Cardiovascular Disease Curriculum and Site Affiliations
The Cardiovascular Fellowship Program is sponsored by Creighton University School of Medicine - Phoenix. It is a comprehensive program that includes clinical rotations at St. Joseph’s Hospital and Medical Center, Valleywise Health and Phoenix Children’s Hospital. The clinical experience involves all aspects of cardiology including outpatient and inpatient care, coupled with diagnostic and therapeutic myocardial imaging (echocardiography, computerized tomography angiography, magnetic resonance imaging, and nuclear).
At St. Joseph’s Hospital and Medical Center rotations will include the Cardiac Intensive Care Unit supervised by cardiologists who specialize in heart failure and are trained in the application of mechanical support devices. Cardiac catheterization will expose the fellows to the conventional diagnostic techniques of right and left heart catheterization, selective coronary angiography, together with exposure to nonsurgical therapeutic structural techniques such as replacement of the aortic valve or insertion of the MitralClip. Exposure to electrophysiology will include one on one teaching in the outpatient clinics together with observation and active involvement in a variety of diagnostic and therapeutic procedures in the electrophysiology laboratory. These procedures range from the insertion of a simple pacemaker to that of ablation for atrial fibrillation.
The mandatory rotation through Phoenix Children’s Hospital provides a unique exposure to the management of Adult Congenital Heart Disease. The cardiovascular surgery needs are provided by two cardiovascular surgeons dedicated to Dignity Health. The fellows will be exposed and expected to participate in a variety of didactic lectures given weekly throughout the three years that will cover subjects ranging from cardiovascular anatomy to molecular cardiovascular genetics.
- Molecular Biology, Genetics and Preventive Cardiology
- Non-invasive Diagnostic Imaging
- Advanced Diagnostic Imaging
- Invasive Diagnostic and Therapeutic Procedures
- Cardiology Grand Rounds
- Heart Failure
- Inpatient Consultations and Management
- Outpatient Consultations and Follow Up
- Heart Failure Inpatient and Out Patient Clinic
- Cardiac Intensive Care Unit (CICU)
- Electrophysiology – Consultations and Procedures
- Cardiac Catheterization – Diagnostic and Therapeutic
- Nuclear Diagnostic Imaging
- Echocardiography – Diagnostic and Therapeutic
- Cardiac Computerized Tomographic Angiography (CCTA)
- Cardiac Magnetic Resonance Imaging (MRI)
- Ambulatory Longitudinal Follow Up Out Patient Clinic
- Research / Quality
Observation and Hands-On Procedures
Our program is a collaborative effort of Creighton University School of Medicine, Valleywise Health and St. Joseph's Hospital and Medical Center.
Affiliations with the following institutions round out a program that provide a balanced experience encompassing managed care, private practice, critical care, ambulatory and primary/preventive care.
St. Joseph's Hospital and Medical Center (553 beds) is a referral center for 5 other hospitals in the city of Phoenix as well as several outlying community hospitals. SJHMC, as a referral center, has extensive experience in difficult and unusual cases, as well as advanced therapies and devices required in the management of patients, such as advanced heart failure and cardiogenic shock. This is further complemented by being the referral center for advanced cardiac surgery performed by our dedicated and Dignity exclusive cardiac surgeons, Dr. Kevin Brady and Dr. Kenneth Ashton. The fellowship rotations provide the training necessary to become competent in all six of the Core Competencies outlined in COCATS 4.
The rotations will include faculty supervision of outpatient and inpatient management together with exposure to diagnostic and therapeutic procedures. Longitudinal follow-up patient care will be actively pursued in the general outpatient clinic and the specialized heart failure clinic. Patient management will include cardiovascular Mendelian disorders (e.g Cardiomyopathy and Channel Disorders) and comprehensive prevention of CAD based on risk stratification by conventional and genetic risk factors (Polygenic Risk Score) predisposing to CAD. Competency in the care of the critically ill patient such as with myocardial infarction, heart failure, or shock will be achieved during the rotations in the CICU and the Heart Failure Critical Care Unit. This will include procedures such as the Swan Ganz cardiac catheterization, Intra aortic balloon pump, the Impella, and others.
The current CICU at SJHMC consists of 6 beds located in the cardiac tower as part of a larger Cardiothoracic Critical Care Unit (CCCU) of 20 beds. The CICU meets all of the requirements of ACGME. Dr. Rajakrishnan Vijayakrishnan, the CICU Director is also the Medical Director of Mechanical Circulatory Support Devices, is certified in both cardiology and advanced heart failure. He will be responsible for the development of the curriculum and the overall supervision of the cardiovascular fellows during their rotations in the CICU. All of the nursing and technical staff are specifically trained in critical cardiac care. In addition to the usual electrocardiographic and hemodynamic monitoring, the unit is served by several Critical Care Specialists trained and dedicated to providing circulatory support devices, mechanical ventilator support devices, and ventricular assist devices, such as Impella and Extracorporeal Membrane Oxygenation (ECMO). This will assure the fellows develop the skills to insert central venous lines, pacemakers, arterial lines, and Swan-Ganz catheterization. They will also be well versed in the indications for intubation, mechanical ventilation, and ventricular assist devices.
A new CICU of 12 beds is currently being constructed in the same cardiac tower but on the 7th floor. The Director for the new CICU, Dr. Hari Dandapantula, has already accepted the position and will start in September 2022. He will assist Dr. Vijayakrishnan in the CCCU while waiting for the completion of the new CICU. Dr. Dandapantula is certified in both Cardiology and Critical Care. The rotations through the cardiac catheterization laboratories will include exposure to diagnostic cardiac catheterization, therapeutic percutaneous cardiac intervention, and various specialized and research procedures such as TAVR and MitraClip Therapy. In the electrophysiology laboratories, the fellows will be exposed to a wide range of procedures including the insertion of pacemakers and defibrillators, cardioversion, ablation, and innovative devices such as the WATCHMAN.
A new Cardiovascular Diagnostic Imaging Center (30,000 sq feet) that is both inclusive and comprehensive is under current construction on the campus adjacent to the SJHMC. Dr. Joshua Eason, the Director of Myocardial Imaging, will be located there along with teaching modules for the cardiac fellows. This will enable the fellows to be trained in comprehensive diagnostic and therapeutic myocardial imaging that includes performing and interpreting echocardiograms, nuclear rest and stress myocardial imaging techniques, computerized tomographic angiography (CTA), cardiac MRI, and Positron Emission Tomography. Initially, the fellows will work under the direct supervision of the faculty. Those seeking level III imaging will eventually interpret the images independently followed by approval by the faculty. The myocardial images obtained by the various imaging techniques (CTA, MRI, etc.) can be visualized and interpreted at any secured monitor whether it be in the outpatient clinic, the CICU, the Cath labs, or on the Wards. This will be a great teaching aid for the residents, cardiac fellows, and faculty. In addition to routine patient activity, multiple clinical trials evaluating drugs and devices will be available throughout all of the rotations. Throughout the rotations at SJHMC didactics lectures will be given from noon to 1pm. In attendance at these didactic lectures will be at least one faculty member and the presentations will be shared between faculty and fellows. These are in addition to the Cardiology Rounds and the Journal Club.
Valleywise Health consists of a new hospital with 230 beds which is the Maricopa County Hospital. It serves a population of diverse ethnicity, varying from the homeless to high income which provides exposure of the fellows to a very diverse ethnic group. It is located within 10 minutes of driving time from the main site (SJHMC). Dr. Merhdad Saririan, the Valleywise Site Director, is responsible for the overall supervision of the training of the fellows. The cardiovascular service performs diagnostic and therapeutic catheterization, diagnostic and therapeutic electrophysiology, together with routine and advanced diagnostic echocardiography. The Critical Care Unit is a combined cardiac and Critical Care Unit of 20 beds. While complex procedures such as ablation or TAVR are not performed at Valleywise Health, the training is enhanced by the exposure to a large clinical outpatient and inpatient population of the county complementing the private patient population at SJHMC. The fellowship rotations will provide exposure to all 6 of the Core Competencies recommended by COCATS-4 in the diagnosis and management of inpatient/outpatient cardiovascular diseases. The fellows will be exposed to a wide range of cardiovascular diseases including routine ischemic heart disease, cardiomyopathies both inherited and acquired, as well as less common diseases such as HIV cardiac diseases, Chagas Cardiomyopathy and Rheumatic Heart Disease. In the diagnosis and management, fellows will have available to them the clinical manifestations along with the full comprehensive range of non-invasive and invasive diagnostic procedures. All of the faculty are full-time employees of the hospital and highly qualified cardiologists. Three of the cardiologists are certified for level III echocardiography. This expertise enables fellowship rotations in routine echocardiography in the first and second years and Advanced Echo Imaging (level III) in the third year.
Phoenix Children’s Hospital of 533 beds is one of the largest pediatric hospitals in the country and is ranked number 9 by U.S News and World Report. This rotation is necessary to provide hands-on experience in the diagnosis and management of Adult Congenital Heart Disease. The training is supervised by Dr. Wayne Franklin, the PCH Site Director. The aim of this rotation is for the fellows to become competent in all 6 of the Core Competencies as it relates to managing Adult Congenital Heart Disease. The cardiologists at Phoenix Children’s Hospital, Dr. Wayne Franklin and Dr. Jordan Awerbach are both trained in Adult Congenital Heart Disease. Dr. Edward Rhee is the Director of Electrophysiology at PCH and also performs electrophysiology at Valleywise Health. Dr. Franklin’s primary appointment is at Phoenix Children’s Hospital but he is also a consultant for St. Joseph’s and Dignity Health Systems and sits on the Board of St. Joseph’s Hospital. During this rotation, they will be exposed to the diagnosis and management of inpatients and outpatients with a wide variety of Adult Congenital Heart Disease. Dr. Wayne Franklin and Dr. Jordan Awerbach will participate in the didactic lectures related to Adult Congenital Heart Disease.