Attack, Cardiac Arrest ​

Braunwald Eugene. Research Advances in Heart Failure. Circulation Research 113, 633–645 (2013). ​ ​ ​ ​

Davidson, S. M. et al. Endothelial cells release cardioprotective exosomes that may contribute to ​ ​ ischaemic preconditioning. Scientific Reports 8, 15885 (2018). ​ ​ ​ ​

Field, M. E. & Page, R. L. Another Shock for Sudden Death Prevention after Myocardial Infarction. New ​ England Journal of Medicine 379, 1274–1275 (2018). ​ ​ ​

Isselbacher, E. M., Meyersohn, N. M., Sarma, A. A., Spooner, A. E. & Tomaszewski, K. J. Case 38-2018: A 54-Year-Old Man with New Heart Failure. New England Journal of Medicine 379, 2362–2372 (2018). ​ ​ ​ ​

Ono, H. et al. Hydrogen Gas Inhalation Treatment in Acute Cerebral Infarction: A Randomized ​ ​ Controlled Clinical Study on Safety and Neuroprotection. Journal of Stroke and Cerebrovascular ​ Diseases 26, 2587–2594 (2017). ​ ​ ​

Sabatine, M. S. et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. New ​ ​ ​ England Journal of Medicine 376, 1713–1722 (2017). ​ ​ ​

Week 9: Case Study: Atherosclerotic cardiovascular disease ​

Barquera, S. et al. Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease. ​ ​ Archives of Medical Research 46, 328–338 (2015). ​ ​ ​

Boesen, M. E., Singh, D., Menon, B. K. & Frayne, R. A systematic literature review of the effect of carotid on local vessel stiffness and elasticity. Atherosclerosis 243, 211–222 (2015). ​ ​ ​ ​

Ridker, P. M. et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. New ​ ​ ​ England Journal of Medicine 377, 1119–1131 (2017). ​ ​ ​

Ridker, P. M. et al. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events. New England ​ ​ ​ Journal of Medicine 0, null (2018). ​ ​ ​

Sage, A. P., Tsiantoulas, D., Binder, C. J. & Mallat, Z. The role of B cells in atherosclerosis. Nature ​ Reviews Cardiology 1 (2018). doi:10.1038/s41569-018-0106-9 ​ ​

Week 10: Case Study: Congenital Heart Disease ​

Bilal, M. S. et al. A better approach for left ventricular training in transposition of the great arteries and ​ ​ intact interventricular septum: Bidirectional cavopulmonary anastomosis and pulmonary artery banding. Congenital Heart Disease 0, ​ ​ ​

Kaltman Jonathan R., Burns Kristin M. & Pearson Gail D. Perspective on Congenital Heart Disease Research. Circulation Research 120, 898–900 (2017). ​ ​ ​ ​

Pierpont Mary Ella et al. Genetic Basis for Congenital Heart Disease: Revisited: A Scientific Statement ​ ​ From the American Heart Association. Circulation 138, e653–e711 (2018). ​ ​ ​ ​

Marian Ali J. Congenital Heart Disease. Circulation Research 120, 895–897 (2017). ​ ​ ​ ​

Pfammatter, Jean-Pierre, et al. “Early Postoperative Arrhythmias after Open-Heart Procedures in Children with Congenital Heart Disease.” Pediatric Critical Care Medicine: A Journal of the Society of Critical ​ Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 2, no. 3, ​ July 2001, pp. 217–22.

Warnes Carole A. Transposition of the Great Arteries. Circulation 114, 2699–2709 (2006). ​ ​ ​ ​

Week 11: Case Study: Heart, Infectious Diseases & Other Abnormalities ​

Matsuura, H. & Ohya, M. Coronary-Artery Occlusion from Kawasaki’s Disease. New England Journal of ​ Medicine 379, e42 (2018). ​ ​ ​

Mensah, G. A. & Engelgau, M. E. Acute Rheumatic Fever and Rheumatic Heart Disease Research. Glob ​ Heart 12, 63–65 (2017). ​ ​ ​

Monasky, M. M. et al. Calcium in Brugada Syndrome: Questions for Future Research. Front Physiol 9, ​ ​ ​ ​ ​ ​ (2018).

Murillo, H. et al. Infectious Diseases of the Heart: Pathophysiology, Clinical and Imaging Overview. ​ ​ RadioGraphics 36, 963–983 (2016). ​ ​ ​

Musher, D. M., Abers, M. S. & Corrales-Medina, V. F. Acute Infection and Myocardial Infarction. New ​ England Journal of Medicine 380, 171–176 (2019). ​ ​ ​ de Waard Vivian. Marfan on the Move. Journal of the American Heart Association 6, e007465 ​ ​ ​ ​

Welch, Ashley. “Woman diagnosed with "broken-Heart syndrome" after dog dies.” CBS News, CBS ​ ​ Interactive, 23 Oct. 2017, www.cbsnews.com/news/woman-diagnosed-with-broken-heart-syndrome-after-dog-dies/. ​ A Publication that supports this article: Maiti, A. & Dhoble, A. Takotsubo Cardiomyopathy. New England Journal of Medicine 377, e24 ​ ​ ​ ​ (2017).