Adult General Cardiology Fellowship

1. To provide outstanding training in all aspects of clinical cardiovascular disease.
2. To educate post-doctoral fellows in the breadth and depth of cardiovascular research, its interpretation, and its application in clinical practice.
3. To facilitate further training in advanced subspecialties of cardiovascular disease for those fellows who choose to pursue more training.
4. To ensure competency in the ACGME core requirements for training in cardiovascular disease.
5. To provide ample opportunities for clinical fellows to develop the technical skills for all aspects of general cardiovascular disease practice.

1. Imaging Conference – Weekly on Monday
2. Electrophysiology – Weekly on Tuesday
3. Cardiology Boards preparation lectures – Weekly on Wednesday
4. M&M Conference – Monthly on Thursday
5. Cardiology Grand Rounds – Weekly on Thursday
6. Heart Failure – Weekly on Friday
7. Cath Conference – Weekly on Friday

The first two years focus on the core requirements for COCATS level one and two for cardiovascular disease. We tailor the third fellowship year to the needs and long-term goals of each individual fellow. Each fellow also participates in a continuity clinic on a weekly basis at our affiliated VA Medical Center. Each fellow is expected and encouraged to participate in clinical or basic research, under the mentorship of the faculty.

The clinical program offers a broad experience in cardiology with particular emphasis in the following areas:

• Bedside cardiovascular physical diagnosis and monitoring techniques including electrocardiography, Holter monitoring, and treadmill stress testing
• Diagnostic electrophysiology, Pacemaker, ICD implantation, and ablation procedures
• Echocardiography, including M-Mode and 2-Dimensional, conventional and color flow Doppler, and Transesophegeal Echocardiography
• Nuclear cardiology including PET, MUGA, and nuclear stress perfusion testing
• Coronary care techniques including electronic pacing and use of Swan-Ganz catheters, thrombolytic therapy
• Cardiac catheterization including hemodynamic evaluation of myocardial and valvular function, endomyocardial biopsy, and coronary arteriography
• Interventional procedures – percutaneous coronary angioplasty and balloon valvuloplasty, coronary and peripheral stent insertion, and pericardiocentesis
• Pre and post-operative management of cardiovascular surgical patients, especially those undergoing heart surgery and heart transplantation
• Cardiac Rehabilitation for the post myocardial infarction and the post-operative cardiac surgical and vascular surgical patients
• Adult congenital heart disease
• Preventive cardiology
• Women's cardiac health issues
• Clinical research
• Basic research

Patients with cardiovascular problems are referred from sites throughout the Southeastern United States, with an expanding base of new referrals. Approximately 4,000 diagnostic and therapeutic heart catheterizations are performed each year. Patients may be referred to the cardiac clinics or admitted to one of two teaching hospitals utilized in the training program. The University Hospital and the Veterans Administration Hospital are both full service hospitals with well-equipped invasive and noninvasive laboratories.

Research is an integral part of the program. Many research opportunities are available.

Areas of current research in our division include:

• Global cardiovascular health
• Basic and molecular aspects of heart failure, ischemia, and aortic aneurysms
• Genetics in cardiovascular disease
• Hypertrophic Cardiomyopathy
• Atrial Fibrillation
• Novel electrophysiology devices and ablation strategies
• Right ventricular physiology and pulmonary hypertension
• Heart Failure with Preserved Ejection Fraction
• Optimal approaches to chronically occluded coronary arteries
• Preventive cardiology and lipid disorders
• Cardiac amyloidosis
• Ablation of ventricular tachyarrhythmias
• Automated intelligence

Goals and Objectives

1. Develop skills at the bedside that can be correlated with invasive and noninvasive studies.

2. Know when to order appropriate invasive and noninvasive studies.

3. Understand the management of acute events, i.e. acute coronary syndromes.

4. Know when and how to use cardiovascular drugs.

Understand decision making: when to do cardiac cath, when to consider invasive procedures, when to order stress test.

Education Content

Ancillary Educational Material

Throughout the rotation, the attending cardiologist provides the cardiology fellow with important reading material (recent publications, classic journal articles, etc.) that should supplement their educational experience on the inpatient service. Time is set aside on a daily basis to make sure that service needs do not interfere with formal education. In addition, educational time is provided to ensure that the fellow’s experience is not diluted by the attending focusing his/her educational efforts only at the level of the resident and students.

Goals and Objectives

1. Be able to interpret electrocardiograms and realize that it is a simple, useful, and non-invasive test.
2. Understand and show that the EKG may enable one to arrive at a diagnosis at times without the need for more expensive procedures, thus being cost effective.

Goals

Our goal is to teach fellows the physiology and pathophysiology of cardiac conduction and arrhythmias. At the end of this rotation, they should understand the theoretical concepts of all arrhythmias. They should be able to conceptually take care of cardiac patients with arrhythmias so they can be stabilized, order appropriate diagnostic tests, and initiate treatment. Investigational or experimental research projects are encouraged during this rotation.

Objectives

The objective of this rotation is to give the general fellow an overview regarding concepts of arrhythmias so they can order appropriate diagnostic tests and initiate effective therapies..

Program Description

The in-hospital phase of the program is carried out by the Heart Center floor nurses and the program dietitian. It includes patient education, counseling by the dietitian, and supervised activity.

The post discharge phases are held in the Gazes Research Institute (GRI), Room 117 (Phase II and Phase III) and the Citadel gymnasium in Deas Hall (Phase IV and the Adult Fitness program) fellow assigned. In the early phase (II), patients are monitored by telemetry as well as by visual monitoring and blood pressure recordings. After completing Phase II, telemetry monitoring is discontinued and Phase III begins. After a few months, the patients are graduated to Phase IV and have the options of attending the exercise sessions at the Citadel gymnasium at 6:30 a.m. or at the GRI between 4 p.m. and 6 p.m. or exercising on their own. Dietary counseling and education regarding atherosclerosis, symptoms of risk factors for coronary artery disease, benefits and techniques of exercise, safety precautions, and stress management are carried out. The patient’s medications are reviewed. Vocation rehabilitation counseling is available.

All patients referred to the program are examined by the Medical Director and usually an exercise stress test is carried out to observe the patient’s response to exercise and to obtain data on which to base the exercise prescription. Psychological evaluation of the patient is carried out by questionnaires.

The program is certified jointly by the South Carolina Medical Association and the South Carolina Chapter of the American Heart Association and re-certified every three years. The safety of patients is assured by the fact that a nurse and exercise director, who is trained in Advanced Cardiac Life Support, are at the exercise location in the Gazes Research Institute and that a designated physician is within five minutes walking distance of this site. The cardiology fellow assigned to the program is the designated physician and will be available for this purpose during the hours of program operations currently 7 a.m. to 12 p.m. and 4 p.m. to 6 p.m. on Monday, Wednesday and Friday. This will require that the physician be on campus by 7 a.m.

Goals

To familiarize the cardiology fellow with the concepts of cardiac rehabilitation, its benefits, and the structure and operation of a formal program.

Objectives

To have the cardiology fellow become knowledgeable in:

1. The evidence for benefit from a formal cardiac rehabilitation program
2. Patient assessment and risk stratification
3. The response of the cardiovascular system to exercise
4. Prescribing an exercise program and the value of different types of exercise
5. Problems related to special categories of patients, for example: cardiac transplantation patients, the elderly, or handicapped
6. Risk factors for coronary artery disease and appropriate management for those which can be modified
7. The psychological aspects of coronary events and psychological assessment of patients.
8. Safety issues
9. The structures of a formal cardiac rehabilitation program including the staff, space and equipment required, and the details of the education component
10. The finances of a program in general terms
11. The criteria for certification of cardiac rehabilitation programs in South Carolina

Goals

Objective

The objective of this rotation is to provide the cardiology fellow with an education experience that provides instruction in all aspects of ultrasound utilized in assessing cardiovascular anatomy and function. The training in echocardiography will be integrated closely with the educational experience in clinical cardiology to include physical diagnosis, cardiovascular catheterization and intervention, surgery, and pathology.

Educational Content

The adult echocardiography laboratory performs more than 12,000 echocardiographic studies, approximately 500 transesophageal studies, and approximately 1,000 stress echocardiograms per year. The fellow will receive exposure to the entire spectrum of acquired and congenital heart disease in adult patients.

Background

Our advanced heart failure team includes nine advanced heart failure and transplant cardiologists and four cardiac surgeons. We have seen tremendous growth in transplant and LVAD implant volumes over the last several years. As the only heart transplant center in South Carolina, we performed 23 transplants in FY19 and 39 transplants in FY20. We have averaged 35-40 durable LVAD implants per year over the same period. We are a Blue Cross Center of Distinction for Heart Transplantation, Optum Center of Excellence (COE) and LifeTrac 'Select' Adult Heart Transplant Center. Our MCS program is certified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and received the Vanguard Award from STS INTERMACS

Goals

The goal of the Heart Failure/Transplant Service rotation is to educate the cardiology fellow in the diagnostic and prognostic modalities available for the patient initially presenting with congestive heart failure and to allow the cardiology fellow to develop expertise in the treatment of congestive heart failure including the use of conventional medications and more aggressive modalities such as intravenous inotropes, intraaortic balloon counter pulsation and left ventricular assist devices. A further goal is to educate the fellow, in a more general way, in the care of the postoperative heart transplant patient specifically exposing the fellow to the management of postoperative hemodynamics, routine clinical follow-up and the myriad of complications that can occur in the immunosuppressed patient.

Objectives
The Medical University of South Carolina Advanced Heart Failure and Transplant Cardiology Fellowship seeks the following for its trainees:

Objectives

Obtain an understanding of the role of radionuclide diagnostic tests in evaluating the patient with cardiovascular diseases

Obtain an understanding of radionuclide imaging from the standpoint of the type of disease processes evaluated, and understanding of the technology available and how it meets the diagnostic needs of the patient in this particular circumstance, and an understanding of radionuclides from the standpoint of nuclear physics, radiation, biology, radio pharmacy and radiation safety.

Develop an understanding of the role of nuclear cardiology in the care of patients with suspected cardiovascular disease.

Obtain the necessary credentials to satisfy the Nuclear Regulatory Commission standards which are acceptable for licensure for the handling of radionuclides at the state level.

Obtain experience in exercise and pharmacological stress testing.

This is one of the core rotations essential to the education of the cardiology fellow. The responsibilities of the cardiology fellow vary somewhat, depending on the nature of the case (diagnostic cardiac catheterization vs. interventional procedure) and whether the patient is an inpatient (in which case the cardiology fellow will have primary responsibility for the precatheterization work-up and, in concert with the attending, arranging disposition for the patient).

Goals