The overall purpose of the Cardiomyopathy, Heart Failure and Transplant rotation is to provide trainees with extensive experience in the diagnosis and management of patients with acute and chronic congestive heart failure and to provide an introductory experience to cardiac transplantation.
Each cardiology fellow will rotate on this service for 2 months during the course of their fellowship. On this rotation, the fellow will learn how to evaluate and manage patients with heart failure related disorders in both the inpatient and outpatient setting. The fellow will also be introduced to the performance of common procedures performed on heart failure and cardiac transplant patients, such as right heart catheterization and RV biopsy.
The overall duties and responsibilities on this rotation include:
The fellow is the point of contact for the Congestive Heart Failure/Transplant service at UIHC Monday through Friday from 8 am to 5 pm and on every other weekend. The CHF/TXP fellow will also be responsible for the management of all CHF/TXP patients admitted to the CCU service. On weekends, the CHF/TXP patients are seen by the cardiology fellow on service. The fellow receives and reviews all Congestive Heart Failure/Transplant inpatients in the ICU and on the inpatient service (non intensive care unit) from other services, performs the initial evaluation, reviews all pertinent laboratory data and related test results, develops an initial management strategy, presents the patient to the Congestive Heart Failure/Transplant attending, The fellow will work closely with the Internal Medicine residents or others involved in the care of CHF/TXP patients. The fellow will teach and supervise these team members and assist them in patient presentation. The fellow will conduct daily rounds on all Congestive Heart Failure/Transplant inpatients and will review each patient with the Congestive Heart Failure/Transplant attending physician during the morning rounds. The fellow will attend Congestive Heart Failure/Transplant Meetings. The fellow will assist the Congestive Heart Failure/Transplant attending during procedures performed in the Cath Lab or on the wards and will progress to higher levels of participation as the fellow’s skill level allows. Fellows will participate in cardio-pulmonary exercise testing and receive training to develop expertise in physical rehabilitation for patients with heart failure. The fellow will communicate the patient’s study information to the house staff post-procedure, write a procedure note, and do the appropriate post-procedure checks (x-ray, operative site, labs, etc).
The staff physician and fellow will care for patients as a team to facilitate patient care and teaching as it relates to the etiology, pathogenesis, clinical presentation, natural history, and the treatments of the various Congestive Heart Failure/Transplant disorders seen. The attending will review the fellow’s presentation, review and constructively critique the fellow’s plan of care, confirm the fellow’s physical exam findings, and review and supplement the fellow’s teaching of other members of the team. The attending may assign readings or other learning activities as necessary. The attending will supervise the fellow during invasive procedures based on the level of the fellow’s skills.
The objectives of this rotation are as follows:
Junior Fellows (first year fellows)
Every patient on the CHF/TXP service will be primarily managed by the fellow with close faculty supervision as part of a team of hospitalists, nurse practitioners, and the CHF subspecialty fellow. The fellows will initially assess patients admitted to the service. The faculty will review the history and physical findings with the team as well as any pertinent laboratory studies. The team will then formulate a plan with the faculty. The fellow may also be involved in procedures performed in the catheterization lab (right heart catheterization, biopsies, coronary angiography).
Senior Fellows (second year fellows and above)
In addition to the goals and objectives of junior fellows, senior fellows will be given more independence in decision making and communication with the patient and health care team.
Training occurs at University of Iowa Hospitals & Clinics and provides experience in a wide range of cardiac pathology in a diverse patient population. Both men and women of all adult ages and of various ethnic backgrounds are seen. Clinical encounters include predominantly inpatient consultation, outpatient consultation in the heart failure clinic, and peri-procedural care. Both non-invasive and invasive procedures are performed, including the interpretation of ECGs, cardiopulmonary stress testing, right heart catheterization, and RV biopsy.
The supervising physician will review the fellow’s presentation, review and constructively critique the fellow’s plan of care, confirm the fellow’s physical exam findings, review and review and supplement the fellow’s teaching of other members of the team. The attending physician may assign readings or other learning activities. The attending will supervise the fellow in the performance of procedures. The fellow will assume progressive levels of responsibility for patient care and procedure performance under the supervision of the attending.