Hello everyone,

I’m a Senior Registrar Cardiologist with completed training in general cardiovascular medicine and a fellowship from the Egyptian Board of Cardiovascular Medicine. My primary interest lies in Heart Failure and Advanced Heart Failure, and I’m keen to pursue further training in this subspecialty.

Here’s my current situation:

I am not ECFMG certified (have not taken the USMLE).

I’m open to training opportunities in non-accredited programs or observerships, especially in English-speaking countries such as the US, Canada, UK, Ireland, or others.

My focus is on gaining advanced clinical and practical exposure in heart failure management, mechanical circulatory support, and heart transplant care.

I’d greatly appreciate your advice on the following:

1. Are there specific programs, hospitals, or institutions known for accepting international physicians for training in heart failure?

2. What are some alternative routes for gaining advanced exposure without ECFMG certification?

3. Any personal experiences, resources, or forums that could help me navigate this path?

Thank you in advance for any suggestions or guidance you can provide!

I have been a big fan of John Mandrola's "This Week in Cardiology" podcast for a long time. I really appreciated his critical appraisal of cardiology studies, his "medical conservatism" and his willingness to challenge the KOLs and other loud voices in medicine.

However, he seems to be becoming more of a nihilist, a luddite and a hypocrite.

I applaud medical conservatism and placing the onus of proof on those pushing new therapies, but one of the reasons that I got into cardiology is because it is an area in medicine where advances in technology has made real, meaningful differences in the lives of our patients. How can you not look at the history of Andreas Grüntzig and others' contributions to cardiology and not be proud and excited about the audacity and ingenuity of their work? We want new technologies and we want to use them to make a difference for our patients.

His latest take is that he is basically endorsing lower reimbursement for cardiologists because, well, I don't know why. Maybe because he already "got his" and is counting down towards retirement instead of trying to make it in a world where every aspect of practicing cardiology (form the patient relationships, to the pay, to the autonomy) is posing increasingly difficult challenges. Maybe it is because his focus is on flying around the world speaking instead of taking care of those patients that anchor the rest of us down to one location the majority of the time. Whatever it is, it seems tone deaf.

Have I become too critical?

Anyone have any good podcast recommendations that focus on EBM or critical appraisal for cardiologists?

I’ve been trying to understand how conclusions can be so straightforwardly drawn from significant composite endpoints when individual constituents of these endpoints fail to meet statistical significance.

I’ve noticed a few randomized control trials in cardiology that have buttressed clinical conclusions solely from composite endpoints that may have met statistical significance yet, when broken down by components that have defined the composite endpoint, statistical significance is no longer apparent. I know these composite endpoints are a strategy to lower sample sizes and increase event rates, but should we be more tempered in our interpretation in these instances?

A reliance on composite endpoints seems to represent a relatively handy way of performing these RCTs. However, how statistically valid is it to be inflating these composite endpoints with individual endpoints that really do not pertain to the question at hand? Appreciate your thoughts.

Does anyone have a copy and is willing to sell a copy of the mortara escribe or eli link pc software? Or is anyone able to recommend software able to read unipro files from the mortara eli 10?

Hi… Im a cardiology resident in Spain (here cardio its a residency, not a fellowship).

How difficult would it be to match a EP fellowship being an IMG with no letters of recommendation or observerships?

I could do the steps and get my ECGMG certification but I dont have the resources to do a rotation there.

I am a current 2nd-year fellow planning to applying to IC this coming cycle. I know that IC adopted a formal match this year and was hoping to hear from people who have just gone through it? How many interviews do you think one needs to safely match? Is it possible to match outside of your home program? Thanks!

I'm a relatively new IC attending, which means I'm starting to see the first wave of follow-up visits for patients I've stented. I've been disappointed in finding that so many patients return to me with complaints of fatigue, tiredness, and other vague symptoms.

I'm pretty meticulous with my PCI; routinely using IVUS, good post-dilation, maintaining therapeutic ACTs. It's not like I'm leaving a bunch of dissection flaps or dodgy distal flow. I walk away from most of my cases satisfied with the results, but nevertheless hear these same issues again and again.

My senior partners tell me not to worry about it. They'll give patients the 'ol "well, you're not as young you used to be" response. I was hoping for a more physiologic answer. While prepping for IC boards I came across chapters that discussed demonstrably increased cytokine levels in DES when compared to BMS or POBA, and thought that might be plausible. I'm not one to marry myself to "woo" theories, but I'm not quite sure how else to explain it to them.

Anyone have a better answer?

Hi! I'm an intern from Ukraine and i have maybe a stupid question. I'm not familiar with the terminology in English, so excuse me if I'm not making myself very clear. I've examined a patient (F, 70 yo) and when i measured her BP the pulse "strength" was different, although it was rhythmical. One beat was stronger the other almost indistinguishable. EKG foundings (i didn't take a picture unfortunately) were RBBB paired with AV 1 block, but sinus without any premature beats. My question is what could be the reasons for the pulse being so different? I know it's probably a dumb question, but i would like to hear your view on the subject. Thanks in advance! P.s. Echo was also without any significant changes

Hey guys,

I unfortunately didn't match to EP this cycle and was surprised by how competitive it's become. There were only two unfilled spots post-match, and each of those positions received 30-40 applications! Meanwhile IC had 56 unfilled and 70 unfilled (although I'm sure not all of them are "real" unfilled spots).

I'm trying to figure out the best way to approach this. I know I definitely want a career in EP, and I plan to reapply next cycle. I currently have a wonderful job as a general/imaging guy, and my colleagues have been very supportive of my EP plans.

I'm trying to decide between:

1. Staying at my current place and focusing on bolstering research. My CV was fairly healthy research-wise, so I'm not sure how much this would help. My current workplace is (pseudo)academic and has an in-house Cardiology fellowship, but no EP fellowship. My colleagues already offered to keep me on as I prepare to re-apply next cycle.

2. Doing a 1 year HF fellowship as a pathway to EP. Although I'm not passionate about HF, I'm curious enough about that I think I'd enjoy doing it for a year and then moving on to EP. Question is, will it be seen favorably by EP programs? I'd probably try to do this at a place with an in-house EP fellowship.

3. 1 year arrhythmia/research fellowship. Not many of these around, but found a couple. This would probably take me away from clinical medicine, which I'm not too keen about leaving.

Thanks for your thoughts. If any of you guys do hear of an open spot later this year or next year before July, please keep me in mind!

Declaration: 35yr experience UK acute physician (hospitalist). My local cardiologists (especially the trainees) seem to apply "type 2 MI" to any patient with even the most trivial of possible provocation. I was wondering what other people's perspective is? The 4th definition makes a distinction between myocardial injury (raised troponin) and myocardial infarction (troponin plus ST changes, new Q waves, new RWMAs) but the core mechanisms are pretty much the same - ischaemia imbalance. So I understand shock, severe hypoxia, tachy-brady arrythmias as mechanisms. But why are patients with a fever/raised markers from a UTI or LRTI but with normal saturations, normal BP and normal heart rates being called Type 2 - there is no significant increased cardiac work or impaired coronary flow in these cases. If on the other hand this is cytokine mediated upregulation of coronary inflammation and plaque events isn't it best to just call these provoked Type 1s and take them to the cath lab?

I'm having trouble understanding why Constrictive Pericarditis and Cardiac Tamponade have prominent/steep x descent in JVP. As, x descent is due to atrial relaxation, but in these cases there will be some obstruction which will not allow atria to completely relax and x descent shouldn't be steep.

So, if anyone can explain it then it would be helpful.

Hello,

I was looking to see if I can get any advice or suggestions for a gap year to bolster my application for next-year's cycle of fellowship apps. What is the outlook on a applicant who did a non-ACGME accredited program vs cardiology hopsitalist vs general hospitalist etc...

I am at a point where I want to keep pursing cardiology despite not matching, but I am unsure where to look for help since I am in a smaller community residency program. Any assistance is appreciated. Thanks!

I’m a junior UK cardiology specialist registrar currently learning to do echos. I’m able to do a full scan according to the BSE minimum dataset and can get good images compared to my peers. I know around 50% of what needs measuring and where on a basic TTE. I am struggling so much with learning to report though. We don’t have any formal teaching other than a sonographer helping with difficult windows or telling you what to write on the report. I’m struggling with how to go about learning it. I have signed up to an exam in the hopes that it’ll push me to learn more but I honestly don’t even know where to start. Are there any good resources that come recommended?

Cardiology fellow here. Im having trouble understanding the concept of HFpEF. Is HFpEF an specific disease of increased extracellular matrix and reduced distensibility that can be imitated by other disease such as AS, amiloidosis, HOCM, etc? Or is HFpEF a clinical syndrome caused by several diseases like the ones Ive mentioned?

If you read some review papers its says the first thing, that is an specific disease with its own histopathology, epidemiology, etc but if you read the definitions used by guidelines it just says its symptoms of HF with preserved ejection fraction and signs of elevated filling pressures… but that definition can be caused by many things!

Theres also a lecture on youtube of Mayo clinic boad reviews that explains using hemodynamic pressure profiles how HFpEF is unique and different from AS, HOCM, etc.

PGY5 and want to take echo boards in summer. Finished 1/4 of Klein… my goal is to do a second run of Klein before the boards

When should I started dedicated studying?

I’m planning to take the nuc boards in a few weeks. Looking for some motivation and study buddies to work through the material and tackle any tough spots. Let me know if you’re in!

Good Day! I'm 2nd year Physical Therapy Student, who have a Case Presentation about CABG x3

Our presentation is hypothetical only, because we don't have any experience about "real patient." My questions are:

1. What is the possible cause for third open surgery?
2. Is it okay to the 1st & 2nd CABG is Secondary to MI?
3. What is the possible diagnosis for the 3rd surgery?

I'm hoping for your response; your answer will be much appreciated.

Edit: I input a wrong heading. This is Question about CABG x3

Edit: Thank you guys so much for your opinions! 😊

I’m a USMD M4 set on cardiology who is currently applying to IM programs and very fortunate to have a strong list of interviews. My top two choices right now are Yale and University of Michigan, since they’re in desirable locations for me, have strong fellowship match lists, strong in-house cardiology fellowships, and will take their own for fellowship.

It’s difficult for me to separate them right now. I know it’s ultimately splitting hairs and I would love to attend either program, but I don’t get to rank both #1.

Which would you choose and why?

Any insight into strengths/weaknesses or other considerations for their respective cardiology fellowships?

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Hello everyone!

I’ve recently joined this community and I’m seeking advice or guidance from any sonographers who may have or have known someone who has ADHD. I’ve been diagnosed from a very young age but has been unmedicated for many years now, I’ve always wanted to do something with the cardiovascular system and I’ve come down to either CVT or Sonography, though I am worried that having it will make it much more difficult in the field. If you have any advice or know someone who has it as either career paths and are doing okay I would love to know what you did to help you through. I want to ensure I make the best decision for myself!

Hi all, trying to figure out what a decent first job out of IC training should look like. Have gotten an incredibly broad spectrum of schedules, compensation structures, and practice models, and having a hard time making sense of it all.

Personally looking for a smaller place where I can grow out of fellowship into a solid cardiologist/IC and build my skills and career gradually thereafter. Not interested in academics, research, teaching, or specializing further into CHIP/CTO/structural/peripheral off the bat. Not pursuing any particular HCOL areas; nor am I locked geographically. Eventually can see myself shifting more into a mixture of clinical and admin work.

What would a solid starting job look like for the above wants? Including clinic/lab/call schedule, CME, admin support, and compensation?

Any input very welcome! Thank you!

Edit: I am incredibly grateful for all of the responses! Thank you guys, this is all very helpful to hear

So I recently started a new position where I am overreading more ED and floor EKGs. There is a class of EKGs that I've had trouble deciding of how I formally want to read them, and I've run into them actually quite a few times (5-10 over the past 2 months)

They typically include the following characteristics:

1. Very young (i.e 15-25; I read pediatric ECGs)
2. Relatively rightward axis (i.e. right around 90)
3. Big giant S waves V1-V2 (i.e. >30mm im V2) with small R waves (i.e. <2mm)
4. Deep, even dominant S waves in V5-V6 (i.e. R and S wave both 15mm in V6) but with normal sized R waves
5. Other various abnormalities (i.e. biatrial enlargement, or Nonspecific T wave changes... not just isolated high voltages that is probably normal in a healthy young athletic person)

Its a clearly abnormal ECG, and I think its actually a finding of LVH with an atypical pattern in the lateral leads (With a borderline RAD being more related to the patient's young age than actual RV hypertrophy).

That says, it feels off to read as LVH with dominant S waves in V5-V6; I also didnt want to read as "possibles" in a clearly abnormal ECG.

It doesn't matter too much from a practical standpoint, the ECGs are abnormal and in an otherwise young, healthy person will lead to a referral... this is more of an art of medicine question to those more experienced than me.

Ive landed on reading it as "Ventricular hypertrophy with a non specific pattern", but "LVH, PO RVH" has crossed my mind as well to not try and get too cute. Curious if others have thoughts

IC currently practicing, wanted to get the feel of who uses lead caps in the Cath lab.

Some basic studies out there I’ve seen using detectors in and outside the cap with the use of the shield show negligible radiation.

Pro/against caps wanted to see if anyone had further insight. Been using one since getting out of fellowship almost every case.

Hello everyone!

I am looking for any advice or feedback. I am currently working in the business setting and looking to make a move into the healthcare field. I have always had an interest in being a Cardiac Tech. The dream would be to work in a Cath Lab. I am currently trying to find the smartest/ cheapest route for myself. I was thinking about getting my EKG Certification to start than potentially getting a hospital or company to pay for my schooling down the line. Any advice is appreciated!

I often see patients with chronic, bilateral, pitting edema in the outpatient setting. If BNP/proBNP and echo are negative for heart failure, can I consider a cardiac cause of the edema to be ruled out? Or is there another cardiac cause to consider? The reason I ask is because I recently talked to a vascular surgeon who said that more often than not the edema I described above usually has a cardiac or renal etiology.

Also, if I can't find a clear cause, does it make sense to put these patients on furosemide (if their potassium looks good)?

Obviously an overly sensational title, and Mandrola is known to be a skeptic (self-proclaimed medical conservative). The OPTION Trial compared LAAC to oral anticoagulation in patients who underwent catheter ablation for Afib, and found that LAAC was non-inferior to oral coagulation with regards to stroke, systemic embolism, or all-cause-death, and superior in reducing risk of non-procedure-related major or minor bleeding. The trial was highly discussed at the recent AHA 2024 meeting and may lead to widespread changes in Afib management, which Mandrola is evidently concerned about. I'm just a medical student, so my perspective is limited, so I'm interested to hear what people in the field think of this trial and Mandrola's criticisms.

https://johnmandrola.substack.com/p/electrophysiology-is-on-the-brink

Hey guys, just a lowly M4 here trying to decide where to spend the next few years, hoping this sub would be more helpful than r//medicalschool. I know this type of post might not be what you're used to here but I figured I'd get the most quality opinions from this subreddit!

So rank lists are due a couple months from now, but I’m already struggling to decide between UCI and Harbor-UCLA for a few reasons.

I’m set on pursuing cardiology, potentially interventional, so I’m trying to figure out which program would better position me for fellowship. Since both programs mainly match fellows internally, the decision really comes down to which has the stronger cardiology fellowship.

The issue with UCI is the lack of transparency. Their cardiology fellowship website barely provides any information, while Harbor’s site is much more detailed. Harbor also seems to have a stronger track record of taking home residents into cardiology (one year, they took 5 in-house residents for cards) and consistently accepts internal candidates for interventional. I found UCI’s fellowship match list on their Instagram page, but even then, it seems they’ve only taken a maximum of 3 internal residents per year into their cardiology program (even though they have a larger residency class than Harbor!), while Harbor has taken up to 5 per year. This makes me hesitant to rank UCI higher despite its academic reputation. Harbor also has a building dedicated to research while I've heard UCI residents have some trouble finding research?

I also slightly prefer Harbor’s location, but I don’t want that to be my main deciding factor. I'm essentially just basing my decision on which has the strongest cardiology program (since I'd likely be matching internally for both options).

TL;DR: I'm deciding between UCI and Harbor for residency, focusing on cardiology fellowship prospects since both primarily match in-house. UCI is more academic but lacks transparency about its cardiology program, and they seem to take fewer in-house residents for fellowship compared to Harbor, which has a stronger track record (up to 5 residents per year). While I slightly prefer Harbor’s location, my decision is ultimately based on which program offers better cardiology fellowship opportunities (for matching in-house, stronger program), and less likely to require a chief year.

​

If anyone has advice or insight, and if you can explain why you selected one over the other in this poll, I’d really appreciate it!

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Does anybody know an aproximation about the total duration of the videos of the ACCSAP program? I have about 3 months until my boards exams in my contrie, in wich i will have pleanty of time so i can run through them. Pretty sure i wont finish it, but i just may try.

I'm a current USMD M4 set on cardiology/EP.

I have Thaler's The Only EKG Book You'll Ever Need, but I want a deeper understanding of how surface ECG translates to what's physically happening over primary pattern recognition for my own curiosity.

From prior posts and looking at previews, it seems like Chou's Electrocardiography may be the best source for this but the most recent edition was published in 2008. Should I consider any other resources instead?

Per title. Ive seen Hospitalist/nocturnist position at Cardiology service. To me, this is kinda position to offload consult service. I passed initial IVs and soon IV w/group. To this point, i was sold this will help Fellowship matching. Be honest, Im not sure Im gonna apply fellowship in future (next cycle, definetely not applying fellowship). Your thoughts about this job? Pros/cons, longivity? Thanks in advance.

So this is more so to those of you who were debating between fellowships and finally decided. I am currently an intern and like Cardiology. I am about to start doing research and really get into the field. But still, somewhere in the back of my head, I keep thinking that this doesn't seem worth it. Cardiology is 3 extra years, and I am seeing on reddit some insane IM salaries that aren't as good as Cards but also not even close to as much work and obviously 3 less years of grunt work. Lot more call and midnight wake ups than our GI brothers and sisters. Way more hours (?) than PCCM. I guess my fear is that I'll do all this research, put in a bunch of hours, work my ass off during fellowship, and at the end look back and think that I wasted 3 years during which I could have made doctor money and done something else w my life w all the extra time I would have had off. Do any of yall regret going into Cardiology, or those of you who finished and are now attendings, would you say it was worth it, or would you rather have done another specialty/stayed as IM?

Partially asking this cuz a family friend of mine who is a Cardiologist even mentioned that he would want his kid to do GI, lot more chill, more money etc. And it kinda threw me off. So wanted to hear the truth of the matter from yall.