Educational Purpose
The second month of echocardiography/Doppler training usually occurs during the first year.
Further experience is gained in learning the technical aspects of image acquisition and also image interpretation under the tutelage of a board-certified sonographer.
Reinforcement of ultrasound physics, image optimization, anatomy, physiology, and pathology of the heart and great vessels.
Topics Covered: Sentinel Medical Knowledge and Patient Care Skills
- More physics of ultrasound
- Further skills in operation of the echo machine
- Assessment valvular function including the standard evaluation of prosthetic heart valves
- Assessment of pericardial disease, specifically pericardial constriction
Clinical Encounter Experiences
- Patients with CHF (diastolic heart failure)
- Patients with valvular stenosis and regurgitation
- Patients with simple congenital abnormalities including a bicuspid aortic valve, Ebstein’s anomaly and ASD/PFO
Teaching Methods
In addition to the didactic teaching, bedside teaching and daily teaching described in teaching methods, year 1, month 1, emphasis will be placed on acquiring technical skills for ultrasound instrument settings such as transducer frequency, use of harmonics, mechanical index, depth, gain, time-gain-compensation, dynamic range, filtering, velocity scale manipulations, and display of received signals.An introduction to exercise electrocardiography is given. Electrocardiographic interpretation during stress testing is taught.
Continued involvement in weekly echo teaching conferences involving staff, faculty and fellows (see teaching methods, year 1, month 1).
Procedure Types Performed
- perform a complete transthoracic echocardiography exam
- make accurate measurements and calculations for 2D and Doppler echocardiography
- explain the difference between pulse-wave and continuous-wave Doppler
Service Types Performed
On call echocardiography (stat echos), and emergency TTEs, on nights and weekends, when the sonographers are not available, are performed by the cardiology fellow on call. Fellows must have established partial competency in performance and interpretation of TTE, or else the back-up fellow must be called for assistance. The on-call attending is always available for assistance.
The on-call fellow provides a preliminary interpretation to the physicians caring for the sick patient. In addition they document their interpretation on an echo lab worksheet. All echoes performed should also have video documentation on video tape or by digital recording.
On-call studies will be officially read by an echo attending within 24 hours. The echo attending interpreting on-call echos will review the studies with the fellow who performed the study to give feedback on echo quality and interpretation. The echo attending on call will be available to assist in interpretation of TTE findings as requested by the on-call fellow.
Night and weekend TEEs are to be performed and interpreted by the on-call fellow and on-call echo attending., Emergent transthoracic echocardiography under supervision of attendings during daytime hours (includes to catheterization or EP labs to rule out tamponade), administration of IV (microbubble) contrast for endocardial definition such as definity or optison, exercise electrocardiography, stress echo (SE) (treadmill portion) under supervision of attending.