Curriculum

Inpatient Care

• Evaluation and treatment of acute cardiac illness
• Diagnostic evaluation and management of non-acute cardiac problems
• Consultation service for assessment of concomitant cardiovascular diseases in patients admitted to other hospital services including evaluation and treatment of patients with heart disease undergoing non-cardiac surgery

The inpatient service focuses around an 18-bed acute care unit and about 100 telemetry beds. More than 3,000 patients a year are cared for in these units. Patients are also seen in the clinical decision (chest pain) unit and the emergency department. When assigned to the in-patient service, the fellow is part of a team consisting of an attending cardiologist, at least 4 internal medicine and emergency medicine residents as well as additional trainees (medical students, a pharmacist and often a social worker).

Outpatient Care
Includes diagnostic evaluation of new patients referred by non-cardiologists as well as follow up of patients after discharge from in-patient cardiology services. During clinical cardiac electrophysiology rotations, fellows also participate in the evaluation and follow up of patients with pacemakers and defibrillator devices. An adult congenital heart disease clinic is also available and can be attended by fellows interested in the subject. The outpatient clinic services more than 12,000 patients annually. An attending cardiologist supervises the fellow during out-patient clinic activities. A special heart failure clinic is present and fellows are allowed to participate in the activities of that clinic on an elective basis.

Diagnostic and therapeutic services
Fellows actively participate on all aspects of diagnostic and therapeutic services provided throughout the cardiology department. The following is a brief description of the available services.

There are three cardiac catheterization laboratories; 2,400 cardiac catheterization procedures are done annually including diagnostic catheterization and coronary intervention. When needed, intracoronary ultrasound and Doppler as well as pressure wires are used to assess physiologic significance of coronary luminal stenosis. The cardiac catheterization laboratory is available 24 hours a day for emergency procedures especially for treatment of ST-segment elevation acute myocardial infarction and insertion of intra-aortic balloon pump and other assist devices as needed. 

A dedicated Electrophysiology Laboratory and a minor procedure room are available within the cardiac catheterization area; 200 pacemakers and implantable cardioverter-defibrillators are implanted annually. The electrophysiology service also provides a wide range of services including ambulatory electrocardiographic monitoring, tilt-table studies, diagnostic and therapeutic invasive electrophysiologic studies such as catheter ablation of supraventricular and ventricular arrhythmias. Last year 950 electrophysiology studies were performed. Assistance is provided to the fellows for insertion of temporary pacemakers when needed on off hours.

Electrocardiographic Laboratory and Pacemaker clinic are also quite active. Last year 38,000 electrocardiographic studies were performed. Routine pacemaker and device evaluations are done as part of the outpatient clinic or in-patient services on a daily basis.

The Exercise Laboratory provides a range of services including treadmill exercise test usually in combination with an imaging modality such as echocardiography or nuclear myocardial perfusion study. More than 4,000 cardiac exercise stress echocardiographic and nuclear cardiology studies are done annually. Pharmacologic stress tests are done with the use of vasodilators (adenosine) or inotropic agents (dobutamine) in combination with echocardiography, nuclear imaging (99mTc-sestamibi) or cardiac magnetic resonance imaging. The program provides all fellows with the opportunity to obtain level II certification in nuclear cardiology.

The fully digital echocardiographic laboratory is equipped with state-of-the art ultrasound machines with capabilities for performance of out-patient and bedside transthoracic and transesophageal studies, stress and three-dimensional echocardiography and assessment of ventricular dyssynchrony. The annual volume of procedures in the echocardiography laboratory exceeds 11,000 studies.  

The hospital also provides high quality non-invasive vascular studies with a volume of 5,500 annually. Cardiology fellows have the opportunity to take part in the activities of the non-invasive vascular laboratory during elective rotations.  

The cardiology department is supported by many specific specialty services such as:

• Cardiac and thoracic surgery 
• Vascular surgery 
• Adult congential heart disease
• Pediatric cardiothoracic surgery

Includes diagnostic evaluation of new patients as well as the opportunity to provide ongoing care to categorical patients such as is those with pacemakers, cardio defibrillator devices, postoperative care of patients who have had valve and coronary artery bypass surgery, adult patients with congenital heart defects, as well as selected research clinic patients. The outpatient clinic service more than 12,000 patients each year.