Heart of the Matter: Key concepts in cardiovascular science PDF
Preview Heart of the Matter: Key concepts in cardiovascular science
Learning Materials in Biosciences Cesare Terracciano Samuel Guymer E ditors Heart of the Matter Key concepts in cardiovascular science Learning Materials in Biosciences Learning Materials in Biosciences textbooks compactly and concisely discuss a specific biological, bio- medical, biochemical, bioengineering or cell biologic topic. The textbooks in this series are based on lec- tures for upper-level undergraduates, master’s and graduate students, presented and written by authoritative figures in the field at leading universities around the globe. The titles are organized to guide the reader to a deeper understanding of the concepts covered. Each textbook provides readers with fundamental insights into the subject and prepares them to inde- pendently pursue further thinking and research on the topic. Colored figures, step-by-step protocols and take- home messages offer an accessible approach to learning and understanding. In addition to being designed to benefit students, Learning Materials textbooks represent a valuable tool for lecturers and teachers, helping them to prepare their own respective coursework. More information about this series at http://www. springer. com/series/15430 Cesare Terracciano Samuel Guymer Editors Heart of the Matter Key concepts in cardiovascular science Editors Cesare Terracciano Samuel Guymer National Heart & Lung Institute Imperial College London & St George’s Imperial College London Medical School London, United Kingdom London, United Kingdom ISSN 2509-6125 ISSN 2509-6133 (electronic) Learning Materials in Biosciences ISBN 978-3-030-24218-3 ISBN 978-3-030-24219-0 (eBook) https://doi.org/10.1007/978-3-030-24219-0 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or infor- mation storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publica- tion does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland V “Fatti non foste a viver come bruti, ma per servir virtute e conoscenza” Dante Alighieri, La Divina Commedia, Inferno, Canto XXVI, vv119–120 Preface by Cesare Terracciano “Not another textbook!” I hear you saying! In the era of digital technology, powerful web browsers, instantaneous globalisation and online lectures, why do we need a textbook in cardiovascular sciences? Knowledge, defined as the accumulation of pure information, is no longer the prerogative and currency of university education, and anyone with a decent smartphone can access all the information available from every part of the world at the press of a few buttons. In the past, even until quite recently, textbooks had a central role in education; they were memorised almost word for word, but now that this information is promptly available using other media and is comprehensive and up-to-date, why do we need a textbook in the learning process of medical sciences? The BSc course in Cardiovascular Sciences has been running for approximately 20 years and is the main undergraduate cardiac teaching activity of the National Heart and Lung Institute; the course was established when the institute joined Imperial College London in the mid-1990s. The course has changed substantially over the years, following the massive changes in university learning, associated with the exponential growth in scientific dis- covery, the diffusion of digital technologies and the Internet. Starting as a module to complement both the BSc in Biomedical Sciences and the Science year of the MBBS curriculum, the course was originally based almost entirely on the basic biology of the cardiovascular system. Over the years, becoming more integrated in the teaching of Med- icine, the pathophysiology aspects have become more important, and cardiac diseases are now the main study subjects of the course. Far from being purely clinical, the main objec- tive of the course is to explore the scientific foundation of cardiac disease, and, in the process, it offers the opportunity to learn about biology, physiology and regulation of the cardiovascular system. For this reason, the course is very popular with medical students who thoroughly enjoy the learning of science within the context of clinical problems. The course is taught by a faculty consisting almost entirely of academics whose primary role is to perform world-leading cardiovascular research. Many of our teachers offer the invaluable experience of being directly involved in the scientific discoveries they teach. Their enthusiasm and understanding of how disease happens, why certain people are affected and others are protected, why a particular treatment should be used and how do we know that it works are passed onto the students together with an extraordinary level of expertise. This is the main factor that has made our course very popular over the years. In this context, the value of university learning shifts from bare memorising of informa- tion to its critical analysis. What the students should gain are guidance, opinions, inter- pretations and experience. Active learning, where students are engaged directly and challenged, where information is dissected and analysed in sessions led by both the stu- dent and the lecturer, where controversies, practical and hands-on applications are the main focus, is the way forward for our course and university learning in general. Active learning activities are only rewarding if the students have already some knowl- edge of the topic, ask more pertinent questions and make more appropriate comments. The problem with this approach is in the lack of fundamental knowledge from the VII Preface by Cesare Terracciano students during the lecture, one that, in the traditional way of thinking, they have come to acquire. So a vicious circle ensues, where students need to memorise basic informa- tion before they can be engaged in active learning. They will spend the best part of the course learning facts that do not require interaction with teachers and only at the end, often after the assessments, are they sufficiently ready for active learning. We must ensure that the students acquire the necessary knowledge before they engage with the lecturers. This information must be manageable, vetted, up-to-date and sufficient for engaging in intelligent and critical analysis of the subject, to allow further and in-depth discussions and carry out practical sessions. This textbook is designed to fulfil this need: the book contains the starting point, the necessary knowledge to engage in the course. In addition, the book has also a crucial role in allowing students coming from different streams, col- leges or different education systems to approach the course from a similar starting point, helping every student to engage and thrive. In order to fulfil this background role, this textbook has two main features: firstly, it is simple and broad in its scope. It only requires a basic understanding that every student at this stage of learning should have. It is not designed to be comprehensive but to pro- vide a manageable list of reading material that should kick-start and engage the students to proceed in the correct direction when they need more in-depth details. Secondly, the chapters have been written by our teachers in close collaboration with previous students of the BSc course in Cardiovascular Sciences. Each chapter is authored by at least one student and one lecturer. The contribution of the lecturer is to ensure scientific rigour, topical and relevant directions and experience, while the students contribute by suggest- ing the correct level of pitching, a more amenable language and a modern twist. The combination of these two roles results in an essential learning tool, a springboard to be used by everyone around the world with a biomedical background who wants to start the journey into science in the context of cardiac disease. Cesare Terracciano London, UK 23 January 2019 V III Preface by Samuel Guymer Preface by Samuel Guymer The heart represents an intellectual endeavour like no other: an apex of contradiction where innumerable interacting mechanisms of increasing complexity converge to create a simple pumping apparatus that propels the volume of a double espresso into our vas- culature each minute, the subject of innumerable research but equally the repository of the soul. As a student of medicine, it was this contradiction that gravitated my curiosity toward this organ like so many before me. How can we know so much about the heart yet still have so many questions? We are, in the words of the Persian poet Ibn Yamin, “the man who doesn’t know, but knows that he doesn’t know.” The Cardiovascular Sciences BSc programme was the catalyst for my realisation (and acceptance) of this identity: a course that provides students with the tools and knowl- edge to challenge the consensus, to question why a particular guideline recommends a specific investigation or therapy. It is a programme that assumes its responsibility to nourish the intellectually hungry whilst simultaneously immersing them in the contro- versies and unknowns that persist in this field. An approach that stands in stark contrast to a medical education that so often retreats into a complacency of lionising the memo- risation of things we know, e.g. that drug x at dose y is indicated in z condition. This shift in the learning paradigm is exemplified by the contrasting embryological theo- ries of sinoatrial nodal origin, both of which are assiduously dissected down to a molec- ular level of detail with no definitive answer as to which is “the truth.” Instead, students are provided the respective evidence bases and encouraged to find “the truth” for them- selves: Is it one of the two predominant theories, some interspersion of both, or perhaps neither? We have attempted to encapsulate this learning mentality within this book, with most chapters containing a section entitled “What We Don’t Know”. It is here that an area lacking a definitive “truth” is expanded upon, allowing you to critically appraise the evi- dence base(s) and reach a conclusion for yourself. Another salient feature of this textbook is the synergy of student and lecturer to create material that covers the fundamentals, the “heart of the matter”, whilst concurrently exploring new developments and research. In this way, we are able to fully utilise the pioneering work being undertaken at the National Heart and Lung Institute. Ultimately, the aim of this textbook is to equip you with an understanding of cardiovas- cular sciences and where the deficits in understanding persist, allowing the finitude of your knowledge to be challenged by the infinitude of your curiosity and pursuit for greater understanding of this contradiction of an organ. Samuel Guymer London, UK 8 February 2019 IX Acknowledgements We would like to thank Mr. Barrett Downing for the invaluable editorial support at all stages of the preparation of this textbook. We are grateful to our illustrator, Ms. Umamah Tarvala, for providing many excellent figures and graphs. Finally, we would like to thank all the past and present students of the BSc course in Cardiovascular Science at Imperial College London; their feedback has been essential for the conceptualisation of this book.
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