Cardiac Catheterization Laboratory

General Goals: The goal of the rotation is to better understand the role of invasive testing in the modern day management of cardiovascular disease. The interaction and integration of the history and physical exam, pre-procedure imaging studies, hemodynamic and invasive imaging will be critically evaluated throughout the rotation. The fellow will have the opportunity to interact with multiple specialists with expertise in various areas of invasive/interventional cardiology. The fellow will be able to perform diagnostic procedure under direct attending supervision.

Objectives: During the rotation the fellow will participate in the acquisition, interpretation and reporting of invasive imaging modalities including hemodynamic data and invasive imaging and therapeutic techniques. The fellow will understand the indication as well as the specific strengths and weaknesses of each modality. The fellow will have increasing responsibility for the care of the patient before, during and after the procedure as dictated by their level of experience. This will include case selection and planning during the procedure.

Specific topics to be covered during the three-year rotation:

• Understand the indications/contra-indications, limitations and complications for cardiac catheterization and angiography. This will include pre and post cath evaluation and assessment.
• Apply the current guideline statements for right and left heart cardiac catheterization and coronary angiography when evaluating patients.
• Apply clinical cardiovascular pathophysiology and the interpretation of hemodynamic waveforms, valve area and shunt calculations, measurement of cardiac output and vascular resistances, and the interpretation of angiographic data in patient management.
• Participate in the placement of pulmonary artery catheters at the bedside with interpretation of the data.
• Place temporary right ventricular pacing catheters using fluoroscopically guided approaches.
• Perform pericardiocentesis under direct attending supervision and understand the indications/contraindications for this procedure.

• Include patients with unstable coronary syndromes including acute myocardial infarction, complex valvular disease, coronary bypass graft angiography and the evaluation of restrictive and constrictive cardiomyopathies.
• Achieve an advanced knowledge level regarding the limitation and complications of the higher acuity patient population.
• Understand the need for and be able to perform brachial/radial artery catheterization
• Understand the appropriate use for, insertion of, and management of complications of intra-aortic balloon pumps.

• Perform complex diagnostic cases including patients with variant anatomy, congenital heart disease, and peripheral arterial disease.
• Gain an understanding of the indications, patient selection, and risks of percutaneous coronary interventions.
• Participate in the education of first and second year fellows on the rotation.