Rotations

Rotations

Consultation Service and Clinics

During their rotation on the Consultative Service, fellows are exposed to all aspects of adult cardiology involving hospitalized patients on medical and surgical services. Each fellow will answer approximately 200-250 consultation requests during the year. Teaching rounds are made each day with the Consult attending and work rounds are conducted each morning with medical residents and 4th year medical students rotating on the service. Fellows will work closely with house staff on the thoracic-cardiovascular surgical team in the care and follow-up of patients undergoing cardiovascular surgery.

Cardiology Clinic

Each fellow will spend one-half day per week in the Cardiology Clinic at which time he or she will work-up both new patients and see follow-up patients. New patients and consults are presented to an attending cardiologist.

Coronary Care Unit

The Coronary Care Unit has ten beds. Fellows on this rotation will serve as a consultant to the house staff and perform or supervise the insertion of temporary pacemaker catheters, Swan-Ganz lines and intra-aortic balloons. The CCU Fellow will round every day with the attending cardiologist, house staff and students and actively participate in both clinical care and teaching activities. Opportunities for participating in any number of clinical research protocols in the CCU setting are available.

Cardiology In-Patient Service

The cardiology In-Patient Service is a 34 bed monitored unit comprising the 4 east unit and part of the 4 Central Unit. This includes all patients referred for cardiac catheterization, for valvular and coronary heart disease and congestive heart failure, as well as arrhythmia management. The In-Patient Service is also responsible for servicing in the role of a consultant in the chest pain unit in the emergency room. The fellow on this service learns how to integrate invasive and noninvasive data for decision-making, and leads the house staff in a daily review of the literature.

Cardiac Catheterization Categories

Nearly 4,200 procedures are performed in three laboratories on a yearly basis. These include diagnostic and interventional procedures - right and left heart catheterization, left ventricular and coronary cineangiography, percutaneous transluminal coronary angioplasty, atherectomy, myocardial biopsy, and balloon valvuloplasty. In the first year, fellows are introduced to the Catheterization Laboratory during a three-month rotation in which they are closely supervised in the performance of right and left heart catheterization, recording and analysis of hemodynamic and ventriculographic data and interpretation of angiographic studies. In the second and third years, more catheterization experience, particularly in the left heart cath techniques, is available with adequate time for pursuit of individual research projects. Training in coronary angioplasty, stent placement, rotoblator operation and intravascular ultrasound will involve an entire 12 months of further commitment to the laboratory which also includes research training.

Noninvasive Diagnostic Laboratory

Approximately 9,500 noninvasive tests each year are performed in this laboratory including 4,500 echo-Doppler procedures, 3,800 exercise stress tests, 600 pharmacologic stress tests, and 2500 nuclear cardiology procedures. While on the Noninvasive Laboratory rotation, Fellows will be trained in performance and interpretation of M-mode and two-dimensional echocardiography, Doppler techniques, transesophageal echocardiography, nuclear cardiology procedures, and treadmill exercise testing. An entire year can be spent in the Noninvasive Laboratory developing expertise in one or more of the imaging techniques (e.g., transesophageal echocardiography or advanced perfusion imaging). Research opportunities are available for Fellows rotating in this laboratory.

Clinical Electrophysiology Service

The Clinical Electrophysiology Service is involved in the evaluation and treatment of patients with cardiac arrhythmias employing programmed stimulation protocols. Approximately 700 procedures are performed in the laboratory each year. The laboratory performs catheter ablation of supraventricular and ventricular tachycardia, performs drug trials using both conventional and investigational agents, and implants standard and investigation antitachycardia devices. Permanent transvenous pacemakers and implantable cardioverter defibrillators are inserted by the cardiologists in this laboratory. An Arrhythmia Clinic is conducted three half-days each week. In addition to standard clinical rotations, an opportunity to spend an entire year of advanced clinical and research training in clinical electrophysiology is also available.

Vascular Medicine Unit

Fellows will have an opportunity to participate in activities related to preventive cardiology programs. This unit is a referral center for hypertension and hyperlipidemia for a vast area of Virginia and West Virginia. Hypertension and lipid clinics are conducted several days per week. Fellows rotating on this service will learn how to use and interpret the results of special laboratory tests and procedures for patients with hypertension and hyperlipidemia. Fellows will rotate at the Cardiac Rehabilitation Center where patients undergo a monitored exercise program, under a physician's supervision.

Electrocardiography Laboratory

Approximately 32,500 electrocardiograms are processed each year in this laboratory. Fellows participate in interpretation of electrocardiographic tracings, Holter monitor recordings and signal-averaged ECG's throughout their clinical cardiology training experience.

Pediatric Cardiology

Each fellow is assigned a one-month rotation on the Pediatric Cardiology service. Fellows will work-up patients and participate in the noninvasive and invasive evaluations as well as see patients in the outpatient setting.

Rounds and Conferences

Daily:
Clinical Consult Rounds with a staff cardiologist
Coronary Care Unit Rounds with a staff cardiologist

Weekly:
Cardiac Catheterization Conference
Cardiovascular Grand Rounds
Cardiology Research Conference
Clinical Cardiology Conference

Monthly:
ECG/Electrophysiology Conference
Noninvasive Conference
Cardiac Clinical Pathology Conference
Journal Club