Birmingham VA Medical Center Catheterization Lab Teaching Service


bvamc_200 The Cardiac Catheterization Lab at the Birmingham Veterans Affairs Medical Center (BVAMC) is part of the Division of Cardiovascular Disease of the UAB Medical Center and Department of Medicine. Teaching teams of attendings and fellows treat veterans who present with a full range of cardiovascular disease. Participation in the interventional procedures will provide an introductory experience with regards to indications, patient selection, performance, complications, and follow up of these patients. This is an extremely valuable opportunity not consistently available to the Cardiology Fellow elsewhere in the training program.

Attendings

Massoud Leesar, MD (Director)
Gilbert Perry, MD 
José Tallaj, MD

Duration of Rotation

Assigned during 2nd or 3rd year of clinical rotation

Clinical
Responsibilities

1. See all patients prior to the scheduled catheterization.

  • Perform a history and physical exam
  • Review relevant laboratory work and results of previous non-invasive & invasive imaging procedures.
  • Review the actual non-invasive study (echocardiogram, nuclear study, etc.) in addition to looking at the report (when appropriate).
  • Provide consultation for new patients with regards to whether catheterization and/or PCI is indicated (after discussion with either the CCU attending or the cath lab attending).


2. Discuss the planned procedure in detail with the responsible attending.

  • Review indications and potential contra-indications for the procedure.
  • plan the procedural approach.


3. Discuss the planned procedure with the patient & family members and obtain informed consent.

4. Read the cath films.

  • Review all hemodynamic data with the attending physician
  • Accurately summarize the findings of the procedure in the catheterization report.
  • Discuss treatment options &recommendations with the attending physician.

 
5. Examine the patient after the procedure.

  • Rule out potential procedure-related complications.
  • Document in the electronic medical record.


6. Discuss the results of the cardiac catheterization or PCI with

  • the patient & family,
  • other members of the Healthcare Team.

In cases in which the patient is not being seen by the CCU or cardiology consult team, the Cath Fellow &  cath lab attending will act as the cardiology consultants.

  • Formulate treatment options and recommendations with the cath attending.
  • Communicate these options and recommendations to the patient and his/her family, as well as to the primary health care team.


7. Attend cath conferences.

  • Present several interesting cases at monthly cardiac catheterization conferences.
  • Assist with Tuesday Noon conference presentations.

Follow-Up Care

Patients who are admitted to the VA solely to undergo cardiac procedures are not cared for by housestaff. The VA cath lab fellow is responsible for

  • admitting and discharging the patient
  • providing care in the hospital, including:
    • frequent communicating frequently with the patient and family
    • writing of daily progress notes
    • entering of orders
    • arranging for off service consults etc.

All such patients are staffed with an attending physician on a daily basis and, as needed, should emergencies arise


Emergent Procedures

Emergent diagnostic and therapeutic catheterizations of VA patients is available 24/7 in the BVAMC cath lab. The  Fellow on the cath lab rotation and the cath lab attending are responsible for performing these cases and for providing appropriate pre- and post-procedure care. Two fellows are assigned for each rotation and alternate to provide coverage for the emergency cases.
Emergent cases average about 1-4 per month.


Call

At night, cross-coverage for emergencies is provided by the VA CCU housestaff. The Cardiology Fellow on call that night should be notified of such emergencies and must see the patient in a timely fashion.


Essential Skills

Cardiology Fellows successfully completing this teaching service will be proficient in:

  1. Performing and interpretating
    • right & left heart catheterizations
    • coronary bypass graft
    • ventricular angiography
  2. Assessing hemodynamics
  3. Measuring 
    • coronary pressure gradients
    • flow and performance 
  4. Interpreting IVUS
  5. Understanding these precedures'
    • indications
    • contra-indications
    • potential benefits & risks
  6. Participating in all Interventional cases in this laboratory
  7. Providing pre- and postprocedure care for patients
  8. Documenting their pre- and post-procedure evaluations electronically