In this rotation, the cardiology fellow currently spends 2-3 months as a dedicated CCU fellow and 2-3 months as a dedicated consultative cardiology fellow, primarily during the first year of training.
Coronary Care Unit (CCU)
The CCU is a critical educational site within the cardiology fellowship training program. In this setting, fellows learn how to manage patients with unstable coronary syndromes, complex cardiac dysrhythmias, and advanced heart failure.
Many of the assessments for the appropriateness of invasive approaches in critically ill patients take place in this setting, as well as in the emergency department and on the step-down units of the inpatient services. Various treatment strategies, including pharmacologic (such as thrombolytic therapy), mechanical (such as intra aortic balloon pump, arrhythmia termination devices, and pericardial drainage catheter) and surgical approaches are employed on a regular basis.
It is understood that the ability to monitor hemodynamics is essential for making appropriate management decisions. All CCUs are equipped with hemodynamic monitoring devices. Furthermore, to function as a training environment for cardiology fellows, the Einstein-Montefiore CCUs are designed to be clinically active, have access to contemporary treatment alternatives, and be involved in ongoing clinical research.
The consultative cardiology training program trains fellows to perform at a leadership level appropriate to an academic medical center. This entails:
- competency in all the subspecialties of a cardiology division
- understanding the indications for and limitations of all cardiac diagnostic tests
- knowledge of the interface between cardiology and cardiothoracic surgery, including postoperative management
- understanding the diverse presentations of cardiac disease
- ability to identify and manage or modify risk factors for cardiovascular disease
- familiarity with the appropriate literature in the specific areas of cardiology
The breadth of this body of information is considerable and is not covered completely during any specific rotation. A structured consultative cardiology service, however, provides the opportunity for the fellow to integrate progressively the knowledge obtained during this and the other subspecialty cardiology rotations and apply it to the diagnosis and management of patients with cardiac disease.
It is expected that as the fellows progress through training, they will become increasingly independent of the attendings in their decision making. In all instances, attending rounds provide a forum for discussion of all aspects of patient management. Furthermore, topics relevant to consultative cardiology are frequently discussed during the core conferences. Both emergency and elective cardiology consults are made at all the teaching hospitals of this institution.
Consultative services for the entire hospital are provided. The expectation is that the care of all patients by the service will be longitudinal (when appropriate), from admission, through interventions, to discharge. A substantial proportion of the consult service at this hospital involves the follow-up care of patients initially admitted to CCU. It is expected that the quality of the consultative service provided will reflect the standards of the division and thus will be both thorough and scholarly.
Following discharge from hospital, many of the covered patients are followed in the out-patient clinic by the fellow who took care of them during hospitalization. The fellows are expected to orchestrate patient referrals to subspecialists within the division and to cardiothoracic surgeons and to follow their patients through procedures. They are expected to go to the operating room and observe procedures done on their patients and to be involved intimately in the post-operative phase of care. The general assumption is that the fellows will function as consultative cardiologists in the academic environment.