Our cardiology training program provides fellows with a comprehensive clinical experience along with powerful research opportunities. Academic endeavors such as leadership roles in various societies, organizations or journals are also emphasized. Clinical rotations are scheduled to ensure fellows meet ACGME standards for general cardiology fellowship as well as COCATS requirements for board certification in Echocardiography and Nuclear Medicine. The majority of the third year is elective, allowing fellows to round out their clinical experience according to personal goals: fellows may choose to concentrate on research developed in the first two years of training, seek additional expertise in sub-specialty areas of cardiology, or do a hybrid of clinical and investigative work. The following are a sampling of some of our core rotations.
Echocardiography
Directors:
Edgar Argulian, MD Mount Sinai Morningside
Marin Nicu, MD BronxCare Hospital
Collectively the echocardiography laboratories at Mount Sinai Morningside and the BronxCare hospital provide a high volume of cases for our fellows who learn the art of performing and interpreting transthoracic echocardiography, stress echocardiography, transesophageal echocardiography (TEE), contrast echocardiography, 3-D echocardiography and strain imaging. Fellows are encouraged to pre-read studies, commit to an interpretation, and then review and learn with the attending. While the rotations at BronxCare allow for personalized experiences in developing the skills needed for TEE, the rotations at MSM provide fellows additional opportunities to work with other imaging fellows and review intraoperative TEEs and structural imaging cases, such as TAVR, MitraClip, TMVR, PFO closure, Watchman devices and Tricuspid Clips. Our fellows are also afforded additional imaging opportunities when rotating in the Valvular Heart Disease rotation at Mount Sinai Hospital. Fellows rotate for approximately 4 months in total at both hospitals during their three years of training, and if desired, fellows can complete additional training at either of the two sites in their third year of fellowship to achieve COCAT IV level 2 training in echocardiography. The majority of our graduating fellows are board certified in echocardiography.
Nuclear Cardiology
Director: Amandeep Singh, MD BronxCare Hospital
Alan Rozanski, MD - Mount Sinai Morningside Hospital
With a wide spectrum of patient pathologies and highly experienced faculty providing a unique opportunity for individualized one on one reading sessions, fellows embrace the nuclear cardiology experience. Our nuclear procedures include stress-rest single photon emission computed tomography (SPECT) and pyrophosphate imaging to assess patients for cardiac amyloid. During the nuclear cardiology rotation, cardiology fellows perform daily stress testing (exercise, regadenoson, and dobutamine stress) followed by afternoon reading sessions. Training in nuclear cardiology is essential for the general fellow and can be tailored to suit individual needs. Interested fellows can enhance their exposure in nuclear cardiology further during their rotations in MSM Nuclear Cardiology laboratory where they can gain experience in the emerging area of PET scan technology and work closely with Dr Alan Rozanski, who is internationally-recognized and is also our Fellowship Program Director. Fellows rotate for a minimum of 2 months at BronxCare Hospital during their first two years of training. If desired fellows can complete additional training at either site to achieve COCAT IV level 2 training in nuclear cardiology. The majority of our graduating fellows are board certified in nuclear cardiology.
Cardiac CT
Director: Swanathan Gurudevanl, MD - Mount Sinai Morningside Hospital
The cardiac computed tomography (CCT) and coronary computed tomography angiography (CCTA) program sees a high volume of cases, with close to 2,000 studies reviewed a year. Mount Sinai Morningside currently uses a 256-slice CT scanner to perform inpatient and outpatient cardiac studies to evaluate coronary artery disease, vascular anatomy, and planning for transcatheter aortic valve replacement (TAVR). During their CCT training, fellows are expected to learn to interpret calcium scans and evaluate coronary anatomy. Fellows will learn to perform a calcium score, recognize calcified and non-calcified plaques, and assess the degree of coronary stenosis on CCTA. Fractional flow reserve calculated from resting coronary CTA is a recently added feature. CCT didactic talks are included in our core curriculum and journal club is held regularly while on the CCT rotation. Fellows do a minimum of one 2-week block. Interested fellows can enhance their educational experience in their third year to allow them to gain COCATS IV level 2 training in Cardiac CT.
Cardiac MRI:
Director: Vikram Agarwal, MD, Mount Sinai Morningside Hospital (Advanced Cardiac Imaging Fellowship Program Director)
In our newly established cardiac magnetic resonance imaging (MRI) program fellows now gain on-site exposure to cardiac MRI. Fellows learn utilization and interpretation of this imaging modality, focusing on pathologies of ventricular structure and function, valve disease, myocardial scar, and myocardial ischemia. Fellows see the full spectrum of evaluation for non-ischemic cardiomyopathies, pericardial diseases, and cardiac masses. This has been an invaluable addition to our Cardiology Fellowship program, leaving behind the tutorials needed to enrich this aspect in years past, and now rounding out our Fellows’ general cardiology clinical understanding with robust cardiac imaging. Fellows do a minimum of one 2-week block. Interested fellows can enhance their educational experience in their third year to allow for a more indepth exposure to MRI. Some of our fellows have gone on to take the CMRI boards achieving board certification immediately after graduation.
Valvular Heart Disease
Directors:
Annapoorna Kini, MD The Mount Sinai Hospital
Stamatios Lerakis, MD The Mount Sinai Hospital
Our valvular heart disease rotation at Mount Sinai Hospital affords fellows the unique opportunity to be part of this rapidly emerging field of cardiology. Fellows will work in the clinic with world renowned interventional cardiologists Drs Samin Sharma and Annapoorna Kini assessing patients with valvular stenosis or insufficiency. Fellows will become familiar with the indications for, and strengths and limitations of the percutaneous treatment of valvular heart disease and learn the optimal diagnostic tools needed for pre-procedure planning. The remaining time will be spent in the cath lab where fellows will learn the skills needed to provide echocardiographic image guidance during percutaneous valve procedures using transthoracic, trans-esophageal or intra-cardiac echo. The time spent in the cath lab also afford our fellows the ability to directly observe percutaneous valve procedures performed by our expert faculty. Fellows will do one 2-week block in this rotation typically in their third year.
Congenital Heart Disease
Directors:
Barry Love, MD The Mount Sinai Hospital
Dr. Ali Zaidi The Mount Sinai Hospital
The congenital heart disease rotation is an excellent way for fellows to directly participate in the care of patients with adult congenital heart disease. Fellows work with Dr. Ali Zaidi, an exceptional physician and leader in the field of adult congenital heart disease and uniquely boarded in Pediatric Cardiology, Adult Cardiovascular Disease, Echocardiography, and Adult Congenital Heart Disease. Dr. Barry Love, an interventional pediatric cardiologist, is also actively involved in the Fellows’ didactics and laboratory exposure. Fellows will have the opportunity to see both inpatients and outpatients, interpret pediatric echocardiograms, and partake in interventional cases for simple and complex congenital heart disease. There are regular teaching didactics included in the rotation, and one-on-one learning time with leaders in the field of adult congenital heart disease. Our cardiology fellows do a one month rotation on the adult congenital heart disease service at The Mount Sinai Hospital.
Interventional Cardiology
Directors:
Nitin Barman, MD Mount Sinai Morningside
Nassim Krim, MD BronxCare Hospital
The rotations in the cardiac catheterization laboratories are often a favorite among our fellows. The majority of rotations in the cardiac catheterization lab take place at the BronxCare Hospital which proudly hosts a STEMI-capable cath lab, which has received the AHA’s Get With The Guidelines Program (GWTG) Mission Lifeline - Gold Achievement Award for STEMI-receiving Centers and Gold Achievement Award for NSTEMIs for over 5 years in a row as well as the ACC-NCDR Platinum Performance Achievement Award for the Chest Pain-MI Registry. Here, fellows develop the skills needed to perform diagnostic cathetereization and percutaneous coronary intervention through one on one teaching with the catheterization lab director. Additionally, when on this rotation, fellows assist in placement of cardiac devices with the director of EP. Since there are no Interventional Cardiology fellows or Electrophysiology fellows at BronxCare Hospital, our fellows are first assistants in all interventional and electrophysiology procedures. Our fellows also rotate at the Mount Sinai Morningside Catheterization lab. The experience at Mount Sinai Morningside catheterization laboratory exposes fellows to training in a variety of complex coronary, peripheral, and structural cases. When rotating at Mount Sinai Morningside, fellows build on the skills they have acquired at BronxCare with focus also placed on a review of coronary anatomy, intravascular imaging, and hemodynamic tracings, as well as techniques for safe and effective arterial access. Teaching extends beyond the cardiac catheterization laboratory into the evening when, if time permits, faculty conduct informal reviews of interesting cases that may include a review of coronary anatomy, a discussion of the appropriateness of each case, an evidence based approach to care, or a review of complications encountered. Our fellows collectively spend approximately 4 months in the cardiac catheterization laboratories. Fellows interested in deeper exposure, have the opportunity to spend additional elective time in the catheterization labs at either site in their second and third year of training and if desired, can achieve COCATS IV level II training in diagnostic Cardiac Catheterization
Cardiac Intensive Care
Directors:
Matthew Tomey, MD Mount Sinai Morningside Hospital
Our fellows rotate in the Cardiac Intensive Care Units (CICU) at both Mount Sinai Morningside and BronxCare Hospitals. The CICU at Mount Sinai Morningside is a large, clinically active unit comprised of 16 beds and is adjacent to the Cardiothoracic Intensive Care Unit (CTICU). At Mount Sinai Morningside advanced Electrophysiology, Heart Failure, and Interventional cases are managed by our CICU team. The CICU at BronxCare Hospital is a smaller unit comprised of 11 beds shared with the Surgical Intensive Care Unit. During the CICU rotation at BronxCare our fellows also provide coverage for the general cardiology consult service and work closely with residents and medical students supervising care and assessments of cases screened into the unit. The collective rotations in the CICU at both sites expose our fellows to a wide range of pathology including acute coronary syndromes, complex structural heart disease, cardiogenic shock, acute decompensated heart failure, arrhythmias, valvular heart disease, and pericardial diseases. During their time in the unit, fellows perform and become adept at a variety of emergency bedside procedures including transthoracic and transesophageal echocardiograms, Swan-Ganz catheter placement, transcutaneous and transvenous pacemaker placement and emergency cardioversion or defibrillation. As our fellows advance in training, they embrace the expectation for greater responsibility in instruction of residents, students, and nursing staff. In total fellows do an average of 3 months of CICU rotations.
Cardiac Electrophysiology
Directors:
Davendra Mehta, MD Mount Sinai Morningside Hospital
Eduard Sklyar, MD Bronx Care Hospital
The Electrophysiology program at Mount Sinai Morningside has long held national and international distinction for its clinical excellence, academic achievement, and its ability to offer a full spectrum of services to patients with known or suspected arrhythmias. The learning experience in electrophysiology includes the ambulatory settings, inpatient consultation, device management, and invasive diagnostic and therapeutic procedures in our laboratories. Fellows are exposed to the basic principles of anatomy and physiology surrounding arrhythmias including the various diagnosis and treatment options. They learn the art of ECG interpretation, and the optimal approach to the assessment of devices including pacemaker and defibrillators, and CRT devices. Additional work might include the work-up of unexplained syncope, risk stratification of patients at risk for sudden cardiac death, electrical cardioversion, and consultation regarding optimization of antiarrhythmics. Additional clinical and laboratory exposure is afforded our fellows when rotating in the BronxCare (which has been awarded the AHA’s Get With The Guidelines AFib Gold Award) both on the consult service and in the catheterization laboratory where fellows are first assistant for all device implantations. The electrophysiology training is provided over a 4-month period usually during the first two years of cardiology fellowship. Fellows interested in deeper exposure, have the opportunity to spend additional elective time in Electrophysiology in the third year of training.
Heart Failure
Directors:
Sean Pinney, MD The Mount Sinai Hospital
Kiran Mahmood, MD Mount Sinai Morningside Hospital
Renowned heart failure faculty are shared across the Mount Sinai Health System and many of our faculty are actively involved in ongoing heart failure research trials. As such the heart failure rotations at Mount Sinai Morningside and Mount Sinai Hospital provide a rich educational experience. While on the heart failure rotation at Mount Sinai Morningside Hospital fellows participate in the outpatient heart failure clinic experience, perform heart failure consultations and round on hospitalized patients. The fellows learn the pathophysiology of heart failure, understand the roles of diagnostic testing in the decision making processes for heart failure and learn how to manage outpatient heart failure including diuretic titration and timing of advanced therapies. Our fellows learn to integrate the results of clinical trials with the clinical care for each patient to develop newer approaches for treating heart failure as well as to understand the interplay between heart failure and various disciplines of cardiology such as arrhythmias, cardiacTimothy Vittorio implantable devices, revascularization, and valvular interventions, imaging, and rehabilitation. Additionally, when rotating on the heart transplant/LVAD service at Mount Sinai Hospital fellows will become familiar with post-transplant or post LVAD patient care including prescribing and monitoring immunosuppressive therapy, infection, transplant arteriopathy and rejection, and bleeding complications Our fellows serve a minimum of one 2-week block on the heart failure service at Mount Sinai Morningside as well as a one month rotation on the heart transplant/left ventricular assist device (LVAD) services at The Mount Sinai Hospital. For interested fellows additional elective time may be spent at either of the two hospitals. Mount Sinai Morningside and BronxCare Hospitals both have been awarded the AHA’s Get With The Guidelines (GWTG) Gold PLUS Award: Type 2 Diabetes Honor Roll.
Consultation Service
Fellows rotate on the consult service in both Mount Sinai Morningside and BronxCare. While rotating on the consult service at BronxCare, fellows also cover the CICU service. Collectively, the cardiology consult services at both hospitals provides in-depth clinical experiences for managing basic and complex cardiac disease while also developing skills as a consultant. Fellows will interact with all of our medical and surgical services, outside hospital systems, and primary care doctors to foster competencies such as systems-based practice, interpersonal skills and communication as well as professionalism. Consults generated from the Emergency Department expose the fellows to another side of consultative cardiology with cardiac pathologies often needing more critical care decision making. Fellows gather information, evaluate the data from imaging and diagnostic modalities and devise treatment plans. Rounds are conducted with the attending to review assessments and recommendations synthesized by the fellow with concurrent review of pertinent literature. Typical consults include chest pain (ranging from non-anginal pain to acute coronary syndromes), supraventricular and ventricular arrhythmias, valvular heart disease, cardiomyopathy, hypertensive urgencies, acute heart failure, pericardial diseases, cardiac tamponade, hemodynamic instability or shock, cerebrovascular disease, peripheral vascular disease, lipid and other metabolic disorders, assessment of cardiac issues in pregnancy, and pre-operative assessments for non-cardiac surgeries. In total fellows do approximately 6 months of the general consult service over the three years of training.
Cardiothoracic Surgery Service
Director:
John Puskas, MD, Mount Sinai Morningside Hospital
Interested fellows can elect to do a 2-week rotation with the CT Surgery Service at MSM where they will work with some of the leaders in Cardiac Surgery and manage patients in the perioperative period. Fellows will develop the skills needed to perform a detailed pre-operative assessment of patients referred for cardiac surgery and determine the strengths and limitations of a surgical vs percutaneous vs medical approach to care, from the viewpoint of a cardiac surgeon. Fellows will perform the initial assessment, including a calculation of the STS score, as well as an assessment for other conditions that might increase one’s risk for surgery, and they will participate in heart team discussions. Fellows will also provide post-operative care for patients in the SICU. This rotation will provide fellows with a better understanding of how best to manage conditions that occur after cardiac surgery including cardiac arrhythmias, hemodynamic instability, post-pericardiotomy syndrome and respiratory failure. This rotation enables the fellow to understand the importance of a proper risk assessment of patients referred for surgery with an emphasis on the “heart team” model and shared-decision making.