Residents spend around 2 months a year on the cardiology services, which are comprised of General Cardiology, Congestive Heart Failure and the Cardiac Intensive Care Unit. Brigham has a strong tradition of cardiology with exceptional teachers and a vast diversity of inpatient cardiology problems including Acute Coronary Syndromes, end-stage heart failure including mechanical circulatory support and heart transplant, severe valvular disease, congenital heart disease, pulmonary vascular disease and electrophysiology. Patients are referred from around the country for specialized procedures and are cared for by our housestaff.
Structured didactics exist on both general cardiology, congestive heart failure and the cardiac intensive care unit.
The General Cardiology service is made up of three teams, each with one attending, two residents (one day, one night) and three interns (only there during the day); one of the services is also joined by a cardiology fellow each day. As with all rotations, the interns are the primary care giver for their patients and the resident and attending focus on leading the team and teaching. As cardiology has many procedures and imaging studies, the census has intentionally been kept low to allow interns the opportunity to explore the primary data with their attendings and residents. These procedures include coronary angiograms, TAVR, TMVR and advanced electrophysiology procedures.
In addition to General Cardiology, patients on these teams may also be cared for BACH (Boston Adult Congenital Heart Disease) or PVD (Pulmonary Vascular Disease) attendings, though still primarily cared for by the housestaff. These patients present opportunities to learn about and care for patients with rare congenital heart diseases and pulmonary hypertension.
The Congestive Heart Failure team is the fourth cardiology floor team and led by a heart failure attending, heart failure fellow along with two residents (one day, one night) and three interns. The Congestive Heart Failure team specializes in caring for patients with end-stage heart failure who may be candidates for advanced therapies including LVADs and transplant, along with those who have already received these therapies. The structure of the service allows for patients to remain on the floor with Pulmonary Artery Catheters while on a variety of inotropes and vasoactive drips. Caring for patients post-transplant helps familiarize housestaff with principles of transplant immunosuppression and allograft vasculopathy and rejection.
The Cardiac Intensive Care Unit is comprised of three junior residents, four interns as well as one fellow and critical care cardiologist. The junior residents rotate on q3 twenty-four-hour call, truly running the unit and all Codes in the cardiology building during those shifts. The interns rotate through on a corkscrew system, getting the chance to experience the unit throughout the day and night. The LCU is a highly educational rotation, caring for the sickest patients in the cardiology building and learning from incredible leaders in cardiology. It provides exposure to mechanical circulatory support (Peripheral VADs, Impellas, ECMO, IABPs), post-cardiac arrest care and malignant arrhythmias.
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