Cardiology

Cardiology

This program operates under the direction of Dr. Peter Casterella and is located on the Cherry Hill Campus of Swedish Medical Center

 

Performance Objectives Cardiology

  • Understand the basic pathophysiology and principles of coronary artery disease and valvular heart disease.
  • Make appropriate judgments and clinical decisions regarding the treatment of coronary artery disease, including acute and chronic coronary syndromes, as well as valvular heart disease
  • Know the indications, risks and benefits of coronary angiography and percutaneous revascularization techniques, including angioplasty, stenting, atherectomy, embolic protection, rheolytic thrombectomy and intra-aortic balloon counterpulsation and become proficient in these procedures
  • Know the indications, risks and benefits of temporary transvenous pacing
  • Understand the indications for, independently interpret and become proficient in the use of fractional flow reserve measurements and intravascular ultrasound
  • Become familiar with the indications for and techniques of balloon valvuloplasty, and percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD).
  • Understand the principles of coronary imaging including radiation safety, limitations of fluoroscopic imaging and recording equipment
  • Evaluate and independently care for patients with acute coronary syndromes including acute myocardial infarction, chronic coronary artery disease, and valvular heart disease, with knowledge of the latest proven pharmacologic as well as mechanical interventions
  • Understand and appropriately interpret clinical trial data regarding acute and chronic coronary syndromes and valvular heart disease with proper integration into patient care
 

Peripheral

  • Understand the basic anatomy of peripheral vasculature
  • Describe imaging modalities and catheter technologies used in peripheral interventions
  • Demonstrate competence in appropriate patient selection and identification of potential complications of PVD procedures
  • Explain the decision-making process for addressing complications associated with peripheral interventions
  • Identify, assess, and recommend treatment options and management protocols for peripheral vascular disease including carotids, upper and lower extremity, renal and cerebral/brachiocephalic
  • Discuss pre- and post-procedural patient management
  • Acquire knowledge of current technology available for peripheral interventions
  • Acquire knowledge in assessing which PVD indications are best suited for specific peripheral interventions
  • Demonstrate a working knowledge of diagnostic and interventional peripheral procedures
  • Demonstrate the procedural skills required for peripheral interventions
 

Specific Educational Objectives

  • Basics of Imaging
  • Basic radiation physics 
  • Basic radiation safety
  • Understanding risks of radiation use
  • Understanding the process of radiation injury
  • Understanding and implementing techniques to minimize exposure
  • Understanding how an image intensifier works
  • Understanding of different types of contrast agents and their associated risks
  • How to optimize angiographic images
  • Basic ultrasound physics
  • Understand the indications for use of an intravascular ultrasound catheter
  • Understand the limitations of an intravascular ultrasound catheter
  • Learning to interpret intravascular ultrasound images
  • Basic Physiology of Coronary and Peripheral Arteries
  • Normal vascular endothelial and smooth muscle cell function
  • Determinants of coronary/peripheral/cerebrovascular flow
  • Collateral circulation -Recognition and function
  • Influence of various pharmacologic agents upon the vascular wall
  • Atherosclerosis - Stages of coronary atherosclerosis with understanding of associated cellular and sub cellular changes within the coronary and peripheral artery walls, Effect of atherosclerosis upon coronary, peripheral and carotid blood flow
  • Response to vessel injury by: Plaque rupture, Balloon-mediated injury, Stent-mediated injury, Radiation (brachytherapy)
  • Influence of micro- and macro-particle embolization upon coronary and peripheral blood flow
  • Basic hematology
 
Achieving Objectives
 
  • Direct attending supervision is mandated for all coronary, valvular, peripheral and carotid diagnostic and interventional cases. This allows direct supervision of the fellows with observation and evaluation of procedural techniques as well as providing reinforcement for good clinical judgment and practice
  • Daily morning patient rounds with discussion of patient cases with the Interventional Cardiology attending physician. These discussions center on the acute patient management issues and review of the cases as well as the indications and complications of any patient procedure. Basic pathophysiology and recent applicable clinical trial data are discussed with an emphasis on their relative importance to each case.
  • Weekly conference with attendings and fellows in attendance. These conferences review recent publications, recent interesting cases, and didactic review sessions. A list of meetings and their topics for the past year is attached.
  • Weekly attendance in the outpatient clinics of the faculty interventional cardiologists. This allows the trainees to evaluate the clinical results of their interventions and their complications.
  • Monthly Quality Assurance review with attendings and fellows to discuss any complications or difficult management decisions.
  • Evaluations
  • Ongoing and informal feedback is provided for all fellows by the attending physicians on all diagnostic and interventional cases
  • Quarterly performance written evaluations of the fellows are provided by the Interventional Cardiology attending physicians. These are reviewed privately with each fellow to provide ongoing performance feedback
  • Twice annual performance reviews are done with all fellows by the Program Director
 

References:

1. Ellis SG and Holmes DR. Strategic Approaches in Coronary Intervention. Williams & Wilkins, 2000. Baltimore, United States

2. Kutryk MJB and SeITUYS PW. Coronary Stenting: Current Perspectives. Blackwell Science Inc., 1999. Malden, United States.

3. Pijls NH, Bruyne BD. Coronary Pressure. KIuwer Academic Publishers. 1997. Dordrecht, United States.

4. Vogel JHK, King SB. The Practice of Interventional Cardiology. Mosby Year Book 1996. St. Louis. United States.

5. Becker RC. Fibrinolytic and Antithrombotic Therapy. Theory, Practice, and Management. 2000. Oxford University Press, Oxford, United Kingdom.

6. Bairn DS, Grossman W. Cardiac Catheterization, Angiography and Intervention. 5th Edition 1996 and 6th Edition 2000.

7. Gantz, SA. Primer of Biostatistics 4th Edition. McGraw-Hill 1997. United States.

8. Popma JJ, Leon MB, Topol EJ. Atlas of Interventional Cardiology. W.B. Saunders Company 1994. Pennsylvania. United States.

9. Ludwig, JW. Coronary Angiography. Boehringer Ingelheim. 1985 St. Antonius Ziekenhuis, Utrecht

10. SeITUYs PW, Kutryk MJB. Handbook of Coronary Stents 2nd Edition. 1998. Martin Dunitz Ltd. United Kingdom.

11. Reisman M. Guide to Rotational Atherectomy. 1997 Physicians Press. United States.

12. Leon MB, Mintz GS.lnterventional Vascular Product Guide. 1999 Martin Dunitz Ltd. United Kingdom