Department of Medicine

• To educate cardiac fellows as to the presentation and course of patients with cardiovascular disease.
• To understand the pathophysiology of the various cardiovascular problems so that proper assessment, therapy and follow-up may be ascertained.
• To use clinical experiences to stimulate expansion of medical knowledge and clinical skills. 

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The goal of the cardiac catheterization laboratory rotation is to transform an internal medicine resident into a highly skilled invasive cardiologist .

Goals for First year fellow:

• gain experience and expertise in the performance of right heart  catheterization
• safely attain arterial access
• gain a practical knowledge of radiation safety.
• gain familiarity with a left heart catheterization.

Goals for 2nd and 3rd year fellows:

• The primary goal is to gain expertise in the performance of left heart catheterization.
• All trainees should learn the appropriate selection of patients for cardiac catheterization, both left and right heart.

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This one month rotation will serve as an introduction to Cardiothoracic Surgery.  The rotation will equip the fellow to serve as a consultant to CT surgeons and improve his/her diagnostic skill as a cardiologist.  A better understanding of the process involved in contemporary CT Surgery should enhance the cardiologist’s ability to more appropriately select patients for surgical therapy.

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The primary educational objective of the CCU experience is acquisition of the knowledge and experience needed for management of critically ill patients with a variety of cardiac, cardiac-related, and non-cardiac disease processes as well as early treatment of stable patients with acute coronary syndromes and/or myocardial infarction. 

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The goal of the echocardiography rotation is to gain a full understanding of the role of noninvasive diagnostic testing in contemporary clinical cardiology.  The fellows will learn all the applications of the following noninvasive modalities during the course of this rotation:

• Transthoracic echocardiography
• Transesophageal echocardiography
• Stress echocardiography (treadmill and pharmacologic)
• Treadmill stress testing
• Interpretation of electrocardiograms
• Interpretation of holter monitors and 30-day event monitors

Given the complexity and array of contemporary noninvasive diagnostics, it is recognized that multiple one-month rotations will be required for mastery of all of the techniques.  Fellows spend a minimum of six months during the three year program rotating through the heart station.  There are three fellows (generally one from each year) on this rotation at any time.  During this period the trainee is directly supervised by one of five non-invasive attendings. 

On a daily basis, non-invasive rounds are held with the non-invasive attending and each test is reviewed , and the fellow's interpretation is discussed and, if need be, revised. 
There is ample opportunity for fellows to obtain "hands-on" experience in performing echocardiograms.  Trained, certified sonographers supervise the performance of one study per day performed by the fellow; this study is subsequently reviewed by the non-invasive attending.  This experience provides valuable training for fellows and enhances appreciation of how technical aspects of the ultrasound examination impact the ultimate quality of the data.  Fellows also gain extensive experience with quantitative aspects of echocardiography during their rotations and gain familiarity with measurements of left ventricular mass, volume, fractional shortening, and wall stress.  Fellows are encouraged to perform quantitative analysis of studies using the off-line analysis systems both for clinical and research studies.

Fellows also have responsibility for EKG interpretation and for performance and interpretation of exercise treadmill tests while on the heart station rotation.    Exercise treadmill testing is performed in the heart station as well as nuclear cardiology.  The heart station is one of three inpatient sites for exercise treadmill testing (in addition to nuclear cardiology and the fitness center).  The heart station generally performs exercise tests on cardiology inpatients on the medical service and for vascular surgery patients, undergoing evaluation for intermittent claudication.  Approximately five exercise tests are performed per day in conjunction with experienced technicians; the fellow is responsible for obtaining the patient's clinical history, performing an examination, and for supervising and providing an interpretation of the test.  A preliminary note is written in the patient's chart; the report is subsequently reviewed with the non-invasive attending later that day.

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The goal of the inpatient and outpatient  EP service experience is to develop the ability to diagnose and manage arrhythmias (bradycardiac and/or tachycardic). The Fellow is expected to know the HRS/AHA/ACC guidelines for brady support and ICD implant, as well as drug therapies for arrhythmias. The fellow’s role on the EP service should not be a repetition of residency, but rather emulate the responsibilities of the attending for a series of challenging arrhythmia patients.  The fellow may perform the initial “attending” admission work-up, assembling all of the relevant data including phone calls to outside hospitals, referring physicians within or outside UMMHC, generate a differential diagnosis and management plan, and present this to the EP inpatient attending (who will be the attending physician of record for the patient).  The fellow will round daily on the patients she/he admits, review diagnostic studies, continuously refine the working diagnosis, devise management plans, and oversee discharge planning, paperwork, and communication. 

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The major goal of the nuclear cardiology rotation is for cardiology Fellows to become proficient in the knowledge, performance and interpretation of nuclear cardiac stress testing. The training in nuclear cardiology should give Fellows the skill and knowledge to perform exercise and pharmacologic stress testing, including dipyridamole, adenosine and dobutamine stress and to interpret myocardial perfusion and radionuclide ventriculography images.

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