Division of Cardiovascular Medicine

INTRODUCTION

The Cardiovascular Division of the University of Louisville School of Medicine offers a research-oriented clinical fellowship program with five positions available each year.  The program has been in existence since 1962 and a total of 170 individuals have completed training since its inception.  The program extends over 36 months and meets or exceeds criteria established by the American Board of Internal   Medicine allowing those fellows successfully completing the program to be eligible to sit for the certifying examination in cardiovascular diseases.  Research time varies depending upon the fellows interest and  career goals. Fellows must have successfully completed Internal Medicine training, be board eligible for the certifying exam of the American Board of Internal Medicine and must be eligible to obtain a Kentucky State License. Candidate selection criteria includes academic achievements including USMLE scores, letters of recommendation and research interests and productivity.  The program has a particular interest in fellows wishing to pursue a career in academic medicine either in the area of basic research or clinical research.

Research can either be in clinical areas or in basic disciplines (cardiac physiology or molecular biology).  A state-of-the-art basic research laboratory with numerous faculty devoted to basic research is available for training in a wide variety of areas involving studies at the molecular, cellular, and whole-animal levels.  Training is bolstered by a number of conferences which encompass a core curriculum covered yearly as well as city wide cardiology Grand Rounds, a research conference Journal Club and combined cardiology and cardiac surgery.

CURRICULUM

The minimum and maximum months for each fellow is listed below:

The following rotations are included:

1. Research (clinical or basic) - 6-12 months

2. Coronary Care Unit/Intensive Care Unit -3-4 months

3. consultation - 5 months

4. Stress test, Holter, EKG interpretation - 2 months

5. Noninvasive (nuclear, echo) - 6-8 months

6. Cardiac catheterization - 5-8 months

7. Heart Failure/Transplantation - 1 month

8. Electrophysiology - 2 months

9. Advanced Cardiac Imaging: Coronary CT Angiography and Cardiac MRI - 1-2 months

During these 36 months the fellow will have a continuous ambulatory care rotation consisting of one-half day per week.

Teaching Conferences required attendance:

1. Non-invasive - Monday 7:45 - 8:45 am
2. Invasive - Tuesday 4:30 - 5:30 pm
3. Cardiology Grand Rounds - Wednesday 8:00 - 9:00 am

4. Journal Club/Clinical Cases/Research/Congenital Heart Disease - Thursday 4:30- 5:30 PM

5. Internal Medicine Grand Rounds - Thursday 8:00 - 9:00 am

Fellows are directly supervised in all patient care and procedural activities and the principles of progressive responsibility are followed and outlined in the written Policy and Procedures provided at orientation yearly.

Fellows are evaluated by faculty for each monthly rotation and meet with the Program Director twice a year and with the Chief of Cardiology twice a year, both for evaluation as well as an opportunity to provide feedback.

GENERAL DESCRIPTION OF THE INVASIVE AND INTERVENTIONAL CARDIOLOGY PROGRAM

The division of Cardiology at the University of Louisville offers a comprehensive, intense clinical and academic training program for fourth-year interventional Fellows.  Two positions are available.

Training will take place at the three core hospitals:  the University Hospital, the VA Medical Center, and the Jewish Hospital.  A large patient population with diverse cardiovascular problems will provide extensive experience in a wide variety of cardiac disorders.  There is a full-time interventional faculty member (Dr. Massoud Leesar ) who will serve as Attending at these hospitals.  The experience acquired with the private patients at the Jewish Hospital will nicely complement that acquired with the patient population at the University Hospital.

Clinical experience will include training in techniques of complex balloon angioplasty, directional, rotational, and TEC atherectomy, intracoronary stenting, intravascular ultrasound, intravascular Doppler velocity determinations.  Exposure is also provided to peripheral vascular interventions including balloon angioplasty/stent deployment of subclavian, renal, and aortoiliac-femoral vessels.  Balloon angioplasty and thrombolysis of the iliac, superficial femoral, and infra-popliteal vessels are also performed.  Fellows will also gain experience with percutaneous revascularization of arterial-venous fistulas and shunts employed in chronic hemodialysis patients.

The Fellow will assist in a traditional fashion in performing interventional techniques with attending physician supervision.  He/she will gain a significant first operator experience.  Responsibility and independence will increase through the year, so that at completion, the interventional Fellow will be fully capable of managing the clinical, academic, and administrative responsibility of an interventional program.

Approximately 300 interventional procedures and 250 to 300 diagnostic catheterization procedures are performed by each interventional Fellow each year.  The Division of Cardiology functions as a tertiary referral center for individuals with acute myocardial infarction and approximately 5 to 10% of the interventional volume consists of the treatment of patients with acute myocardial infarction.

Interventional Fellows will have the opportunity of participating in a number of clinical research projects at the University of Louisville.  A major clinical research program focuses on the investigation of the phenomenon of ischemic preconditioning during balloon angioplasty.  A number of studies are in progress which are designed to elucidate the mechanism whereby brief episodes of ischemia increase the tolerance of the myocardium to the injury associated with subsequent ischemic episodes.  Interventional Fellows will be required to play an active role in these studies.  In addition, the Division of Cardiology is involved in numerous multicentered clinical trials.  Our program participates in percutaneous myocardial revascularization (PMR) and intracoronary radiation therapy.  A number of other clinical studies including Accolysis, Reversal Trial and A-Z Trial, are in progress which involve the participation of the great majority of patients undergoing an interventional procedure in one of our clinical trials.

In addition to the clinical research program of the Division of Cardiology, the Institute of Molecular Cardiology offers a vigorous basic research programs that are focused on the molecular biology of myocardial ischemia (particularly with regard to the mechanism of ischemic preconditioning and myocardial reperfusion injury) and on the use of gene therapy to deliver genes to blood vessels and the myocardium.  In the the Institute of Molecular Cardiology, a multi-disciplinary team of fifteen Ph.D.’s (including physiologists, pharmacologists, and molecular biologists) and several research Fellows are working in a state-of-the-art experimental laboratory  (5,000 square feet).  Virtually every experimental preparation is available, including isolated myocytes, isolated hearts, open-chest rabbits, pigs, and dogs and conscious rabbits, pigs, and dogs.  Efforts are underway to develop adenoviral vectors for transfer of genes in intact animals.  In addition, a well-equipped catheterization laboratory with a state-of-the-art fluoroscope is available for experimental animals, which allows studies of restenosis or other investigations requiring fluoroscopy and cineangiography.  The University of Louisville provides support services for these endeavors, including laboratory technicians and statisticians to help with data acquisition and analysis.  Interventional Fellows are encouraged to take an active role in projects pertaining to gene therapy and molecular biology, as well as in those focusing on myocardial ischemia.

At the completion of their training, the interventional cardiovascular Fellow at the University of Louisville will be well prepared to begin an academic or clinical career.

UNIVERSITY OF LOUISVILLE HEALTH SCIENCES CENTER--ELECTROPHYSIOLOGY FELLOWSHIP

The Electrophysiology fellowship program at the University of Louisville Health Science Center is a one-year program, which will provide the fellow with a broad range of clinical experience.  Instruction will occur at three local institutions: University of Louisville Hospital, the Veteran’s Administration Hospital and Jewish Hospital.  Each facility has a well-equipped and well-staffed lab.  State of the art recording systems are utilized, as is a computerized mapping system for complex mapping and ablation.  These hospitals provide care to the local population from which a vast experience will be gained.

The fellow will provide in-patient care as well as consultative services under direct attending supervision.  The weekly EP Clinic offers further training in the outpatient management of arrhythmias as well as device follow-up. 

Noninvasive studies such as transtelephonic monitoring, 24-hour holters, event recorders and tilt table testing are routinely performed and evaluated.  However, the majority of the fellows time will be spent in the EP laboratory where he will work closely with the attending but assume primary operator experience for diagnostic electrophysiology procedures, ablation and implantation of pacemakers, standard implantable cardioverter defibrillators and biventricular devices.

Electrophysiology Fellows have the opportunity to participate in ongoing clinical research trials.  There is a strong interest in device therapy as well as ablation.  Original research projects are encouraged.

Education is enhanced through participation in weekly conferences including Cardiology Grand Rounds, EP conference and Journal Club.

Upon the completion of their training, the Electrophysiology Fellow will be well prepared to begin the independent practice of Electrophysiology.