CHI St. Luke's Health-Baylor St. Luke's Medical Center with Texas Heart® Institute is among the busiest centers in the world offering care for complex cardiovascular conditions. During a three-year fellowship training program in cardiovascular disease that is accredited by the ACGME, trainees will gain experience in physical diagnosis, clinical decision-making and performance of cutting edge diagnostic and therapeutic procedures that are the core requirement knowledge of the modern cardiologist. A wide exposure that includes clinical and consultative cardiology, echocardiography, nuclear imaging, magnetic resonance imaging and cardiac catheterization ensures a broad knowledge base and the experience necessary to manage common and uncommon cardiovascular diseases. In addition a busy cardiovascular surgical program ensures experience in pre-operative and post-operative care and decision analysis for surgical referral.
The first year of fellowship training is devoted to the core requirements for proficiency as a cardiovascular disease specialist. These include, the coronary care unit, echocardiography, nuclear imaging, exercise stress testing, clinical/consultation services and cardiac catheterization. During in-house call during this first year the trainee acts as a consultant during emergency resuscitation efforts and gains experience with the management of acute myocardial infarction, emergency pacing and mechanical assistance of the circulation.
The second year of fellowship is devoted to increasing clinical experience on clinical and consultation services with elective time that allows increased exposure to cardiac catheterization, cardiac imaging and research. Two months are devoted to clinical electrophysiology where the trainee assists in the evaluation and management of complex cardiac rhythm disorders, performance of electrophysiological studies and placement of cardiac pacemakers and implantable defibrillators. Elective rotations in echocardiography, nuclear medicine, magnetic resonance imaging, heart failure and congenital heart disease allow the trainee to broaden his/her experience and explore opportunities for additional training and specialization.
In the third year, elective time may be scheduled to allow more intense training in an area of interest or to allow time for clinical research. Additional electives offered during the third year include interventional cardiology and peripheral vascular disease where the trainee may begin honing the skills that are necessary for the performance of complex revascularization or vascular repair procedures.
The St. Luke's Cardiac Nuclear Imaging laboratory performs 3,876 imaging procedures each year, and 2,407 stress exams. Elective rotations provide training in the handling of radioactive materials as well as the performance and interpretation of exercise and pharmacological imaging studies.
The echocardiography laboratory performs more than 15,200 imaging procedures each year. Here, the trainee gains skills necessary for the performance and interpretation of transthoracic echocardiograms. During elective rotations, trainees may become proficient in the performance and interpretation to transesophageal echocardiograms, intra-operative TEE, exercise and contrast studies.
Magnetic resonance imaging is rapidly becoming the preferred method for diagnosis for many complex cardiovascular diseases and offers promise for the performance of non-invasive coronary angiography, myocardial viability imaging, and stress-perfusion studies. During elective rotations in a department that is actively involved in research in cardiovascular MRI, the trainee will be introduced to the basic concepts of magnetic resonance imaging and interpretation of cardiac and vascular studies. The Cardiovascular MRI Lab performs more than 2900 (CT and MR) imaging procedures per year that cover the breadth of cardiovascular MRI, thus providing a unique opportunity for both research and clinical exposure.
CHI St. Luke's Medical Center has a busy cardiac transplantation service and performed 36 transplant procedures in 2009. The transplant service is actively involved in the research with mechanical assistance devices and the total artificial heart. As a result, an elective rotation in Heart Failure offers exposure to the management of end-stage heart failure, evaluation for cardiac transplantation, pharmacological and mechanical assistance of the circulation and the management of complications occurring both early and late after transplantation.
The rapidly changing environment of medicine has shifted initial clinical and diagnostic evaluation of all but immediately life-threatening conditions to the outpatient setting. Therefore, in addition to in-patient experience, the program offers each trainee a weekly continuity clinic under the direct supervision of an attending faculty physician. In this setting, the diagnostic evaluation the frequently occurs before hospitalization may be experienced as it occurs and the natural history of various disease states may be better understood.
Educational conferences are held each day at noon. Each trainee is an active participant in the development and presentation of topics relating to echocardiography, nuclear imaging, electrocardiography, electrophysiology, clinical case review and cardiac catheterization. Additional conferences held weekly address interventional cardiology and cardiac pathology. Each Friday, a morning basic science conference and noon Cardiology Grand Rounds are hosted during which an accomplished research scientist or clinician who is typically invited from another institution presents groundbreaking research or reviews of relevant topics.
During three years of fellowship, trainees accumulate outstanding clinical experience and have the opportunity to design an educational program that is tailored to their individual needs or desires. An additional year of training designed to provide proficiency and allow certification in the subspecialties of interventional cardiology, echocardiography, nuclear imaging, electrophysiology, cardiovascular MRI, and clinical research is available.
CHI St. Luke's Medical Cener is a 864 bed facility with the largest contiguous catheterization laboratory in the world. Eleven catheterization laboratories offer exposure to diagnostic heart catheterization, coronary angiography, peripheral angiography, coronary and peripheral revascularization, balloon valvotomy and electrophysiological testing and intervention. With 60 teaching staff cardiologists, a clinical volume of 29,385 in-patients are seen each year. A 30 bed CCU and 9 bed chest pain clinic handle approximately 3,065 patients each year. In 2009, there were 71,357 ECG's, 13,365 echocardiograms, 279 stress echocardiograms, 780 treadmill tests, 1,628 TEE's, 9,000 peripheral vascular studies. A total of 8,564 adult heart catheterizations were performed, including 1,563 percutaneous coronary interventional (PCI) procedures, 977 Electrophysiologic studies, 654 implantable defibrillators. In addition, 603 pacemakers, 182 myocardial biopsies performed, and 671 peripheral vascular procedures (108 Aneurysm exclusion procedures).
The new Denton A. Cooley building is a state of the art facility with patient care facilities devoted to the care of patients after surgical and percutaneous revascularization. Two vascular biology laboratories located in the Cooley building are devoted to analysis of growth factors and genetic studies actively seeking the trigger for acute coronary syndromes and methods of encouraging growth of coronary collateral vessels, preventing restenosis after angioplasty and regenerating damaged myocardium.
Cardiology fellowship trainees are expected to actively participate in research projects that are ongoing during their time here. During the first year, a faculty mentor is identified with whom the trainee may work and gain experience in the performance, design or financing of research projects. There are a wide variety of research opportunities addressing clinical practice, epidemiology and basic science topics. Areas of active investigation include new coronary stents, distal protection devices, carotid stenting, stent graft of abdominal aortic aneurysm, gene and growth factor therapy and the use of new anticoagulant drugs during coronary revascularization. Additional work is underway in congestive heart failure, magnetic resonance imaging, new diagnostic tests for the identification of unstable coronary artery disease, and outcomes after coronary revascularization. Ongoing basic science research includes the study and production of various growth factors and the TexGen project a blood banking study of genetic markers for cardiovascular disease under the guidance of Dr. James T. Willerson.
Research activities are periodically reviewed with Drs. Emerson Perin and James Willerson. Fellows are encouraged to develop and implement research projects in their area of interest. Understanding statistical methods, project design and the importance of critical and creative thinking in the performance of research is emphasized.