Curriculum

The Interventional Cardiology training program will provide formal instruction for the fellows to acquire knowledge of the following content areas:

• the role of platelets and the clotting cascade in response to vascular injury
• pathophysiology of restenosis
• the role and limitations of established and emerging therapy for treatment of restenosis
• physiology of coronary flow and detection of flow-limiting conditions
• detailed coronary anatomy
• radiation physics, biology, and safety related to the use of x-ray imaging equipment
• the role of randomized clinical trials and registry experiences in clinical decision-making
• the clinical importance of complete versus incomplete revascularization in a wide variety of clinical and anatomic situations
• strengths and limitations, both short- and long-term, of percutaneous versus surgical and medical therapy for a wide variety of clinical and anatomic situations related to cardiovascular disease
• strengths and limitations, both short- and long-term of differing percutaneous approaches for a wide variety of anatomic situations related to cardiovascular disease
• the role of emergency coronary bypass surgery in the management of complications of percutaneous intervention
• strengths and weaknesses of mechanical versus lytic approach for patients with acute myocardial infarction
• the use of appropriate pharmacologic agents in the post-intervention management of patients
• strengths and limitations of both noninvasive and invasive coronary evaluation during the recovery phase after acute myocardial infarction
• understanding the clinical utility and limitations of the treatment of valvular and structural heart disease
• the assessment of plaque composition and response to intervention

Principal Teaching Methods

The interventional cardiology fellow will be responsible, with close attending supervision, for the daily performance of cardiac catheterization and angiography on inpatients and outpatients with cardiac disease assigned to the interventional service. This includes all relevant pre-procedure evaluation and post-procedure care/follow-up. Direct one-on-one teaching between attending and fellow takes place during pre-procedure evaluation and patient counseling, during performance of the procedure, and during post-procedure review of hemodynamic tracings, diagnostic angiographic and procedural films. Patient follow-up and disposition are also established after discussion with the referring physician. Teaching of interventional cardiology fellows occurs via the following mechanisms:

1. Bedside cardiac teaching, focusing on clinical pre-intervention assessment of the patient, review of relevant prior cardiac testing, and selecting the optimal approach to diagnostic and interventional catheterization (e.g. vascular route, setup for hemodynamic acquisition, stress/pharmacologic interventions, choice of angiographic contrast, etc.). 
2. Intra-procedure teaching of proper techniques regarding vascular access, catheter manipulations, hemodynamic recording, image setup, and performance of the procedure.
3. Post-procedure review of all data and determination of patient management after integration with the clinical presentation and pertinent procedural data.
4. Formal didactic presentations focusing on the indications, technical performance, interpretation, and possible complications of invasive and interventional cardiac catheterization procedures.