Cardiac Intensive Care Unit
The cardiac fellow serves as the admission and administrative physician responsible for all the ongoing operational aspects of the CICU. Daily rounds are made in the CICU with the attending cardiologist, medical students and three assigned house staff. The discussion on these rounds stresses the patient’s history, diagnostic physical findings, analysis of electrocardiographic and angiographic studies, and review of the patient’s laboratory data. Plans are developed for further diagnostic studies and decisions are made as to the therapeutic approach for each patient. Discharge planning begins soon after admission to the unit. The cardiac fellow is responsible for the insertion of Swan-Ganz monitoring catheters, arterial line placement and temporary transvenous pacer insertion.
Cardiac Consultation and Cardiac Surgery Service
The Consultation Service provides cardiovascular consultations to medical and surgical patients with diagnostic and/or therapeutic problems. The service also provides follow-up care at the request of the attending physician, and it often serves as the interface between the medical services and the invasive and non-invasive laboratories.
The Cardiothoracic Surgery Service provides the cardiology fellow with the opportunity to follow patients who are undergoing cardiovascular surgery including CABG, valve and transplantation. Patients are evaluated and managed in the Surgical Intensive Care Unit and on the Cardiac Surgical floor. The fellow is supervised by an attending cardiologist. This service offers an excellent experience in aggressive intensive care.
Cardiac Non-Invasive Laboratories
The non-invasive laboratories perform echocardiography, Doppler and color Doppler studies, transesophageal echo, treadmill exercise testing, resting and exercise radionuclide ventriculography, stress echo, and diagnostic radioisotope scans including SPECT MPI and when indicated, magnetic resonance imaging and Cardiac CT. During the echocardiography and exercise/nuclear rotations, the cardiology fellow obtains hands-on experience in performing these studies and interpreting the graphic information.
Cardiac Catheterization Laboratory
This rotation provides an extensive experience based on the career goals of the individual fellow. The hemodynamics of normal and abnormal circulatory states are stressed. Normal and abnormal coronary anatomy as well as congenital coronary indications and complications of diagnostic and therapeutic techniques are reviewed. The performance of these procedures is learned on a one-to-one basis with a faculty attending. The techniques of diagnostic cardiac catheterization including coronary and ventricular angiography, and aortography are learned. Under supervision, the fellows are responsible for the performance of the catheterizations, the interpretations of the data and the presentation of the data to members of the health care team. Advanced training in interventional cardiology is available in the 3rd and 4th years.
All fellows rotate through the clinical Electrophysiology Laboratory and Electrophysiology Clinical Service. During this time, the initial emphasis is on learning management of arrhythmias in a global sense, both non-invasive and invasive. Fellows participate in clinical electrophysiology studies, including both diagnostic and therapeutic (radio frequency ablation) procedures. In addition, the laboratory runs a busy pacemaker and defibrillator implantation service. The electrophysiology service includes active in-hospital consultation functions and an outpatient clinic. In addition to the teaching and clinical functions, the Electrophysiology Laboratory actively performs research that is both centered at Temple University and involves participation in multi-center trials.
Heart Failure and Transplantation Service
The fellow will participate in the daily clinical rounds of the Heart Failure and Transplantation Service. During the rotation, the fellow learns all aspects of transplantation, including pre-operative selection, peri-operative medical and surgical problems, immunosuppression, and long term follow-up. Observation during the transplant procedure itself is encouraged. In addition, the management of end-state congestive heart failure will be stressed, including investigational drug trials, intravenous inotropic therapy, intra-aortic counterpulsation and ventricular assist devices.
During the first year of fellowship, each fellow will be required to develop a research project. The interests of the individual fellow are given consideration in trying to develop a project that is within the capabilities of the participant and which is likely to be completed within the limits of the fellow’s time at Temple. Fellows may select from among the ongoing basic or clinical projects already underway, or may initiate their own after staff approval. The fellows are encouraged to submit their research for review and consideration for presentation at national meetings. All research projects will be carefully supervised by and reviewed with the faculty investigators. The fellows will be supported and educated in seeking intramural and extramural funding for long time projects.
Pediatric/Adult Congenital Heart Disease
One month of the three years is spent rotating with the pediatric cardiologist from Temple University Children’s Medical Center (TUCMC) learning congenital heart disease, especially as it applies to the adult patient. The diversity of pathology and volume is quite good and there are patient management conferences. The rotation affords an excellent view into the care of adult congenital heart disease.