Curriculum: Description of Services

Primary teaching service

The inpatient teaching service will provide evaluations and patient care for cardiology patients on the cardiac step-down floor and patients presenting to the emergency room for cardiac admission to the step-down. The service will consist of a supervising cardiologist, a Fellow, an internal medicine resident and one to two interns.

Consult ICU/open heart

This consultative service will provide evaluations and patient care for both medical and surgical intensive care unit, heart surgical and heart surgical step-down unit patients. These patients often have a high acuity of illness and are on mechanical ventilation with hemodynamic monitoring. Patients on ECMO, LVAD, as well as patients with postoperative cardiogenic shock are seen on this service. The service personnel will consist of a supervising cardiologist, a Fellow and a physician assistant.

Cardiac intensive care unit

The cardiac intensive care unit service provides evaluation and patient care for patients with high acuity cardiac conditions such as STEMI, acute pulmonary edema, VT storm, heart block and cardiogenic shock. These patients often require urgent coronary angiography, hemodynamic monitoring and support, and/or stat echocardiography. The teaching service is comprised of one teaching attending, one Fellow, one medical resident and two to three interns.

Clinical service (LVH–Muhlenberg)

LVH–Muhlenberg is a 200-bed acute care hospital. Advanced cardiac service including PCI, CABG, valve replacement, device placement and complex ablations also are performed at LVH–Muhlenberg. The inpatient teaching service at LVH–Muhlenberg will provide evaluations and patient care generally in the cardiac, medical and surgical intensive care units and the cardiology step-down floor. The service personnel will consist of a supervising cardiologist, a Fellow and an emergency medicine resident.

Heart surgical rotation

The purpose of this rotation is to give the second-year cardiology Fellow exposure to the management of patients prior to, during and following heart surgery. In addition, the Fellow will be involved in perioperative transesophageal echocardiography and pre-op placement of central lines and swan ganz catheter placement. Fellows will rotate under the supervision of a cardiothoracic surgeon and cardiac anesthesiologist. Fellows are expected to present at cardiology/cardiothoracic interdisciplinary conference following this rotation.

Rehab, Holter, ECG

The purpose of this rotation is to give the third-year Fellow exposure to inpatient and outpatient cardiac rehabilitation, interpretation of Holter and ECG.

Echocardiography

Fellows are expected to attain COCATS Level 2 in echocardiography by the completion of their second year of fellowship. Recently all fellows have taken and passed the echocardiography boards early in their third year of fellowship. First-year fellows concentrate on basic transthoracic exam performance and interpretation. Second-year fellows focus on complex disease, 3-D echocardiography, stress and dobutamine echocardiography and transesophageal echocardiography. All graduating fellows are expected to independently and competently perform all aspects of echocardiography discussed above. Additional training is available the third year in the form of electives and may lead to COCATS Level 3 expertise in echocardiography. Since the volume of the LVH–Cedar Crest echo lab exceeded 13,000 during the last fiscal year, there is more than sufficient volume for teaching purposes.

Stress – nuclear

This combined rotation incorporates aspects of exercise physiology, exercise ECG, pharmacologic stress test and nuclear imaging.

It is expected that upon completing the stress - nuclear cardiology rotations, all fellows will have a comprehensive understanding of the clinical concepts and a working knowledge of the technical concepts related to various myocardial perfusion studies with a strong emphasis on nuclear stress testing.

Fellows who wish to practice the specialty of nuclear cardiology are required to have at least four months of training. This includes a minimum of 700 hours of didactic, clinical study interpretation and hands-on patient care in nuclear cardiology. Additional external training in nuclear physics and radiation safety is required is to become authorized users of radioactive materials in accordance with the regulations of the Nuclear Regulatory Commission (NRC).

Catheterization laboratory

While rotating in the high-volume cardiac catheterization laboratory (for Fiscal Year 2015 there were more than 2,476 diagnostic coronary catheterizations and 1,496 interventional coronary patient procedures), the Fellows will be responsible for the assessment and performance of diagnostic cardiac catheterization procedures, including pre-procedure assessment of the risks and benefits to the individual patients, performance of the procedure at a level commensurate with training, post-procedure care and management of complications. Cardiology Fellows will work under direct supervision of cardiology attendings in the cardiac catheterization laboratory. Fellows are expected to present cases at the weekly cardiac cath conference.

Electrophysiology laboratory

Cardiology fellows will become acquainted with a wide spectrum of cardiac rhythm disturbances, their clinical presentation and management. The fellows will become involved in the evaluation and care of patients with cardiac arrhythmias from presentation to the hospital through diagnostic testing, initiation and follow up of therapy. Emphasis will be placed on gathering pertinent historical, physical examination and non-invasive data to judge whether or not invasive electro-physiologic testing, anti-arrhythmic therapy and/or device-based therapy is warranted. The inpatient teaching service will provide evaluations and patient care throughout the hospital including the medical, cardiac and surgical floors, intensive care units, maternity suites, operation suites, recovery room and in the emergency department at LVH–Cedar Crest.  Fellows choosing advanced training in electrophysiology may elect to spend elective time during the third year to prepare for an advanced fellowship.

Research

As part of the academic environment, it is critical that fellows be involved in meaningful supervised research in cardiovascular disease or in associated areas. Fellows are expected to learn how to conceive a research hypothesis, review the appropriate literature, design a project, obtain data, analyze data, synthesize results, present data in conference and prepare a manuscript of results for publication. Each Fellow has at least four weeks of protected research time per year. Each Fellow must complete an appropriate project during his/her fellowship, and it must be written as a manuscript in order to complete his/her fellowship. 

Advanced imaging

The third-year fellows acquire knowledge, technical skills, and interpretive skills necessary to learn the appropriate indications, diagnostic yield, and the appropriate application of the resultant diagnostic information for clinical management and risk stratification utilizing cardiac computed tomography and magnetic resonance imaging. Fellows are encouraged to take an elective course on cardiac computed tomography outside the institution. 

Elective rotations

Elective rotations available include the following: echocardiography, nuclear cardiology, lipid management, congestive heart failure, electrophysiology (both laboratory and device surveillance), cardiac catheterization, research, CT coronary angiography, cardiac magnetic resonance and vascular medicine and imaging. Fellows may take up two blocks of outside electives during the fellowship