Ascension Providence Hospital Interventional Cardiology Responsibilities

Cardiology Trainee Responsibilities

The Cardiology trainee will work with the Cardiology faculty attendings in the cardiac catheterization laboratory to evaluate patients referred for diagnostic cardiac catheterization and peripheral angiography.


The Cardiology trainee will perform a careful history, physical examination, and will review the appropriate laboratory and test data available from the hospital records for each patient.  Following this, the Cardiology trainee will develop an initial diagnostic plan.  The Cardiology trainee will present each patient to the Cardiology faculty attending of record.  The patient will then be re-examined by the Cardiology faculty attending and a final diagnostic plan decided upon and initiated.


The Cardiology trainee will also provide a careful assessment of long-term cardiac evaluation and treatment plans prior to discharge from the cardiac catheterization laboratory.  This will include the anticipation of reversible cardiovascular risk factors, the clear enunciation of appropriate cardiac medications, and the effective communication with the patient's primary care and/or specialty care physician.  This discharge plan from cardiac catheterization laboratory will be carefully reviewed and revised accordingly with the Cardiology faculty attending.


An evaluation of patients for cardiac catheterization will require the Cardiology trainee and faculty attending to primarily review important cardiovascular tests and/or treatments initiated during the course of their patient evaluation.  This will include the review of echocardiograms, exercise treadmill tests, cardiac nuclear imaging tests, ABI, segmental pressures, Duplex findings, etc.


A key ingredient to the cardiac catheterization rotation is exposure to the performance of right and left cardiac catheterization from different approaches.  The Cardiology trainee will determine the appropriate approach in consultation with the Cardiology faculty attending.  The Cardiology trainee will perform right and left heart catheterization and peripheral vascular catheterization under the supervision and guidance of the Cardiology faculty attending, including: cardiac output determinations, cineventriculography, cannulation of the left and right coronary arterial systems,aortography, lower and upper extremity angiography, selective renal, mesenteric, carotid and vertebral angiography. 


An important aspect of the cardiac catheterization rotation is the level of exposure to the interpretation of hemodynamic data, including: analysis of pressure waveforms, determination of valve areas, analysis of regurgitant volumes and fractions, shunt detection, measurement of renal flow reserve and significance of hemodynamic gradients.


Another key ingredient of this rotation is that the Cardiology trainee will have gained expertise in interpreting cineventriculograms and coronary arteriograms.  The Cardiology trainee will be expected to perform the initial analysis of this data.  Then, the Cardiology trainee will present this information to the Cardiology faculty attending.  At this time, the integration of the cardiac catheterization and peripheral vascular data with other noninvasive and invasive diagnostic studies is anticipated.


In addition, the Cardiology trainee working with the Cardiology faculty attending is expected to gain expertise in making decisions regarding the appropriateness for the utilization of cardiac catheterization and peripheral vascular data for clinical decisions regarding medical therapy and percutaneous and surgical revascularization procedures.


The resident will be trained in: temporary pacemaker insertion, pericardiocentesis, endocardial biopsies, placement of intra-aortic balloon devices, and percutaneous revascularization procedures, including: balloon angioplasty, atherectomy, endoluminal stenting, intravascular ultrasound, intra-coronary Doppler flow velocity measurements, and balloon valvuloplasty, rheolytic thrombectomy, and intravascular brachytherapy.  Proficiency in the performance of these procedures is anticipated.


The Cardiology trainee will also be expected to perform a careful history, physical examination, and review appropriate laboratory and test data available in the hospital records on patients referred for percutaneous revascularization procedures.  Following this, the Cardiology trainee will present each patient to the Cardiology faculty attending of record.  The patient will then be re-examined with the Cardiology faculty attending and a final plan initiated.


A unique feature of the advanced cardiac catheterization/interventional training program is the management of patients prior to, during, and following their percutaneous revascularization procedure.  The Cardiology trainee will be expected to follow their patient on the Cardiology in-patient unit following the procedure with the Cardiology faculty attending of record.  Initially, he/she will provide an evaluation and management note in the chart on a daily basis.  Each patient receiving concurrent care on the in-patient Cardiology service will be reviewed on a daily basis with the Cardiology faculty attending of record.  The Cardiology trainee will also provide a careful assessment of long-term treatment plans just prior to discharge.  This will include the anticipation of reversible cardiovascular risk factors, clear enunciation of appropriate cardiac and vascular medications, and effective communication between the patient's primary care and/or subspecialty care physician.  The discharge plan will carefully review and be revised accordingly with the Cardiology faculty attending.


A unique feature of the advanced cardiology catheterization/interventional training program is the expertise gained in performing percutaneous coronary and peripheral vascular interventions.  The Cardiology trainee will be expected, with the Cardiology faculty attending, to determine the appropriate percutaneous procedure to perform, be familiar with all equipment that may be available for performing a particular procedure, selecting the appropriate equipment, the performance of the procedure and, following the patient in the immediate recovery.  The Cardiology trainee will also be responsible for providing information to the patient and their family regarding the outcome of the procedure.

The Cardiology trainee in the advanced cardiac catheterization/interventional training program will also be expected to understand risk assessment in terms of percutaneous revascularization procedures.  The Cardiology trainee will be expected to develop a high level of sophistication identifying high risk coronary and peripheral vascular percutaneous procedures, identify potential complications, understand treatment options, and develop an understanding of the appropriate management of these complications either in the cardiac catheterization laboratory or elsewhere.  Part of this knowledge is understanding the potential need for cardiac and vascular surgery.


The Cardiology trainee in the advanced cardiac catheterization/interventional program will be expected to present difficult and complex cases and complications of percutaneous revascularization at the interventional conferences.  The Cardiology trainee will be expected to prepare the presentation, have reviewed the literature, have thoughtful discussion prepared of the problem, be prepared to answer all inquiries, and discuss potential alternatives.

The Cardiology trainee will participate actively in all clinical and research cardiac catheterization conferences.


The Cardiology trainee will be responsible for participation as co-investigator in large ongoing cardiac catheterization studies and be responsible in the design, data collection, and completion of smaller clinical studies under the mentorship of one or more of the Interventional Faculty.

The Cardiology trainee will also be responsible for the preparation of one or more grant-in-aid submissions to regional or national funding agencies for peer-review.


The Cardiology trainee will also develop educational and teaching skills by assuming responsibility for rounds, lectures, and clinical conferences of Internal Medicine residents and medical students.