Cardiovascular Medicine Fellowship

In the clinical rotation, two fellows form the core of a clinical team, which further includes a rounding attending cardiologist, residents on cardiology elective, and medical students.

Daily activity involves rounding in the coronary care unit (CCU), surgical intensive care unit, and telemetry floors and responding to consultation from other services. Procedures, which are performed with the house staff, include pericardiocentesis, pulmonary artery catheterization, intra-aortic balloon counter pulsation, and temporary pacing.

As in other clinical rotations, the fellows read hospital electrocardiograms on a daily basis, receiving feedback after the tracings are read over by an attending cardiologist. Given the depth of clinical experience in this rotation, each fellow is able, by the end of the second year, to deal effectively with most consultations.

In the third year, senior fellows periodically have the opportunity to employ their ability to formulate an effective management plan by leading rounds in the CCU under the supervision of an attending cardiologist.

In the Catheterization Laboratory, each first-year fellow receives an introduction to diagnostic catheterizations as an assistant in a high-volume, state-of-the-art laboratory performing over 1,500 procedures per year. This exposure leads to increasing independence in the performance of diagnostic procedures in the second and third fellowship years, along with progressive participation in a variety of interventional procedures.

By the end of the catheterization experience, each fellow has had direct experience with balloon angioplasty, stent deployment, directional and rotational atherectomy, percutaneous closure of patent foramen ovale, myocardial biopsy balloon valvuloplasty, and peripheral vascular disease management and therapy.

Fellows are responsible for evaluating each patient and for formulating an action plan for all diagnostic and interventional procedures in consultation with the attending cardiologist.

Fellows prepare a weekly catheterization conference devoted to a relevant topic with representative clinical cases and a review of the literature.

In the second and third years, each fellow rotates through the Cardiac Electrophysiology Laboratory. The fellow rounds daily on the inpatient EP service and participates directly in the invasive and noninvasive procedures in the electrophysiology laboratory, including diagnostic electrophysiology studies, radiofrequency ablation, cardioversion, permanent pacemaker implantation, pacer-cardioverter-defibrillator implantation and follow up testing, implantable loop monitor placement, and tilt-table testing.

In addition, each fellow receives abundant exposure to the outpatient management of implantable anti-arrhythmia devices in several busy clinics.

After rotating through one of the busiest electrophysiology services in New England, most fellows who graduate our program are well-trained in implanting permanent pacemakers and can independently analyze, program, and troubleshoot ICD devices.

Fellows with a particular interest in electrophysiology have the opportunity to focus their efforts in their third year and to apply for a fourth year as an electrophysiology fellow.

One month rotations in the Echocardiography Laboratory provide fellows in their second and third years an in-depth introduction to cardiac ultrasound. Imaging modalities include transthoracic echocardiography, multi-plane transesophageal echocardiography, epicardial echocardiography, exercise stress echocardiography, and dobutamine stress echocardiography.

The laboratory operates three Philips Sonos 5500 systems, representing the leading edge in imaging technology. Intraoperative interaction with cardiothoracic surgeons provides unique decisionmaking experience in the fast-paced environment of the operating room, most notably in the management of mitral valve repair.

The rotating echocardiography fellow leads a weekly conference, presenting focused topics in echocardiography with illustrative case studies and relevant literature. The aim of this rotation is to create proficiency in the performance and interpretation of transthoracic echocardiography, and to provide a firm foundation for further experience in transesophageal echocardiography. The emphasis throughout is on hemodynamic quantization and the integration of echocardiographic data with the clinical history.

With more than 5,500 studies per year performed by this laboratory, the acquisition of echocardiographic expertise is a realistic goal.

Interventional cardiovascular training begins in the third year of the cardiovascular fellowship. This two-year track will encompass the full breadth of interventional training to include, but be exclusive to, balloon angioplasty, coronary artery stenting, and directional and rotational atherectomy, as well as structural heart disease (SHD) therapy such as PFO/ASD and valvular interventions.

Given the robust vascular medicine program at BMC Brighton, the interventional fellow will further be trained in the full breadth of vascular disease interventions such as lower extremity, extracranial carotid, and other arterial disease lesions such as renal and subclavian.

Additionally, training in venous interventions and noninvasive vascular reading will occur throughout the fellowship.

Each first-year fellow receives an initial exposure to echocardiography as a component of the noninvasive rotation. Daily responsibilities include direct participation in the performance of all exercise treadmill testing, both with and without concomitant nuclear and echo imaging. Fellows are directly involved in the performance of pharmacologic (adenosine, dipyridamole, and dobutamine) stress studies.

Afternoon hours are spent reading the day’s nuclear studies and interpreting echocardiographic studies.

Individuals desiring a license in nuclear medicine have ample opportunity over the course of three years to amass the required clinical, laboratory, and classroom hours.

The Division of Vascular Medicine at BMC Brighton has played a pioneering role in the development of various diagnostic and therapeutic approaches to patients with atherosclerotic vascular disease and is a unique and special feature of the cardiology fellowship program.

Rotation on this service provides experience with the management of peripheral vascular disease in both inpatient and outpatient settings. Aspects of this service include interpretation of noninvasive vascular studies and participation in diagnostic and therapeutic catheterization.

BMC Brighton is a regional referral center for carotid artery and renal artery angioplasty and stent implantation. In addition, the Division of Vascular Medicine has gained national and international recognition for uniting molecular biology with interventional cardiovascular medicine in the trials of vascular endothelial growth factor (VEGF) in patients with severe peripheral vascular disease and coronary artery disease.

Fellows who develop a strong interest in peripheral vascular disease have the opportunity to apply for a fourth-year fellowship position dedicated to this subspecialty.

Each fellow is assigned a continuity care clinic for one half-day, once a week, with a designated staff member in the Cardiology Division at BMC Brighton.

Fellows see new patients and follow them continuously during their follow-up appointments over the course of the 36-month fellowship.

Additionally, fellows actively participate in the Peripheral Vascular Clinic and Pacemaker/ICD Clinics.

In order to provide an intensive exposure to adults and children with congenital heart disease, each fellow spends one month in the third year of their training at Massachusetts General Hospital.