Cardiology

• Elective and site director: Dr. Chetana Reddy

• Pediatric cardiology faculty

  • 1. • Dr. Wilson King

       • Dr. Gloria Lehman

       • Dr. Ugo Nwankwo

       • Dr. Bob Petersen

       • Dr. Renu Peterson

       • Dr. Chetana Reddy

       • Dr. Jamie Sutherell

• Adult congenital cardiology faculty

  • 1. • Dr. Lisa Alderson

• Pediatric CT surgery faculty

  • 1. • Dr. Chuck Huddleston

       • Dr. Corinne Tan

• Pediatric cardiology fellows

  • 1. • Dr. Erica Bonura

       • Dr. Brad Dayton

       • Dr. Christopher Iskander

• Division Administrator: Barb Bequette (barbara.bequette@health.slu.edu)

• +/- resident and/or fourth year student on pediatric cardiology elective (2-4w)

• +/- Third year clerkship or career exploration student (1w)

• Multidisciplinary healthcare team providers: nurses, echo and EKG techs

• Personalize your experience

  • Fourth year students. Cardiology activities and schedule are personalized based on interest and typically include a week of clinic, a week of cardiac catheterization, a week of inpatient/consult service, and a “choice” week. Please contact Dr. Reddy at least 6w prior to starting to finalize your schedule and to discuss your rotation goals, objectives, strategies, dates/times of educational conferences (variable), as well as any schedule requests. Share your schedule with the student education office. Knowing which week/s you will not in clinic really helps us with clerkship student scheduling!

  • Third year students. Clerkship and CE students typically spend all or most of cardiology block in clinic. They have the opportunity to observe cardiac catheterizations if interested. Contact Dr. Reddy if you have specific questions or schedule requests after reviewing the site overview

    • Please let us know which weeks you will be on inpatient/consult, clinic, and if you will be doing an individual study project. We determine the Clerkship (M3) schedule based off the number of learners already assigned in each clinic. Therefore, it is helpful for us to know which weeks you are doing these activities/clinic, etc. in order to best create the Clerkship schedule.

• • Review Learners on Pediatrics Spreadsheet

    • Consider touching base with any outgoing learners and/or those scheduled with you.

    • Use the "insert comment" feature. We will go through to finalize

      • Cardiology tab. Designate experiences you wish to participate in during a given half day. Often multiple options: clinics, catheterizations, intern academic half day (for M4s) are available during a given half day. Potential considerations include your own goals and interests, presence of other learners, how busy a clinic is (eg. if two clinics held during a given half day session, you might want to pick one with a greater number of patients), variety of experience, and/or continuity with a specific attending. We request no more than 2 learners per clinic/attending.

        • The expectation for all mini electives is a full work week in clinic potentially with a caveat that on half days a clinic is not held, you may be assigned to other tasks: Ranken Jordan visit, inpatient consults, procedures, individual study, etc at the discretion of the site director.

• • Day 1. Students typically meet the cardiology group at Cardiology and Cardiothoracic Surgery conference Monday 7:30 am, Cardiology Conference Room, 5th floor North Tower (same building as Danis Auditorium). If starting on a day other than Monday, come to cardiology clinic ~20 min before the first patient is scheduled to allow for site orientation

• Individual Study

  • Pediatric cardiology individual study materials

• White coat: required

• Clinics. CG Cardiology

• Inpatient/consult service (M4 elective students only; M3s have the option of red team “mini-elective")

  • EPIC Systems lists > CG Resident Treatment Teams > CG cardiology

• Cath lab. We encourage all students to check the procedures scheduled during your time on cardiology. Extent of procedure involvement is based on individual interest.

  • Login to EPIC

  • Click the Red EPIC button in the top left corner

  • Choose Reports

  • Choose OR Report

  • Choose Master Daily Schedule

  • Put Cath Lab and Hybrid Cath Lab in the room section

  • Enter start and end days of your cardiology rotation

  • You can “pin” the OR report or Master Daily Schedule for easier access (see google sheet for image of master daily schedule)

Presenting Problems

• Murmur

• Syncope

• Chest Pain

• Palpitations

Diagnoses

• Acquired Heart disease

  • Kawasaki Disease

  • Endocarditis

  • Myocarditis

  • Rheumatic Fever

• Benign Murmurs

• Congenital structural heart disease

  • ASD

  • VSD

  • Tetralogy of Fallot

• Cardiac surgery planning and recovery

• EKG Interpretation

• Heart failure

• Marfan Syndrome

• Postural Orthostatic Tachycardia Syndrome

• Prolonged QT syndrome

• Pulmonary Hypertension

• Wolff Parkinson White syndrome

*Topics recommended for early review in bold

Cardiology-CT Surgery Conference

• Mon 7:30-10AM

• Cardiology Conference Room (5th floor North Tower)

• Discussion of patients scheduled for cardiac surgery and review of the caths performed the previous week

M&M

• Last Friday of the month 7:30-8:30

• Cardiology Conference Room (5th floor North Tower)

• Surgical and Cardiac cath M&M discussion

• Fellow’s Cardiology Core Curriculum: Average two lectures per week July-September

• Cardiology Fellows Conference: Monthly

• Echo Conference: Monthly

• Cardiology Journal Club: Monthly

• Cardiac Pathology Conference: Quarterly

• Adult Congenital Heart Disease Conference: Ad hoc

• As most patients will have vitals as well as an EKG prior to being seen by an attending, the work-up process by the nurse can take up to 15-20 minutes.

• After actively observing 1-2 patient visits, you may see a patient independently. You are encouraged to review the clinical history, echocardiograms, electrocardiograms, X-rays and catheterization data for your patients and to ask questions.

• Medical documentation

  • Clerkship students are encouraged but typically not required to document in cardiology clinic.

  • Documentation is expected for elective students.

Clinic Learner Objectives

• Gather an age appropriate, accurate, problem focused medical history from a pediatric patient, family, and/or ancillary sources

  • • Identify the reason for the visit and what questions are important to ask for this specific chief complaint

    • Focus on the key aspects of a cardiovascular history and review of systems

    • Practice building rapport with children and families in a subspecialty clinic setting

• Perform an age appropriate, accurate, comprehensive or problem focused pediatric physical examination with focus on cardiac exam while taking into account patient’s developmental level, physical, and emotional comfort

• Observe at least one echocardiogram being obtained

  • Focus on echo indications as well as what the experience is like for the patients

  • Review the echocardiogram you observed with the attending/fellow

  • Observe at least one ECG being obtained

    • Focus on EKG indications, lead placement, and what the experience is like for the patients

    • Review the ECG you observed with the attending/fellow

• Seeing new consults is a great opportunity to take a history, perform a thorough physical exam, and to work on an assessment, differential, and recommendations. Elective students will often spend a week on the inpatient/consult service. Both elective students and others have an opportunity to be involved in cardiology consults outside of that time period. Let the inpatient fellow or attending know you will be interested in seeing new consults, share your contact information, and ask him or her to let you know about any consults that might come during your time on cardiology.

• Cardiology serves as the primary team for the patients on the red team. They are a consulting service for other hospitalized patients.

• Students on the cardiology inpatient/consult service should pick patients to primarily follow which includes pre-rounding, working with the team to come up with an assessment and plan, and presenting the patients during cardiology team round, +/- red team rounds. In order to minimize overlap with red team students and interns, those on the inpatient/consult service should primarily pick cardiology patients not on the red team.

• Medical Documentation

  • Document a consult (initial or follow up) for each encounter

  • Route note to the supervising physician (resident, fellow, or attending)

  • End each note with: “Discussed with Dr. X (attending)” so the team knows that they can act on plan.

  • Support your recommendations citing primary literature, review article, or a textbook.

Cardiac Catherization Lab

• Students have the opportunity to observe catheterization lab cases. Typically the cardiac cases occur on Monday through Thursday. On Fridays there are typically electrophysiology cases. Please check EPIC for schedule

• Locations

  • Hybrid cath lab: 2nd floor across from the pre-op room. Most cases

  • Electrophysiology cath lab (2nd floor near the PICU)

• You are required to wear scrubs in the cath lab. You will also need to wear lead during the procedure since fluoroscopy is used.

• For each case, look through the chart for the patient to familiarize yourself with what their diagnosis is and why they are coming to the cath lab. It is extra helpful to try and identify what their anatomy is if they have congenital heart disease. (HINT: If they have had previous cardiac catheterizations, there is usually a PedCath report in Epic that will have a diagram of their anatomy.)

• Plan to come to the cath lab around 30 minutes before the case is scheduled to start

Cardiac Echo Lab (elective students only)

Location: Dallas Heart Center, West Tower, Ground Floor.

Daily Schedule

• • PICU cardiothoracic surgery (CTS) AM rounds 6:30

    • CTS patients names in red on board

    • CTS rounds are led by attendings and fellows on the PICU, CTS, and cardiology teams. Residents and students are not expected to present information.

  • Cardiology inpatient/consult team rounds (variable time)

  • Cardiology-Cardiothoracic Surgery Conference (Monday 7:30-10AM)

  • Red Team rounds. The cardiology team joins red team in their conference room (TCU 3227) to discuss floor patients on the cardiology service. Starting time is variable as red team rounds with pulmonary medicine first. Cardiology rounds typically start later on Mondays due to conference

  • PICU cardiothoracic surgery (CTS) PM rounds (weekdays only)

    • CTS will round sometime between 4:30 and 5:30. Typically only the on-call resident/AI, fellow, and attendings will attend the afternoon rounds.

• Students on the cardiology inpatient/consult service should pick patients to primarily follow which includes pre-rounding, working with the team to come up with an assessment and plan, and presenting the patients during cardiology team round, +/- red team rounds. In order to minimize overlap with red team students and interns, those on the inpatient/consult service should primarily pick cardiology patients not on the red team.

Cardiac Catherization Lab

• Students have the opportunity to observe catheterization lab cases. Typically the cardiac cases occur on Monday through Thursday. On Fridays there are typically electrophysiology cases. Please check EPIC for schedule

• Locations

  • Hybrid cath lab: 2nd floor across from the pre-op room. Most cases

  • Electrophysiology cath lab (2nd floor near the PICU)

• You are required to wear scrubs in the cath lab. You will also need to wear lead during the procedure since fluoroscopy is used.

• For each case, look through the chart for the patient to familiarize yourself with what their diagnosis is and why they are coming to the cath lab. It is extra helpful to try and identify what their anatomy is if they have congenital heart disease. (HINT: If they have had previous cardiac catheterizations, there is usually a PedCath report in Epic that will have a diagram of their anatomy.)

• Plan to come to the cath lab around 30 minutes before the case is scheduled to start

Cardiac Echo Lab (elective students only)

Location: Dallas Heart Center, West Tower, Ground Floor.