PRINCE GEORGE’S HOSPITAL CENTER
INTERNAL MEDICINE RESIDENCY PROGRAM
SECTION 6: CARDIOVASCULAR DISEASE AND HEALTH
This section has been reviewed and approved by the Chief, Division of Cardiology as well
as the Program Director, Internal Medicine Residency Program at Prince George’s Hospital
Center.
________________________
Chief, Division Of Cardiology
______________________________
Program Director, Residency Program
I. Overview
Cardiology is the prevention, diagnosis, and management of disorders of the
cardiovascular system, including ischemic heart disease, cardiac dysrhythmias,
cardiomyopathies, valvular heart disease, pericarditis and mycocarditis, endocarditis,
congenital heart disease in adults, hypertension, and disorders of the veins, arteries, and
pulmonary circulation. Management of risk factors for disease and early diagnosis and
intervention for established disease are important elements of cardiology.
The residents at Prince George’s Hospital Center gain experience from a wide variety of
patients admitted to the Heart Center. Cardiac Catheterization Laboratory and
Cardiothoracic Surgery facilities are invaluable additions to the learning experience.
During their cardiology rotation and through didactic conferences in cardiology residents
learn EKG interpretation. All residents are certified in BLS and ACLS. Resident
responsibilities during the cardiology rotation are described under Rotations and
Procedures in Section I of the Resident Handbook.
The residents gain experience in the management of patients in the Coronary Care Unit,
in the step down unit (PCRU) and in consulting on patients on the medical, surgical,
OB/GYN floors as well as the Intensive Care Unit, under the supervision of a staff
Cardiologist. The purpose of the Coronary Care rotation is to provide the resident with
an intellectual environment, instruction, and interaction with patients manifesting acute
and critical cardiac conditions allowing the resident acquire the knowledge, skills and
attitudes essential to the management of such patients.
It is imperative that the residents understand that the patient is a human being with
fears, feelings, concerns, anxieties, likes, dislikes, denials as well as occupational, social
and family interactions and problems. All of these factors must be understood in order to
appreciate and care for the patient since all of these factors will have an impact on the
patient outcome. Prince George’s Hospital Center receives a large a large volume of
patients with cardiac diseases. Not only is the resident exposed to a wide variety of
cardiovascular disease processes, but the socioeconomic status of our patient
population is diverse and allows the resident to experience how the aforementioned
human factors influence disease, perceptions, treatment and outcomes.
The resident patient encounter may occur in either the inpatient or outpatient setting.
The encounter may also involve patients with chronic cardiovascular disease or acutely
ill patients with potentially catastrophic or life threatening cardiovascular illness.
This rotation will provide the resident with a wide variety of experiences in cardiology.
This will include both inpatient and emergency department consultations. This rotation is
designed to provide training and education in the specific aspects of cardiology that will
be most relevant to the primary care practitioner.
 The rotation will provide training in the appropriate diagnosis, management, and
ongoing treatment of cardiac conditions for residents in internal medicine.
 The resident will participate in the consultation and management of patients with
acute and chronic disorders of the cardiovascular system.
 Mechanisms of cardiovascular disease, clinically relevant pathophysiology, clinical
manifestations and evidence-based therapy of these disorders will be emphasized.
 The resident will demonstrate understanding of the principles, indications, utility, and
interpretation of invasive and noninvasive cardiovascular diagnostic tests.
II. Principle Teaching Methods
This consists of frequent encounters with the medical resident and making that person
accountable for performance. Primarily this consists of bedside rounds on a daily basis
for approximately 2 hours. Here most of the teaching and evaluation is carried out but it
is accompanied by being available to the residents during the remainder of the day and
at night for additional support. Included in these rounds are short 15 or 30 minute
discussions on current medical topics driven by patient encounters and initiated by the
resident, but completed by the attending physician. The latest information dealing with
the topic as provided by a literature search and pertinent articles are made available.
Formal teaching through didactic lectures atleast twice a month.
The residents will also receive reading material at the beginning of each of their
cardiology rotations. These reading materials are labeled as packets 1,2,3, 4 to
correspond with the resident’s1st, 2nd, 3rd and 4th rotation . These reading materials are
listed under the subsection of reading resources .
The residents are also required to interpret a minimum number of EKGs, Stress tests,
Cardiac Cath and 2D echo reports with the attending for each rotation. These tests
should serve as a starting point of discussion of patient care based on current guidelines
and evidence based medicine. These requirements are delineated in the form of a
logsheet at the end of this section. During their rotation residents must make a double
sided copy of the logsheet and complete the stated requirements by the end of the
month. To receive a satisfactory for the month the residents must turn in a completed
logsheet to the program coordinator.
The residents are also required to take a test at the end of each rotation. These tests are
labeled test 1,2,3,4 to correspond to the residents’ 1st, 2nd, 3rd and 4th rotation and are
based on the reading materials for these rotations
III. Strengths and Limitations
The cardiology faculty consists of voluntary faculty with a strong commitment to patient
care and resident education. The patient and disease exposure is very broad and typical
of a community-based hospital. The Heart Center at Prince George’s Hospital Center
serves as a referral center to many of the area hospitals due to its Interventional
Cardiology and Cardiothoracic Surgery facilities. This provides a unique experience for
residents in a community-training program.
IV. Goals and Objectives for Cardiology Rotation
Legend of Learning Activities
Learning Venues:
1.
Direct patient care: supervised by attending physician
2.
Management Rounds with CCU team
3.
Cardiology Conferences
4.
Self Study
5.
Core Department of Medicine Lecture Series
Evaluation Methods:
A.
Attending Evaluation
B.
Direct Clinical Observation
C.
Peer Evaluation
D.
Nursing Evaluation
E.
In-Training Examination
The Principal educational goals for the Cardiology Rotations are listed by ACGME core
competencies.
Competency: Patient Care
Working with the Attending Cardiologist, provide
effective care for patients admitted to, patients
diagnosed with, or patients consulted on for
cardiovascular diseases
Improve auscultation and physical examination skills.
Correlate the examination of patients during care with
the results from the echocardiography and
catheterization lab.
Effectively evaluate and manage patients with acute
cardiac illness.
Effectively manage patients with undiagnosed chest
pain, including use of appropriate diagnostic testing
Indentify and understand the management of the most
common reasons for cardiac consultation including risk
assessment for non cardiac surgery
Competency: Practice Based Learning and
Improvement
Identify and acknowledge gaps in personal knowledge
and skills in the care of acute cardiac patients and
cardiology.
Develop real-time strategies for filling knowledge gaps
that will benefit patients on the cardiology primary
service.
Residents will accept feedback and work to improve
deficiencies.
Residents will enter near misses and errors in the new
innovation system
Learning Venues
1
Evaluation Method
A, B, C
1,6
A, B, C
1
A, B, C
1, 2, 4
A, B, C, E
1, 2, 4
A, C, E
:
ALL
A,B,C,E
ALL
A,B,C,E
ALL
A,B,C,E
F
Effectively evaluate and manage selected interesting
patients who have undergone interventional
procedures.
Competency: Medical Knowledge (Also See
Appendix )
Identify and understand the management of the most
common cardiac conditions in hospitalized patients
including chest pain/coronary artery disease,
congestive heart failure, arrhythmia management,
valvular heart disease and the evaluation of chest pain
syndromes.
Understand the appropriate use and interpretation of
diagnostic cardiac testing and the appropriate patient
selection criteria. (ECG, exercise stress testing,
myocardial scanning, echocardiography, and stress
echocardiography)
Understand and identify the appropriate patient
candidates for the various non-invasive imaging
modalities and how these tests are performed. They
should also understand the limitations of these
procedures and their applicability in different
circumstances.
Expand clinically applicable knowledge base of the
basic and clinical sciences underlying the care of
patients with chest pain and acute cardiac disease.
Access and critically evaluate current medical
information and scientific evidence relevant to acute
cardiac care.
 Pose answerable questions to solve dilemmas
in patient care
 Identify which type of article (primary
[diagnostic, treatment, prognostic, etc…] vs.
secondary [reviews]) that is needed to answer
the particular question)
 Demonstrate the ability to use computer-based
literature searches to identify references
relevant to patient problems
 Understand how individual patient
demographics may affect the application of
medical literature.
Understand the physiologic and pathophysiologic
principles of invasive hemodynamic monitoring
including indications.
Indentify and understand the management of the most
common reasons for cardiac consultation including risk
assessment for non cardiac surgery
Competency: Interpersonal Skills and
Communication
Communicate effectively with patients and families.
3,4,5
A,B,C,E
ALL
A,B,C, E
ALL
A,B,C, E
ALL
A,B,C, E
ALL
A,B,C, E
ALL
A,B,C, E
ALL
A,B,C, E
1, 2, 4
A, C, E
1
A, B,C,D
Communicate effectively with physician colleagues
1,2
A, B,C,D
and members of other healthcare professions to
assure timely, comprehensive patient care.
Communicate effectively with colleagues from other
services to coordinate optimal patient care.
Competency: Professionalism
Seek to excel in their clinical and scholarly work
Maintain a state of inquiry and actively seek out new
information by reading to enhance knowledge
Attend and be prepared to actively participate in all
conferences
Accept and complete all patient care responsibilities
with the utmost care
Behave with the utmost professionalism toward
towards patients, families, colleagues, and all
members of the health care team.
Seek out, accept feedback, and work to improve
deficiencies.
Provide feedback to the course director to improve the
rotation as needed
Competency: Systems-Based Practice
Understand and utilize the multidisciplinary resources
necessary to care optimally for the cardiac patient.
Collaborate with other members of the health care
team to assure comprehensive care for patients with
cardiac illness and complaints.
Use evidence based, cost-conscious strategies in the
care of patients with cardiac illness and complaints.
1,2
A, B,C,D
ALL
ALL
A,B,C,D
A,B,C,D
A,B,C,D
1,2
A,B,C,D
1,2
A,B,C,D
ALL
A,B,C,D
ALL
A,B,C,D
1,2
A,C
1,2
A,C
1,2
A,C
V. Educational Content
A. Coronary Artery Disease
1)
The management of unstable angina and acute myocardial infarction to include
treatment of:
 Chest pain syndrome
 12-lead ECG changes and cardiac arrhythmias
 Rational use of reperfusion therapy (thrombolytic agents, Angioplasty,
CABG, and other modalities of reperfusion)
 Catastrophic cardiac complications to include acute mitral insufficiency,
ventricular septal defect and ventricular myocardial rupture
 Mechanical complications of acute MI including cardiogenic shock
 Indications for urgent angiography and intra-aortic balloon pump
 Use of noninvasive tests in the acute care
 Indications for the use of the Swan-Ganz catheter (Hemodynamic
monitoring)
2)
The management of the myocardial infarction patient in the PCRU after leaving
the coronary care unit:






Monitoring Activity (including cardiac rehabilitation)
Diet
Medications
Role of stress test pre-discharge
Role of cardiac imaging and ancillary noninvasive evaluation (Echo, Holter)
Post-MI risk stratification and indications for invasive evaluation. Prognosis
of myocardial infarction patients through the use of non-invasive testing
(echos, treadmills, nuclear scans, holter monitors, etc) and invasive tests
(cardiac catheterization).
3) The ambulatory care of coronary patients:
 History and physical exam
 Electrocardiogram
 Indications and/or result interpretation of special procedures; Stress test:
Imaging, Pharmacological vs. Exercise, Thallium or Echocardiography,
including choice of pharmacologic agent (dobutamine vs adenosine); Gated
blood pool (Cardiac output studies); Holter and event monitoring; Cardiac
catheterization
 Outpatient cardiac risk factors management: identification of modifiable and
non-modifiable risk factors.
 Outpatient management of cardiovascular diseases and medications.
 Primary and secondary prevention of CAD (Coronary Artery Disease) with
emphasis on the National Cholesterol Education Program (NCEP) guidelines.
B. Valvular Heart Disease
1) The evaluation and management of patients with valvular heart disease:
 Diagnostic procedures, Echocardiography (TEE), Hemodynamics
 Treatment of congestive failure, arrhythmias and other complications
 Indications for surgical therapy, Valvuloplasty
2) The ambulatory care of patients with valvular heart disease
3) Clinical follow-up
 Appropriate use of diagnostic tests and their interpretations
 Medical management of valvular heart disease, including antibiotic
prophylaxis
 Indications for surgical intervention.
C. Hypertension
1) The acute management of hypertensive crisis
2) Ambulatory evaluation and management of hypertension
 Diagnostic work up: essential versus secondary causes
 Diet
 Drug therapy
 Chronic complications of hypertension -- recognition and treatment
 Emphasis on JNC-VI recommendations for management of hypertension
D. Cardiomyopathy/Congestive Heart Failure
1) Recognition, evaluation, and treatment of systolic vs. diastolic abnormalities
2) Recognition of Hypertrophic Cardiomyopathy
3) Management of heart failure as per ACE/AHA guidelines and recommendations
4) Indications for the use of the Swan-Ganz catheter (Hemodynamic monitoring)
E. Arrhythmias
1) Acute hospital management of cardiac arrhythmias
 Recognition of tachyarrhythmias and bradyarrhythmias.
 Differentiating supraventricular from ventricular tachyarrhythmias, heart
blocks
 Non-pharmacologic (Valsalva, CSM) diagnostic and therapeutic measures
 Electrical Cardioversion and Defibrillation
 Pacemakers (see below)
 Indications for Electrophysiological studies
2) Ambulatory management of cardiac arrhythmias
 Diagnosis (ambulatory and event monitoring, signal averaging ECG, EPS)
 Drugs vs. catheter ablation vs. surgery
3) Atrial fibrillation
 Indications for cardioversion, chemical and electrical
 Stroke risk assessment and prevention
 Control of ventricular rate
F. Peripheral Vascular Disease
1) Recognition, evaluation, and treatment of Arterial occlusion, Acute vein thrombosis,
Aneurysm (Dissecting aneurysm):
 Diagnostic tests: Doppler, Ultrasound, Angiography
 Treatment: medical versus surgical
 Prevention: risk factor management
G. Pericardial Disease
1) Recognition, evaluation, and treatment
 Acute pericarditis and pericardial effusion
 Pericardial tamponade
2) Medical vs. surgical treatment
H. Cor pulmonale and pulmonary hypertension
1) Recognition, evaluation, and treatment
 Pulmonary embolism
 Primary and secondary pulmonary hypertension
2) Medical vs. surgical management
I.
Congenital Heart Disease
1) Recognition, evaluation, and treatment
2) Medical vs. surgical
J. Pacemakers
1) Indications acute (transvenous) and temporary versus permanent pacemakers
2) Types of pacemakers and follow up
K. Syncope
1) Recognition, evaluation, and treatment
2) Medical vs. surgical etiologies
3) Investigative studies and their interpretation
 Holter
 Electrophysiological Study (EPS)
 Tilt Table
L. Perioperative Medicine
1) Perioperative cardiac risk assessment and interventions
2) Functional status in perioperative risk assessment
3) Perioperative use of Beta Blockers
4) Endocarditis Prophylaxis
 Valvular Heart Disease/Prosthetic Heart Valves
5) Antithrombotic Therapy in Patients with Mechanical and Biological Prosthetic
Heart Valves
6) Indications for perioperative invasive monitoring
VI. Reading Resources
The residents are required to read the following packets during the rotation. The packet
numbers 1,2,3 and 4 correspond to the 1st, 2nd, 3rd and 4th rotation.
Packet 1
Mandatory Reading List:
1.
Acute coronary syndrome and STEMI
a. ACC/AHA 2002 Guideline Update for the Management of Patients with
Unstable Angina and Non ST Segment Elevation Myocardial InfarctionSummary Article
b. ACC/AHA 2004 Guidelines for Management of Patients with ST Elevation
Myocardial Infarction- Executive Summary
c. Birnbaum et al. Admission Clinical and Electrocardiographic Characteristics
Predicting In-Hospital Development of High Degree Atrioventricular Block in
Inferior Wall Acute Myocardial Infarction. Am J Cardiol 1997;80:1134-38
d. Zimetbaum et al. (2003) Use of the Electrocardiogram in Acute Myocardial
Infarction. NEJM 348(10) 933-40
2.
Cardiogenic Shock
a. Hochman et al. (1999) Early Revascularization in Acute Myocardial Infarction
Complicated by Cardiogenic Shock. NEJM Vol 341(9) 625-634
3.
Hyperlipidemia
a. NCEP III
4.
Physical Examination
a. Mayo Board Review for Cardiology. (See Handouts)
5.
ECG diagnosis
a. Dubin’s Textbook on EKG
6.
Atrial Fibrillation
a. ACC/AHA/ESC 2001 Guidelines for the Management of Patients with Atrial
Fibrillation: Executive Summary. A Report of The American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
and the European Society of Cardiology Committee for Practice Guidelines
and Policy Conferences.
b. Falk (2001) Atrial Fibrillation. NEJM 2001; 344 (14) 1067-
Optional Reading List:
a. ACC/AHA 2002 Guideline Update for the Management of Patients with
Unstable Angina and Non ST Segment Elevation Myocardial Infarction –full
text
b. ACC/AHA 2004 Guidelines for Management of Patients with ST Elevation
Myocardial Infarction- Full Text
c. ACC/AHA/ESC 2001 Guidelines for the Management of Patients with Atrial
Fibrillation: Full Text
d. EAFT (1993) Secondary Prevention in Non Rheumatic Atrial Fibrillation after
Transient Ischemic Attack on Minor Stroke. Lancet 1993;342: 1255-62
e. Warren et al. (1995). Transesophageal Echocardiographically Facilitated
Early Cardioversion from Atrial Fibrillation Using Short Term Anticoagulation:
Final Results of a Prospective 4.5 year Study. J Am Coll Cardiol 1995;
25:1354-61
f. Kopecky et al (1987). Natural History of Lone Atrial Fibrillation: A Population
Based Study over Three Decades. NEJM Vol 317(11)669-74
g. Risk Factors for Stroke and Efficacy of Antithrombotic Therapy in Atrial
Fibrillation: Analysis of Pooled Data from Five Randomized Control Trials.
Arch Intern Med 1994. Vol 154: 1449-57
Unassigned Reading List:
a. Gunnar et al. (1990). Prognosis of Late Versus Early Ventricular Fibrillation in
Acute Myocardial Infarction. Am J Cardiol 1990;66:10-15
b. Boden et al. (1998). Outcomes in Patients with Acute Non Q Wave
Myocardial Infarction Randomly Assigned to an Invasive as Compared with a
Conservative Management Strategy. NEJM Vol 338 (25) 1785-92
c. Schomig et al (1996) A Randomized Comparison of Antiplatelet and
Anticoagulant Therapy After the Placement of Coronary Artery Stents. NEJM
1996; 334:1084-9
d. Leon et al. (1998) A Clinical Trial Comparing Three Anti-Thrombotic Drug
Regimens after Coronary Artery Stenting. NEJM 1998; 339:1665-71
Packet 2
Mandatory Reading List:
1. Acute Coronary Syndrome
a. ACC/AHA/ SCAI 2005 Guideline Update for Percutaneous Coronary
Intervention- Summary Article: A Report of the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines
b. ACC/AHA 2002 Guidelines Update for Management of Patients with Chronic
Stable Angina- Summary Article
2. STEMI
a. A Clinical Trial Comparing Primary Coronary Angiography with Tissue
Plasminogen Activator for Acute Myocardial Infarction (GUSTO II b)
b. Zijlstra et al (1993). A Comparison of Immediate Coronary Angioplasty with
Intravenous Streptokinase In Acute Myocardial Infarction. NEJM 1993;
328:680-4)
c. De Boer et al (1994). Immediate Coronary Angioplasty Versus Intravenous
Streptokinase in Acute Myocardial Infarction: Left Ventricular Ejection
Fraction, Hospital Mortality and Reinfarction. J Am Coll Cardiol 1994;
23:1004-8
d. Hillis et al. (1990) Risk Stratification Before Thrombolytic Therapy in Patients
With Acute Myocardial Infarction. J Am Coll Cardiol 1990; 16:313-5)
3. Hyperlipidemia and progression of CAD
a. Pitt B, et al. (1999). Aggressive Lipid Lowering Therapy Compared with
Angioplasty in Stable Coronary Artery Disease. NEJM 1999;341: 70-76
b. AHA/ACC Guidelines for Secondary Prevention for Patients with Coronary
and other Atherosclerotic Vascular Disease: 2006 Update
4. Congestive Heart Failure
a. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of
Chronic Heart Failure in the Adult: A Report for the American College of
Cardiology/American Heart Association Task Force on Practice Guidelines.
b. Jessup et al. (2003) Heart Failure. NEJM 2003; 348:2007-18
c. Cohn. (1996). The Management of Chronic Heart Failure. NEJM 1996;
335:490-99
5. Non-cardiac surgery in patients with heart disease
a. ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular
Evaluation for Noncardiac Surgery- Executive Summary
b. ACC/AHA 2006 Guideline Update on Perioperative Cardiovascular
Evaluation for Noncardiac Surgery: Focused Update on Perioperative Beta
Blocker Therapy
c. Manango et al. (1996). Effect of Atenolol on Mortality and Cardiovascular
Morbidity after Noncardiac Surgery. NEJM 1996; 335:1713-20
6. Coronary Artery Bypass Surgery
a. ACC/AHA 2005 Pocket Guidelines on Coronary Artery Bypass Graft Surgery
Packet 3
Mandatory Reading List:
1. Sudden cardiac death and ICD
a. Liberthson (1996) Sudden Death From Cardiac Causes in Children and
Young Adults. NEJM 1996; 334(16): 1039-44
b. DiMarco (2003) Implantable Cardioverter-Defibrillators. NEJM (2003);
349(19): 1836-47
c. Moss (1996) Improved Survival with an Implanted Defibrillator in Patients with
Coronary Disease at High Risk for Ventricular Arrhythmia. NEJM (1996) 335
(26): 1933-40
2. Valvular heart disease
a. AHA/ACC 2000 Pocket Guidelines for the management of Patients with
Valvular Heart Disease
b. Freed et al. (1999). Prevalence and Clinical Outcome of Mitral Valve
Prolapse. NEJM 1999; 341(1) 1-6
c. Carabello et al. (1997). Valvular Heart Disease. NEJM 1997; 337(1):32-41
d. Pellika et al (1990) The Natural History of Adults with Asymptomatic,
Hemodynamically Signification Aortic Stenosis. J Am Coll Cardiol 1990;
15:1012-7
3. Dilated Cardiomyopathy and Myocarditis
a. ACC/AHA
Contemporary Definitions
and
Classification
of
the
Cardiomyopathies: An American Heart Association Scientific Statement from
the Council on Clinical Cardiology, Heart Failure and Transplantation
Committee.
b. Mason et al. (1995) A Clinical Trial of Immunosuppressive Therapy for
Myocarditis. NEJM 1995; 333: 269-275
c. Kasper et al, (1994). The Causes of Dilated Cardiomyopathy: A
Clinicopathologic Review of 673 Consecutive Patients. JACC: 23: 586-590
4. Supraventricular tachycardia
a. ACC/ AHA/ESC 2003 Guidelines for the Management of Patients with
Supraventricular Arrhythmias
b. Delacretaz. (2006). Supraventricular Tachycardia. NEJM 2006; 354(10):
1039-51
5. Ventricular tachycardia
a. Brugada et al. (1991) A New Approach to the Differential Diagnosis of a
Regular Tachycardia with Wide QRS Complex. Circulation 1991; 83: 16491659
6. Syncope
a. Kapoor. (2000) Sycope. NEJM 2000; 343(25):1856-62
b. Grubb. (2005) Neurocardiogenic Syncope. NEJM 2005; 352(10):1004-10
c. Farrehi. (1995) Syncope: Diagnosis of Cardiac and Noncardiac Causes
Geriatrics 1995; 50: 24-30
Optional Reading List:
a. AHA/ACC 2006 Guidelines for the management of Patients with Valvular
Heart Disease
Packet 4
Mandatory Reading List:
1. Cardiomyopathy
a.
Kushwaha et al. (1997). Restrictive Cardiomyopathy. NEJM 1997; 336:
267-276
b.
Spirito et al. (1997). The Management of Hypertrophic Cardiomyopathy.
NEJM 1997; 336(11): 775-85
c.
Nishimura et al. (2004). Hypertrophic Obstructive Cardiomyopathy. NEJM
2004; 350(13): 1320-38a
2. WPW
a. Munger et al. (1993). A Population Study of the Natural History of WPW
Syndrome in Olmsted County, Minnesota, 1953-1989. Circulation 1993; 87:
866-73
3. Pulmonary HTN
a. Shapiro et al (1997) Primary Pulmonary Hypertension: Improved Long Term
Effects and Survival with Continuous Intravenous Epoprostenol Infusion. J
Am Coll Cardiol 1997; 30:343-9
b. Rubin (1997). Primary Pulmonary Hypertension. NEJM1997; 336(2):111-117
4. Pacemaker
a. ACC/ AHA/ NAHSPE 2002 Guideline Update for Implantation of Cardiac
Pacemakers and Antiarrhythmia Devices- Summary Article
5. Exercise stress testing
a. ACC/ AHA 2002 Guideline Update fro Exercise Stress Testing- Summary
Article
6. Peripheral Vascular Disease
a. ACC/AHA 2005 Guidelines for the Management of Patients with Peripheral
Artery Disease (Lower Extremity, Renal, Mesentric and Abdominal Aortic)Executive Summary
7. Infective Endocarditis
a. Baddour et al (2005). AHA Scientific Statement on Infective Endocarditis:
Diagnosis, Antimicrobial Therapy, and Management of Complications –
Executive Summary
8. Metabolic Syndrome
a. Grundy et al. AHA/ NHLBI Scientific Statement on Diagnosis and
Management of the Metabolic Syndrome- Executive Summary
All residents are encouraged to complete reading of their MKSAP section on Cardiology
during their rotation. They should also use MDConsult and Up To Date to read on a
case-by-case basis.
PRINCE GEORGE’S HOSPITAL CENTER
INTERNAL MEDICINE RESIDENCY PROGRAM
CARDIOLOGY LOGSHEET
RESIDENT NAME______________________________________________
PGY LEVEL_______________ ROTATION MONTH AND NUMBER_____________
LABORATORY
DATA
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supervising
attending & DATE
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supervising
attending & DATE
MR#
Interpretation of
result by resident
(diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supervising
attending & DATE
EKG
2D ECHO
CARDIAC CATH
STRESS TEST*
RESIDENT NAME:
LABORATORY
DATA
MR#
Interpretation of result
by resident (diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supervising
attending & DATE
MR#
Interpretation of result
by resident (diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supervising
attending & DATE
MR#
Interpretation of result
by resident (diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supervising
attending & DATE
MR#
Interpretation of result
by resident (diagnosis/
management plan)
Comment by
supervising attending
(correct/not, missed
findings etc)
SIGNATURE of
Supervising
attending & DATE
EKG
2D ECHO
CARDIAC CATH
STRESS TEST*
Hours of work –
Residents rotate for calls q 4 days (24hr call), and maximum of 30 hrs continuous work.
On-call resident admits patients from 3:30 p.m. to 7:30 a.m.
Two residents will admit new patients from 8:00 a.m. to 3:30 p.m. on week days (the pre call
resident and the resident who is not post call nor on call).
Every other Thursday a.m. (9:00 to 12:00) the resident on call will go the Glenridge clinic for
outpatient cardiology clinic.
During the weekends the residents who are not on-call are off.