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 is 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 a hybrid of clinical and investigative work.
Cardiac Intensive Care Unit
Director: Matthew Tomey, MD
Co-Director: Amir Ahmadi, MD
The Cardiac Intensive Care Unit (CICU) at Mount Sinai Morningside is truly at the core of the cardiology program, serving as a central place of interaction of all cardiac subspecialties. It is a favorite amongst our trainees. The unit is comprised of 16 beds and is adjacent to the Cardiothoracic Intensive Care Unit (CTICU). Each year the CICU sees approximately 1000 admissions. Fellows gain exposure to a wide range of pathology including acute coronary syndrome, complex structural heart disease, cardiogenic shock, acute decompensated heart failure, arrhythmias, valvular heart disease, and pericardial disease. In addition, Mount Sinai Morningside has a robust cardiovascular surgery program with whom we work closely.
During the CICU rotation, fellows not only learn from our knowledgeable attendings but also take leadership roles in teaching. As our fellows advance in training, they embrace the expectation for greater responsibility in instruction of residents, students, and nursing. 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. Advanced Electrophysiology, Heart Failure, and Interventional cases are managed by our teams in the CICU, as well as palliative care discussions when medical therapies are maximized. In total, our fellows learn the art of critical care cardiology.
The cardiology consult service provides in-depth clinical experience 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 invoke another side to consultative cardiology with cardiac pathologies often needing more critical care evaluation. 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, adult congenital heart disease, hypertension and hypertensive heart disease, heart failure, pericardial diseases, cardiac tamponade, cerebrovascular disease, peripheral vascular disease, lipid and other metabolic disorders, assessment of cardiac issues in pregnancy, and pre-operative assessments for non-cardiac surgeries.
Director, Arrhythmia Institute: Davendra Mehta, MD
Director, Electrophysiology Laboratory: Ranjit Suri, MD
Our Electrophysiology program 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 laboratory.
Fellows’ electrophysiology training is provided over a 2-month period during the first two years of cardiology fellowship. Meeting COCATS requirements, fellows are exposed to the basic principles of anatomy and physiology surrounding arrhythmias, various diagnosis and treatment options, ECG interpretation, management of pacemaker and defibrillator patients, work-up of unexplained syncope, risk stratification of patient at risk for sudden cardiac death, electrical cardioversion, and pharmacology. Graduating cardiology fellow are strong in their basic electrophysiology knowledge to care for patients in their future careers, and for fellows interested in deeper exposure, elective time in Electrophysiology is encouraged in the third year.
Director: Kiran Mahmood, MD
While on the heart failure service at Mount Sinai Morningside, cardiology fellows participate in our outpatient heart failure clinic experience, perform heart failure consultations and round on hospitalized patients. Renowned heart failure faculty is shared with The Mount Sinai Hospital and many are actively involved with ongoing heart failure research trials. Each fellow will also spend a concentrated month on the heart transplant/left ventricular assist device (LVAD) services at The Mount Sinai Hospital. Further elective time may be spent at The Mount Sinai Hospital for interested fellows.
Objectives for the heart failure rotations include to learn the pathophysiology of heart failure; become masterful in cardiac consultation for new onset heart failure management or acute decompensation of chronic heart failure; understand the roles of diagnostic testing in the decision making processes for heart failure; learn how to manage outpatient heart failure including diuretic titration and timing of advanced therapies; gain experience in integrating the results of clinical trials into the unanswered questions and newer approaches for heart failure; and understand the interplay between heart failure and various disciplines of cardiology as arrhythmia, devices, catheterization, cardiac surgery, imaging, and rehabilitation.
Principle objectives of the fellows experience during the heart transplant/LVAD rotations include selection criteria for heart transplant; UNOS transplant listing; post-transplant patient care with immunosuppressive therapy, infection, arteriopathy, and rejection; and experience with LVAD management.
Director: Nitin Barman, MD
For over two decades, Mount Sinai Morningside has offered formal cardiac catheterization rotations in interventional cardiology. We believe this training is an essential foundation on which technical and clinical experience of treating patients with coronary heart disease is derived. Our curriculum is designed to provide fellows with a comprehensive and extensive understanding of atherosclerotic heart disease including pathophysiology at the basic science level, medical therapies, and finally indications and technical aspects of invasive therapies. Further, an emphasis is placed on the understanding of hemodynamics, especially in shock states where mechanical support is considered.
We benefit from a high volume program that emphasizes hands-on training in a variety of complex coronary, peripheral, and structural cases. Our mission is to provide exceptional and diverse clinical training in all aspects of interventional cardiology such that the fellows are ready to excel as general cardiologists or go on to subspecialty training from the moment they finish our program. Our highly accomplished and dedicated faculty are committed to teaching the art of interventional cardiology. Teaching by our faculty extends beyond the cardiac catheterization laboratory as we emphasize evidence based medicine and guideline directed medical care with careful attention to appropriate use of catheterization and percutaneous coronary intervention. Before the procedure, cases are discussed in detail with the general and interventional cardiology fellows, including the indications for the procedure, and various approaches to treating the patient. Following the case, complications or difficulties encountered during the case are reviewed, and the attending and fellows will review post-procedure management. Further instruction is provided during outpatient clinics, journal club, and weekly conferences.
Director: Edgar Argulian, MD
The echocardiography laboratory at Mount Sinai Morningside is a unique high-volume center with over 9000 transthoracic echocardiograms (TTE) performed and interpreted annually. The lab participates in all aspects of clinical cardiology and engages in a variety of high-level research activities. During their time in the lab, fellows with perform and interpret TTEs as well as stress echocardiography, transesophageal echocardiography (TEE), intracardiac echocardiography, contrast echocardiography, 3-D echocardiography, intraoperative TEE, and carotid and other types of vascular imaging. Fellows are encouraged to pre-read studies, commit to an interpretation, and then review and learn with the attending. We have a unique experience within our lab, where for 2 weeks blocks during 1st and 2nd years, fellows have hands-on scanning training to develop their skills. A new program to enhance echocardiography training is intraoperative TEE under the instruction of our excellent cardiac anesthesiologists. All of our cardiology fellows achieve COCATS level II training in echocardiography, and for fellows with imaging career goals, the third year is scheduled to align with completion of level III training.
Director: Alan Rozanski, MD
Nuclear Cardiology at Mount Sinai Morningside is jointly run by the Department of Cardiology and Division of Nuclear Medicine. The section is supervised by Dr. Alan Rozanski, an internationally recognized Nuclear Cardiologist who has overseen this section for the last 30 years. Dr. Gordon Depuey, another leader in the field, is a Nuclear Medicine member of this section. In addition, we have highly seasoned technical staff who create an excellent learning environment. With a wide spectrum of patient pathologies and strong academic research opportunities, fellows enjoy their experience in nuclear cardiology.
Our nuclear procedures include stress-rest single photon emission computed tomography (SPECT), rest-redistribution thallium studies (to assess myocardial viability or resting myocardial ischemia), pyrophosphate imaging to assess patients for cardiac amyloid, and equilibrium gated blood pool radionuclide angiography (“MUGA” studies) to assess resting left ventricular function.
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. All fellows achieve COCATS level II as part of their clinical training, and interested fellows can pursue level III during their third year or through additional post-fellowship training.
Cardiac Computed Tomography
Director: Harvey Hecht, MD
The cardiac computed tomography (CCT) and coronary computed tomography angiography (CCTA) program see a high volume of cases. 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.
Cardiac Magnetic Resonance Imaging
Director: Vikram Agarwal, MD
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 Mount Sinai Morningside 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.
Vascular Medicine/Endovascular Interventions
Director: Vishal Kapur, MD
Being the newest member of Division of Cardiology, the Vascular Medicine/Endovascular Intervention program aims to provide comprehensive care to patients presenting with vascular disease. We have a fully equipped IAC certified laboratory where fellows get hands on training on ultrasound use and interpretation of various vascular imaging including peripheral arterial, venous, carotid, abdominal, aortic, subclavian and renal. Fellows become eligible to sit for RPVI examination if they complete the necessary requirements. From an endovascular intervention standpoint, during the catheterization laboratory rotation, fellows observe the latest interventional techniques used to manage simple and complex vascular disease. The goal of this service is a robust “cardiology and vascular” experience for the fellows in training.
Adult Congenital Heart Disease
All 3rd year cardiology fellows rotate on the adult congenital heart disease service at The Mount Sinai Hospital with Dr. Ali Zaidi, an exceptional physician uniquely boarded in Pediatric Cardiology, and Adult Cardiovascular Disease, Echocardiography, and Adult Congenital Heart Disease. Dr. Barry Love, 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 such leaders in the field of adult congenital heart disease.
A central component of our cardiology fellows’ experience is their weekly cardiology clinic, taking place one afternoon per week. Fellows attend clinic at either our newly renovated Cardiovascular Institute (CVI) at Mount Sinai Morningside or at Mount Sinai West on 59th street between 9th and 10th Avenue. Each fellow manages approximately 8 new or follow-up patients each clinic session under the supervision of clinical faculty. Fellows’ growth is nurtured through one faculty mentor assigned to each fellow in the ambulatory setting, enabling direct clinical teaching. The goal of the ambulatory setting is to learn continuity and synthesis. Fellows take ownership as the principle cardiologist for the patient and enjoy following their “practice” closely throughout the three years of training. Additionally, fellows learn to apply their growing fund of knowledge, intermixed with evidence based literature, to create effective plans that fits the unique needs of each patient.
James J. Peters Veterans Hospital
Site Directors: Calvin Eng, MD; Lawrence Baruch, MD
The Bronx Veterans Affairs Medical Center is a multilevel healthcare Center of Excellence for Veterans Affairs (VA) and a renowned research center. The cardiology fellow experience at the VA is unique, and as such, particularly rewarding. Rather than discrete clinical rotations, the fellows are integrated into the day to day cardiology activities: stress testing, echocardiography, telemetry inpatient, cardiac consultation, and cardiology ambulatory clinics. The cardiac intensive care unit sees a range of advanced cardiac pathology including unstable angina or myocardial infarction, decompensated heart failure, and uncontrolled arrhythmia. Cardiac imaging with CCT and MRI is also robust, with studies including calcium scores, non-invasive coronary angiography, myocardial function and scarring, and cardiac tumor or thrombus localization. Our cardiology fellows rotating at the VA work side by side with the cardiology attendings, resulting in a well-rounded personalized educational experience.