The programme of lectures and other activities
SUBJECT-RELATED DAYS include morning and afternoon sessions, with multimedia based theoretical lectures and practical exercise consisting of listening and validating digital phonocardiograms (1st week), viewing and interpreting echocardiographic images (2nd week).
Students will be provided with relevant literature for further reading. Their performance in the evaluation of "sound" (pediatric cardiac auscultation accuracy) and "ultrasound" (pediatric echocardiography basic skills) will be assessed in the end. Participant students will also be asked to complete evaluation questionnaires at the end of the IP course.
1 ARRIVAL DAY.
2 Introduction, preliminary validation of the background knowledge of participants, introduction to multimedia "virtual" teaching environment, sound physics.
Participant students and teachers will introduce themselves; a brief presentation of the corresponding medical schools and countries (culture, landscape, and living conditions) by participant students is supported, to create a team feeling among participants.
Participants are allowed to listen to various normal and abnormal phonocardiograms and document their findings. Their performance in this initial test will be compared to their performance at the end of the course as a quality measure. Furthermore, it enhances participants' interest on subsequent theoretical lectures while participants get familiar with the multimedia "virtual" teaching environment.
Presentation of sound physical properties including frequency, intensity, harmonics, absorption etc, with reproduction of artificial sounds, so that participants acquire basic skills of correct sound classification and description.
3 Mechanical function of Normal and Malformed Heart and associated auscultatory findings.
An introductory teaching course with theoretical lectures regarding the normal anatomy and mechanical events of heart function, the genesis of heart sounds and murmurs, the electromechanical coupling of heart function.
Presentation of the embryology and anatomy of most common congenital heart disease, with emphasis on the expected cardiac auscultatory findings. Video presentation of 2D and Doppler echocardiographic studies of various types of heart defects will be demonstrated, to enhance the understanding of the genesis of normal and abnormal heart sounds. Following these lectures, participants should be able to describe correctly the expected auscultatory findings in various states in terms of location, intensity, radiation, and timing. Notes will be provided for afternoon reading.
4 Multimedia auscultation - Digital Phonocardiography A. Normal heart tones, innocent murmurs.
Participants will listen to digital phonocardiograms obtained from pediatric cardiology outpatients, corresponding to a wide spectrum of mild to severe congenital heart disease, innocent heart murmurs and arrhythmias. A commercial digital stethoscope with 3 lead ECG has been used for storing in a PC of the phonocardiogram and the corresponding ECG line (for timing of heart sounds). For the reproduction of heart sounds high accuracy earphones are used, so as to stimulate the traditional listening using a conventional stethoscope. A conventional cable connection of the PC with the peripheral headsets through an amplifier, allows for an accurate transmission of the stored sound without any signal loss. Participants can simultaneously listen to the recording and view the corresponding graphic display of the sound (frequency, amplitude) etc on the screen. By using time bars and high or low pass filters the teacher can isolate and emphasize the abnormal heart sound and reproduce it repeatedly. Then longer segments, without filter are presented and this process is repeated up to the point participants can identify the abnormal sound only by listening the original recording.
Participants will have an introduction on classic and digital phonocardiography and will listen and differentiate normal cardiac tones, identify systole and diastole in children of various age groups and listen to a wide spectrum of innocent murmurs of childhood.
B. Abnormal heart tones, wide P2 split, arrhythmias, clicks
The same techniques of high quality reproduction of selected digital phonocardiograms will be used. The teaching is focused on abnormalities of heart tones, abnormal split of P2, various arrhythmias and clicks, Each case will be presented along with clinical data, echocardiographic images and video presentation.
5 Multimedia auscultation-Digital Phonocardiography C. Abnormal murmurs. & Dynamic auscultation
The same techniques of high quality reproduction of selected digital phonocardiograms will be used. The teaching is focused on abnormal murmurs, including various types of systolic, diastolic and continuous murmurs. Each case corresponds to five recording locations (apex, lower, upper left and upper right parasternal area, jugular fossae) in accordance with the standard practice during live auscultation. Participants will have the chance to describe all variables related to abnormal murmur including site of maximum intensity, frequency and intensity change over time, relation to heart tones etc. Selected cases will demonstrate the effect of position (dynamic auscultation) on auscultatory findings in certain forms of heart disease. Each case will be presented along with clinical data, echocardiographic images and video presentation.
6 Cardiac auscultation final test. Students will have to blindly evaluate and document their auscultatory findings following listening to a random sample of normal and abnormal digital phonocardiograms
Complete physical evaluation, Personal and Family History principles
Heart auscultation is a part of a more complete physical evaluation which should include the recognition of abnormal phenotypes (genetic syndromes), appropriate blood pressure measurement, obtaining a detailed personal and family history. Manifestations of critical neonatal congenital heart disease will be discussed along with the importance of family history in cases of inherited heart disease (Students must identify cases with a higher probability of heart disease based on correct personal and family history and physical evaluation.
Topics include: Performing a cardiac status-clinical examination,
Genetics of congenital heart disease and associated genetic syndromes
Decision Making based Clinical Findings.
Heart disease without a murmur-neonatal critical congenital heart disease
Preparticipation screening of young athletes
Selected reading material will be provided to students.
7 WEEKEND 1st day
Participating students and teachers will be offered a chance to come to contact with Cretan history by participating in guided tours to the Heraklion Museum, Knossos Palace etc. Participant teachers will also have the time to discuss about future co-operation in the setting of academic exchange programs or research projects during dinner.
8 WEEKEND 2nd day
Participating students and teachers will be offered a chance to come to contact with the Cretan landscape and traditional Cretan living, through visiting mountain villages, tasting traditional Cretan food and wines. A short introduction on traditional Cretan and music will be provided through live demonstration of traditional music instruments.
9 From sound to ultrasound: The basic principles of modern non invasive diagnostics in pediatric cardiology, namely ultrasound and Doppler, are presented in comparison to sound physics. Ultrasound physics will be presented, safety issues, potential artifacts will be explained, and appropriate configuration of echocardiographic systems is presented.
From M-Mode to 3D echo: Old and new echocardiographic techniques are presented along with most commonly used echocardiographic measurements.
From fetal to adult congenital heart disease echocardiography: principles and techniques of fetal, neonatal, pediatric and adult echocardiography.
10 Ultrasound in congenital heart disease i.
Fetal and pediatric cardiology echocardiograms will be presented, along with a detailed discussion of natural course and treatment options.
Including critical neonatal CHD, common obstructive lesions. Main clinical findings, genetic background, diagnostic criteria and treatment options will be presented. Selected reading material will be provided to students.
11 Ultrasound in congenital heart disease ii.
Fetal and pediatric cardiology echocardiograms will be presented, along with a detailed discussion of natural course and treatment options.
Including critical neonatal CHD, common mixing lesions, ventricular and atrial septal defects, discordant connections, situs abnormalities etc. Main clinical findings, genetic background, diagnostic criteria and treatment options will be presented. Selected reading material will be provided to students
12 Ultrasound in cardiomyopathies and acquired heart disease.
Various forms of cardiomyopathies (hypertrophic) and acquired heart disease including myocarditis, rheumatic fever, Kawasaki disease should be appropriately detected as they are associated with significant morbidity and mortality if undiagnosed. Main clinical findings, genetic background, diagnostic criteria and treatment options will be presented. Selected reading material will be provided to students.
13 Ultrasound final test, Final theoretical test, conclusions
Participants will have to complete a multiple choice test, based on knowledge that should have been gained through the complete course, including physical evaluation, indications for echocardiography, diagnostic criteria of genetic syndromes, basic knowledge for the interpretation of pediatric ECGs etc. Anonymous questionnaires will be provided to participants for the evaluation of the full course, along with their comments for further improvement of the IP course
14 DEPARTURE DAY
