Echocardiography
The Program trains Fellows to both perform and interpret M-mode and 2-dimensional echocardiography as well as doppler studies in adult patients. In addition, an active Transesophageal Echocardiography Program is in place and Fellows gain experience in the performance and interpretation of this valuable echo modality. Pediatric Echocardiography and fetal echocardiography are currently performed by the Board certified Pediatric Cardiologist on staff. Competency in pediatric echocardiography is not planned as part of our Adult Cardiology Program. At the present time, over 15 adult echocardiograms are performed each day. As skill is developed, the Fellow interprets and performs as many echocardiograms as possible, thereby guaranteeing a sufficient experience base for full echocardiography proficiency.

Nuclear Cardiology
The Nuclear Cardiology experience consists of experience assisting with the performance and interpretation of rest, exercise and pharmacological stress imaging studies. Most tests are performed in the mornings. Reading is performed by a Nuclear Cardiologist and a Nuclear Medicine Radiologist who interpret all studies with the fellows. Didactic training in Nuclear Medicine sufficient to qualify for an independent nuclear license, is not part of our Fellowship experience. Sufficient exposure is gained, however, to provide full competence in interpretive skills. Additionally, opportunity exists for all fellows to participate in the Nuclear Cardiology Service at Yale University for 1-2 months.

Coronary Care Unit
Bridgeport Hospital has a six bed CCU and 48 beds of telemetry, which are used for acute and intermediate level cardiovascular care. On this rotation, the Fellow functions as a Junior Attending being the first level of resource for the PGY-2 and PGY-1 who are assigned to the CCU. Considerable experience in insertion of temporary pacemakers, arterial lines, and Swan Ganz catheters is obtained as well as direct experience in the management of critically ill and hemodynamically unstable patients. In addition to covering the CCU and telemetry units, the Fellow on this rotation also participates in activities of the EP Service (described above).

Cardiac Surgery
Bridgeport Hospital supports an active and aggressive Cardiac Surgical Program. Every patient going to cardiac surgery has a Cardiologist in consultation, who functions as an active partner in patient management. Fellows gain experience in the perioperative management of cardiac surgical patients primarily through rotation in the cardiac surgical service. Surgical night call is not part of this rotation, but active participation in pre, intra, and post operative management is expected.

Outpatient Clinics
Longitudinal and consultative experience in the care of cardiac patients is obtained through outpatient cardiac clinics. There are both Adult and Pediatric Cardiac Clinics, the latter being under the supervision of the Pediatric Cardiology Section. Clinics meet once per week for four hours with the first year Fellow attending the Pediatric, and the second and third year Fellows attending the Adult Cardiac Clinic (thereby fulfilling the ABIM requirement of 24 consecutive months of clinic experience to acquired board eligibility).

Cardiac Rehabilitation
Bridgeport Hospital operates both Inpatient (Phase I) and Outpatient (Phase II and III) Cardiac Rehabilitation Programs. The Inpatient Program is directed by the Cardiac Rehabilitation Coordinator, who is the Department of Nursing. Experience with an exposure to this part of the Program is obtained during the CU/Cardiac Teaching Service Rotation. The Outpatient Program is coordinated with the Phase I Program that is under the Director of the Cardiology Section. Fellows interact with the Cardiac Rehabilitation Service during the Fellowship in order to gain experience in the proper writing of exercise prescription and monitoring of patient progress.

Cardiac Catheterization Laboratory
The laboratory facilities consist of a biplane suite which was opened in May, 1984, and a new C-arm, 2 table, “swing lab” which opened in June 1995. In addition to the laboratory, there are areas for patient preparation, recovery room, outpatient catheterization, cine film processing room, cine viewing, and administrative and conference office. Bridgeport Hospital was the first hospital in the state to perform PTCA and intracoronary Streptokinase reperfusion in acute myocardial infarction. As such, we have an aggressive interventional cardiology heritage in which our Fellows participate. During the three years of required Fellowship, Fellows spend sufficient time in the Catheterization Laboratory to become fully acquainted with indications for, performance and interpretation of catheterization studies. Fellows also participate in weekly Catheterization Conferences where case histories, cath data, films, noninvasive data and topics in invasive cardiology are reviewed. Because of the increasing sophistication of interventional techniques, to obtain certification of competency in interventional techniques, a Fellow would have to spend a fourth year devoted predominantly to Interventional Cardiology.

Cardiac Electrophysiology Service
The EP Service was initiated as a joint venture between Bridgeport Hospital and Yale University School of Medicine in July, 19992. Attending electrophysiologists are members of the Yale University faculty. The electrophysiology suite is equipped for invasive electrophysiology testing and tilt-table testing. Cardiology Fellows participate in the following activities of the Electrophysiology Service:

1. evaluation of inpatients and outpatients referred for evaluation of known or suspected arrhythmias
2. assisting with performance of procedures in the Electrophysiology Laboratory
3. interpretation of signal-averaged electrocardiography and holter monitors
4. attendance at Defibrillator-Pacemaker Clinic
5. participation and presentation of cases at the monthly electrophysiology conference.
   
   

Fellows will gain experience with all aspects of arrhythmia diagnosis and management. Those wishing to pursue a career in Electrophysiology will need to pursue opportunities for third and fourth year fellowships dedicated specifically to Electrophysiology at other institutions.