the Program

PROGRAM FACTS

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OVERVIEW

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The Aurora Health Care Cardiovascular Disease Fellowship Program

We invite you to become acquainted with our fellowship program in the subspecialties of Adult Cardiovascular Disease. We will introduce our program directors and faculty members, describe our clinical and laboratory facilities, and tell you what it's like to live and work in Milwaukee.

The best gauge of a fellowship program is how it shapes the careers of its graduates.

The Milwaukee Heart Institute is home to one of the nation's top cardiology program. It is part of Aurora Sinai Medical Center, the Milwaukee Clinical Campus for the University of Wisconsin School of Medicine and Public Health.

Clinical assignments include rotations at Aurora Sinai Medical Center, the Milwaukee Heart Institute, Aurora St. Luke's Medical Center - the state's leader in number of cardiac services - and Children's Hospital of Wisconsin, a nationally known and respected pediatric facility.

Both the Milwaukee Heart Institute and Aurora St. Luke's Medical Center have cardiac catheterization laboratories with national and international reputations for their expertise in the management of high-risk patients and performance of complicated procedures. This has included pioneering investigative techniques and devices. Aurora Sinai Medical Center also has an animal research laboratory and has participated in numerous clinical trials.

The majority of our trainees have pursued successful careers in academics, private practices and some have joined our own faculty. After viewing this site, I think you, too, will find that our fellowship program offers the educational opportunity you seek.

We believe that the combination of our faculty, excellent clinical facilities, multiple clinical arenas, and research will afford you an unparallel graduate medical education experience.

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Cardiovascular Disease Fellowship (3 year program)

Cardiology Program: 1st Year
The first year of the basic program consists of 12 months of clinical cardiology. Six fellows are selected each year.

Clinical campuses used during this year are the Milwaukee Heart Institute, Aurora Sinai Medical Center, and Aurora St. Luke's Medical Center. Any animal laboratory research is conducted in the Winter Research Building on the Aurora Sinai Medical Center campus, whereas clinical research may be conducted at any of the clinical areas.

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Critical Care Cardiology

This clinical assignment is four months each at Aurora Sinai and Aurora St. Luke's Medical Centers. Critical care experience focuses on arrhythmia management, hemodynamics, the use of pharmacologic therapy, and management of all acute cardiac disorders. Fellows are responsible for all critical care cardiology consults and management, along with temporary transvenous pacemaker placement, Swan-Ganz catheter insertions, and resuscitation. They will also serve as teaching resources for the internal medicine teaching service. Attendance is expected at daily rounds in the Coronary Critical Care Unit.

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Noninvasive Cardiology

Rami Gal, MD, ASMC Rotation Director
Steve Port, MD, ASLMC Rotation Director
Kiran Sagar, MD, ASLMC Rotation Director

This rotation involves four months in the cardiac echocardiography lab, stress lab, nuclear cardiology lab, and EKG interpretation. Instruction is provided by the assigned attendings, more senior-level fellows, and each lab's technician.

Echo Lab Techniques
Transthoracic echo
Stress echo
Transesophageal echo
CT Angio

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Noninvasive Peripheral Vascular Lab

Rami Gal, MD, ASMC Rotation Director

In this lab, fellows have the opportunity to observe performance of noninvasive peripheral ultrasound studies in the echocardiography laboratory. They learn to interpret non-invasive peripheral vascular studies under the supervision of one of the cardiovascular attendings.

Studies
Carotid duplex
Venous duplex
ABI and extremity arterial duplex

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EKG Interpretation (Electrophysiology Faculty)

Fellows on the noninvasive rotation are responsible for reading hospital electrocardiograms at the Aurora Sinai Medical Center campus each morning. All EKGs are over-read by the assigned attending faculty reader.

Studies
12-lead EKG
Rhythm Strip
Holter Monitor

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Stress Testing

Fellows assigned to the stress laboratory learn monitoring and interpreting of exercise and pharmacologic stress studies.

Studies
Treadmill
Bicycle
Pharmacologic stress

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Nuclear Cardiology

Fellows read nuclear cardiology studies daily, along with more senior-level fellows and the assigned attending for that day.

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Outpatient Clinics

Each fellow spends the equivalent of one half-day per week in a general cardiology consultation clinic during the first year at either Aurora St. Luke's Medical Center or Aurora Sinai Medical Center.

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Research

Neil Oldridge, PhD, Basic Research Director
Suhail Allaqaband, MD, Clinical Research Director of Cardiology and Interventional Cardiology Fellowship Programs

Each first-year fellow selects a faculty mentor and initiates a research project. A project should be well under way by the completion of the first year. Fellows' research efforts, activities and times are designed to run concurrent with clinical experience throughout the fellow's training.

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Cardiology Program: 2nd Year

The second year of the Cardiovascular Fellowship Program provides rotations to: 1 month rotation at Children's Hospital of Wisconsin for training in congenital heart disease diagnosis and management, 6 months in the Cardiac Catheterization Laboratory at the Aurora Sinai Medical Center and Aurora St. Luke's Medical Center campus, 3 months on the electrophysiology service and 2 months of heart failure at Aurora St. Luke's Medical Center.

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Congenital Heart Disease

Michael Earing, MD, Pediatric Cardiology Rotation Director

Faculty physicians of the Pediatric Cardiology Section of the Medical College of Wisconsin supervises fellows in this 4-week inpatient and outpatient rotation at Children's Hospital of Wisconsin. Located 6 miles west of downtown, Children's Hospital of Wisconsin houses 7 inpatient units including a 24-bed Pediatric Intensive Care Unit, 22-bed Neonatal Care Unit, 24-bed Hematology/Oncology/Transplant Unit, and Emergency Department/Trauma Center. Experience in assessment, diagnosis, management, and treatment of congenital heart disease is gained by attendance in outpatient clinics, in echocardiography and catheterization laboratories, and in the inpatient areas. Training includes a variety of patient care management and didactic conferences.

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Cardiac Catheterization and Peripheral Vascular Laboratory

Tanvir Bajwa, MD, ASMC Clinical Director and ASLMC Cardiac Catheterization Laboratory
Anjan Gupta, MD, ASLMC Clinical Director

During this 6 months rotation, fellows are responsible for pre-procedure assessment, participating in the procedure, interpretation of studies, and post-procedure patient management. During assignment in this area, fellows present selected cases at the weekly Cardiac Catheterization conference.

Techniques
Diagnostic heart catheterization
Management/intervention in acute MI
Device and pharmaceutical trials
Pericardiocentesis
Endocardial biopsy
Second assist in interventional procedures
Peripheral vascular angiography
Intra-aortic balloon pumps
Thrombolytic and IIb/IIIa therapies

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Heart Failure, Transplant

Dianne Zwicke, MD, Rotation Director

Fellows spend two months at Aurora St. Luke's Medical Center working with Dr. Zwicke and Dr. Hastings. Activities include inpatient and outpatient consultations, introduction to the catheterization laboratory, and care of post-transplantation patients.

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ASLMC Electrophysiology

M. Eyman Mortada, MD, ASLMC Rotation Director

During their 3 month assignment on the electrophysiology service, fellows develop a basic understanding of management and treatment of arrhythmias, as well as appropriate use of noninvasive and invasive electrophysiology techniques. Under the supervision of the electrophysiology faculty, fellows attend outpatient clinics, participate in and interpret studies, participate in pacemaker management, inpatient consultations and management, and interpret surveillance and ambulatory devices.

Studies
Cardioverter-defibrillator implantation and maintenance
Clinical EP consultation (inpatient and office)
Comprehensive invasive EP testing
Advanced Intracardiac mapping
Tilt-table testing
Catheter and intraoperative ablation
Transtelephonic monitoring for PM and loop recorders
Pacemaker implantation, testing and follow-up
Clinical trials for drugs and devices
Holter monitoring
Intracardiac ultrasound
Signal-averaged EKG interpretation

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Outpatient Clinic Assignment

Each fellow is assigned to a cardiology teaching physician's clinic for one half-day per week. Clinics are held at all campus sites: the Milwaukee Heart Institute on the Aurora Sinai campus, and the Professional Office Building on the Aurora St. Luke's campus.

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Research

Protocols designed in the first year are implemented throughout the course of the second year. Faculty mentoring begun in the first year continues during this phase of research development. It is expected that these projects will be presented at a national or international meeting or submitted to a referenced journal. Fellows' research efforts, activities and times are designed to run concurrent with clinical experience throughout the fellow's training.

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Cardiology Basic Program: 3rd Year

Third-year rotations are individually designed by the trainee and the program director. Typically, this 12-month period is devoted to additional time in the Cardiac Catheterization Laboratory, Electrophysiology Laboratory and the Noninvasive Laboratory, elective rotations, as well as ongoing research.

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Cardiac Catheterization and Peripheral Vascular Laboratory

Tanvir Bajwa, MD, Clinical Director

Individual fellows spend differing amounts of time in this laboratory (a minimum of two months). Third-year fellows typically spend 25% of this year in the Cardiac Catheterization Laboratory. Participation in research involving investigational devices and drug trials will be part of this rotation.

Techniques
All procedures previously listed, plus:
Percutaneous transluminal coronary angioplasty (PTCA) and stenting
Exposure to transseptal catheterization and valvuloplasty
Peripheral vascular angiography and intervention
Endomyocardial biopsy
Limb salvage
Pharmacologic management with thrombolytics and IIb/IIIa inhibitors

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Noninvasive Cardiology

Rami Gal, MD, ASMC Rotation Director
Steve Port, MD, ASLMC Rotation Directors
Kiran Sagar, MD, ASLMC Rotation Directors

A fellow who chooses additional experience in the noninvasive laboratories is allowed to select two months off elective time during the third year. The goal is to prepare the third-year fellow to function on the same level clinically as would a junior attending. If the laboratory's director determines the fellow to be adequately trained, he may grant permission for the trainee to attend a course for licensing in nuclear cardiology and participation in performing transesophageal echocardiography. Cardiac CT experience and setting takes place in an office-base practice non-invasive lab located on Aurora St. Luke's Campus.

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ASLMC Pulmonary Hypertension Rotation

Dianne Zwicke, MD, Rotation Director

Fellows spend one month at Aurora St. Luke's Medical Center working with Dr. Zwicke and Dr. Tumuluri. Activities include inpatient and outpatient consultations, introduction to the catheterization laboratory and care of post catheterization patients.

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Research

Prior to graduation, each fellow must complete one qualified research project(s). Fellows' research efforts, activities and times are designed to run concurrent with clinical experience throughout the three years of the fellow's training.

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Preventive Cardiology

V. Shrinivas Murthy, MD, PhD, Director

The primary goal of preventive cardiology curriculum is to provide the learner with the knowledge, skills and strategies for successfully initiating a maintaining preventive care using a team approach in the practice of clinical cardiology. The program provides additional educational, clinical and research opportunities for fellows interested in cardiology careers with an emphasis on prevention.

Our program utilizes the available resources to provide comprehensive teaching and self-guided learning opportunities in cardiovascular physiology, pathology, pharmacology and epidemiology related to the following diseases with emphasis on prevention.

Atherosclerosis: Ischemic heart disease, peripheral vascular diseases and vascular aneurysms. These topics and related subjects which have significant impact on atherosclerosis such as tobacco abuse, metabolic syndrome, insulin resistance, diabetes, obesity, exercise, dyslipidemias and platelet function are covered.

Hypertension: Topics include renin-angiotensin-aldosterone system, sympatheric nervous system, endothelium function and related peripheral humoral system, vascular smooth muscle function are discussed.

Heart failure: Left ventricular function and improvement of its performance with various pharmacological modalities are covered.

Patients referred to Preventive Cardiology Clinic for the management of dyslipidemia or hypertension are managed in collaboration with the referring fellow so as to enhance the learning experience.

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Cardiac Rehabilitation Didactic Sessions

Neil Oldridge, PhD

Dr. Oldridge teaches a regular research and conference series for fellows with a focus on cardiovascular disease prevention and rehabilitation.

Conferences, along with journal clubs and research conferences, provide fellows with extensive resources for their learning experience.

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Fellows required conferences

  • Analysis of Intracardiac Electrograms (every Monday, Noon - 1 p.m. Milwaukee Heart Institute, 1st Floor)
  • Cath Conference (every Tuesday, 5 p.m. - 7 p.m., Milwaukee Heart Institute, Conference Room, 1st Floor)
  • Cardiology Noon Conference (every Wednesday, Noon - 1 p.m. Aurora Sinai Medical Center, 5 North Conference Room)
  • Fellow's Journal Club Conference (Thursday, Noon - 1 p.m., Milwaukee Heart Institute, Conference Room, 1st Floor) 2 Cardiology Fellows Journal Club presentations, 1 preventive cardiology/clinical pharmacological conference and 1 research conference, rotating presentations every 4 weeks
  • Cardiovascular Disease Board Review Sessions (every Friday, Noon - 1 p.m., Aurora Sinai Medical Center, 5 North Conference Room)
  • Interventional Cardiology Cath Conference (every 3rd Friday, 6 a.m. - 7 a.m.) Aurora St. Luke's Medical Center, Cath Lab Conference Room