To achieve Level 1 competence in invasive cardiology, the trainee is formally assigned to the cardiac catheterization laboratory for 4 months during which he/she is expected to become:
- familiar with the indications for cardiac catheterization
- competent in managing patients before and after catheterization procedures
- familiar with the interpretation of hemodynamic tracings, ventriculograms and coronary angiograms
- conversant with the mechanics of left and right heart catheterization
The Level 1 trainee is also expected to:
- evaluate on average at least 2-3 patients referred for catheterization each day
- present those patients to the appropriate attending
- participate in the procedure(s)
- review the hemodynamic and angiographic data with the attending physician
Facility with the mechanical aspects of the procedure is not emphasized at this stage of training, although certainly the fellow is instructed in sterile techniques of obtaining vascular access, identifying various catheters and devices, catheter manipulation techniques as well as the indications for and risks of cardiac catheterization and interventional procedures.
It is also assumed that, in concert with the CCU experience, the Level 1 trainee will develop particular competence in right heart catheterization and hemodynamic data interpretation, in addition to temporary pacemaker insertion.
Because of the nature of the rotation, which involves long hours and fairly intense one-on-one interactions between the fellow and the faculty member, there is immediate and constant evaluation and feedback. A formal evaluation is generated at the end of each rotation. This evaluation takes into account the technical skills, clinical competencies, professionalism, and scholarship.
Level 1 Cognitive Knowledge Base
- Understand the indications for cardiac catheterization.
- Understand coronary anatomy, its variations, and con-genital abnormalities
- Understand coronary physiology
- Understand the complications of the procedure and their management, such as hypotension, acute myocardial ischemia, congestive heart failure, renal failure, vascular complications, contrast reactions, retroperitoneal bleeding, and cardiac tamponade
- Select the optimal treatment modality, including medical therapy, percutaneous coronary intervention, or surgical therapy, with understanding of the indications for and risks of each revascularization strategy
- Understand cardiac hemodynamics, including the measurement and interpretation of pressure, flow, resistance, and cardiac output
- Interpret hemodynamic findings in a variety of cardiac conditions, including various forms of myocardial disease, pericardial disease, valvular stenosis and regurgitation, congenital heart disease (including shunt calculations), and pulmonary vascular disease
- Understand the indications for and complications of pericardiocentesis and recognize tamponade physiology
- Understand the indications for and complications of other laboratory procedures, such as endomyocardial biopsy, intra-aortic balloon counterpulsation, and retrieval of foreign bodies
- Understand basic principles of X-ray imaging, radiation protection, and radiation safety
- Understand the anatomy of and methods to access cardiac chambers and coronary arteries via the femoral, brachial, and radial access sites
- Interpret coronary, ventricular, atrial, and aortic angiography and determine left ventricular ejection fraction
Understand the indications for and complications of contrast agents and drugs commonly used for invasive procedures, such as heparin, low-molecular-weight heparin, glycoprotein IIb/IIIa receptor antagonists, other antiplatelet drugs, thrombolytic drugs, vasopressors, vasodilators, and antiarrhythmic drugs