University of Washington
School of Medicine
Cardiology Fellowship

Clinical Training

• Cardiac catheterization and angiography
• Echocardiography and adult congenital heart disease
• Coronary care units at Harborview and University Medical Centers
• Nuclear cardiology
• Electrocardiography, electrophysiology, and pacer follow up
• Transplant cardiology and heart failure clinic
• Cardiology consult services
• Outpatient continuity clinics (half day per week) during all years of training.

ROTATION GUIDELINES

General Cardiology (UWMC)

1. Supervise the Medicine R1s for patient admissions including the initial evaluation, plans and orders from 8 AM to to 8 PM.

2. Lead work rounds with the Medicine R1s and ensure daily plans and orders for all patients on the inpatient Cardiology Service.

3. Work closely with the Attending Cardiologists in decision making and patient management.

4. Participate in daily teaching rounds with Attending, Pharmacist, and 4 Medicine R1s.

5. Evaluate patients with acute chest pain in the Emergency Department and on other inpatient services, as needed.

6. Read and study the ACC/AHA guidelines for patient management of common cardiac diagnoses, including acute myocardial infarction, unstable coronary syndromes, atrial fibrillation, congestive heart failure, etc.

Harborview Medical Center

Clinical Cardiology and Catheterization (HMC)

1. Supervise the inpatient Cardiology Service.

2. Evaluate (with the housestaff) and perform acute interventions in unstable patients (right heart catheterization, vasopressor or inotropic support, temporary pacers, unstable arrhythmias, thrombolytic therapy, urgent cardiac catheterization, emergency echocardiography or pericardiocentesis).

3. Present case-oriented didactic presentation to medical housestaff and students at one noon hour conference per month. Present patient cases at one clinical correlation conference per month (clinical/ECG/echo/nuclear/cath).

4. Attend one ½ day HMC Cardiology Clinic per week, in addition to one ½ continuity clinic session.

5. Evaluate patients for cardiac catheterization and participate in performance and interpretation of the catheterization procedure (goal 50 procedures per 8 weeks)

6. Read and study recommended textbooks and articles on ECG interpretation, echocardiography and clinical cardiology.

Cardiology Consults (UWMC)

1. Perform cardiology consults and appropriate follow-up in conjunction with the medical students and Consult Attending.

2. Teach the medical students in daily review sessions.

3. Review 20 ECGs daily with the medical students and 20 additional ECGs with the Consult Attending.

4. Assist the General Cardiology Fellow with evaluation of patients with acute chest pain and with inpatient admissions as needed.

5. Read and study the ACC/AHA guidelines for management of conditions commonly encountered on the consult service.

Nuclear Cardiology I (VAMC)

1. Observe and perform quality control under the supervision of a Nuclear Medicine Technologist (goal 10 studies).

2. Perform and interpret pharmacological stress cardiac nuclear studies under the supervision of a qualified Attending.

3. Perform acquisition, reconstruction, and analysis of tomographic thallium and radionuclide ventriculogram studies (goal 100/month).

4. Interpret ECGs, 24 hr ECGs, and pacemaker surveillance ECGs with medical students and review selected cases with the Attending Cardiologist.

5. Attend and participate in the VAMC Friday Cardiology Conference.

6. Read and study recommended textbooks and articles on non-invasive cardiology and cardiac rehabilitation.

Advanced Cardiac Imaging (UWMC)

1. Participate in performance and interpretation of nuclear cardiac studies, including exercise stress perfusion imaging, pharmacologic perfusion imaging, and radionuclide ventriculography (goal 100 studies per month) Studies will include both SPECT and PET/CT

2. Correlate results of noninvasive imaging with coronary angiography and clinical outcomes.

3. Participate in readings sessions of other thoracic and cardiac imaging modalities, including chest tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET).

4. Attend a ½ day per week Adult Congenital Heart Disease clinic.

Cardiac Catheterization I (VAMC)

1. Evaluate, write a brief H & P, and develop the initial management plan on patients admitted for cardiac catheterization. Goal 15 cases per week. (Total about 125 per 8-week rotation).

2. Perform and interpret diagnostic catheterization with the Attending Cardiologist.

3. Perform post-procedure patient evaluation and discuss results with the housestaff. Maintain communication with the physicians on the Cardiology service and the Catheterization Lab.

4. Observe coronary angioplasty procedures if time allows.

5. Correlate angiographic and clinical findings. Discuss impact of angiographic findings on patient management.

6. Evaluate patients in ½ day per week clinic at the VAMC.

7. Plan and participate in the Friday VAMC Cardiology Conference.

8. Read and study recommended textbooks and articles on cardiac catheterization and clinical cardiology.

Cardiac Catheterization II (UWMC)

1. Evaluate, write a brief H & P, and develop the initial management plan on patients scheduled for cardiac catheterization. Goal 15 cases per week. (Total about 125 per 8-week rotation).

2. Perform and interpret diagnostic catheterization with the Attending Cardiologist.

3. Perform post-procedure patient evaluation and discuss results with the housestaff. Maintain communication with the physicians on the Cardiology service and the Catheterization Lab.

4. Observe coronary angioplasty procedures if time allows.

5. Correlate angiographic and clinical findings. Discuss impact of angiographic findings on patient management.

6. Read and study recommended textbooks and articles on cardiac catheterization and clinical cardiology.

Echocardiography I and Exercise Testing (UWMC)

1. Perform echocardiograms under the supervision of a qualified sonographer. (40/month)

2. Interpret echocardiograms under the supervision of an appropriately qualified physician. (75/month)

3. Perform scheduled treadmill exercise tests and review the results with an Attending (40/month).

4. Read and study recommended books and articles on echocardiography.

5. Correlate echocardiographic findings with physical examination findings and other clinical data. Interact with referring physicians when echocardiograms are requested and when further interpretation of echocardiographic results is needed.

Echocardiography II (HMC)

1. Perform echocardiograms under the supervision of a qualified sonographer. (40/month)

2. Interpret echocardiograms under the supervision of an appropriately qualified physician.(75/month)

3. Evaluate patients for whom a transesophageal echocardiogram has been requested.

4. Interpret and review electrocardiograms (20 traces per day, 3 days per week), with rotating medical students, residents and consult service attending.

5. Attend Lipid Clinic ½ day/week.

Advanced Echocardiography III (UWMC)

1. Participate in the performance and interpretation of complex transthoracic echocardiography studies (goal 50/month)

2. Perform and interpret exercise and pharmacologic stress echocardiographic studies (goal 40/month)

3. Evaluate patients for transesophageal echocardiography, participate in patient management, performance of the procedure and interpretation. (goal 20 /month).

4. Perform contrast echocardiographic studies when needed.

5. Participate in intraoperative transesophageal studies and observe cardiac surgical procedures in patients with a range of cardiac diseases.

6. Read advanced textbooks and article on echocardiographic diagnosis.

Electrophysiology and Cardiac Arrhythmias (UWMC)

1. Attend 2 outpatient EP and pacer ½-day follow-up clinics per week.

2. Perform cardioversions (goal 10) and temporary pacer insertions (goal 20 total) under the supervision of an attending cardiologist.

3. Interpret 24 hour ECGs (goal 150 total) and event monitors with attending supervision.

4. Participate in EPS and operating room procedures for diagnosis and treatment of arrhythmias.

5. Perform consults on patients needing device implantation or with refractory arrhythmias.

6. Assist in management of inpatients on the nonresident arrhythmia service.

7. Read and study recommended textbooks and articles on electrophysiology and arrhythmias.

Heart Failure and Cardiac Transplantation (UWMC)

1. Participate in admission and day-to-day management of patients on the inpatient service in collaboration with the ARNP and R3 on the service. Work closely with the attending on patient management including leading daily work rounds.

2. Consult upon and follow CT surgical patients following VAD insertion or cardiac transplantation.

3. Perform right heart catheterization and endomyocardial biopsies ½ day per week in post-transplant patients and correlate the pathologic findings with clinical and other non-invasive data. (Goal 50 studies)

4. Perform beside right heart catheterization and interpret hemodynamics in critically ill patients with heart failure. Assist in placement and management of intra-aortic balloon pumps and other ventricular assist devices.

5. Attend the weekly multidisciplinary cardiac transplant recipient selection committee meeting; presenting patients for initial transplant consideration and providing follow-up on hospitalized patients.

6. Read and study recommended textbooks and articles on heart failure, pharmacology, and heart transplantation.

Continuity Clinic

1. All fellows are assigned a 1/2 day per week continuity clinic that extends over the 24 months of clinical training at the UWMC or HMC, with 12 months of continuity clinic at the VAMC. Each fellow is assigned a specific attending for the duration of the clinic experience.

2. In each clinic session, the fellow will see 1–3 new and 3–6 return patients.