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.

For the general cardiologists out there, any regrets about choosing general?

As a fellow contemplating general, I worry about:

• the grind and possibly higher burnout rate of doing outpatient clinic 3-5 days a week with 30-40 pts per day.
• lack of diversity of case and complexity in practice (it seems a lot of general cardiology is seeing palpitations and the like as our field gets more and more specialized)
• lack of diversity of what is done in daily practice (i.e. clinic vs reading vs procedure etc; more dependent on seeing higher volume of pts, as opposed to a subspecialty where you perform more different tasks throughout the week)

Of course there are many advantages to general and disadvantages to sub specialties but the above are personally meaningful considerations.

Would love to hear your thoughts. Thank you 🙏

Hi reddit. I am an intern planning to go into cardiology. I am spending the month on our gen cards service. We have sent a lot of HFrEF patients to the cath lab for revasc. Unfortunately, I have already seen some complications, multiple patients on dialysis that is attributed to the cath, as well as some CCU stays requiring MCS.

I read up on the REVIVED trial (as far as I know, the only RCT we have in this space) and it seems pretty damning. I listened to John Mandrola's take on it and I found it pretty compelling. I understand the diagnostic value of LHC for nailing the diagnosis. But outside of like, Left Main disease or symptomatic angina, why are we doing PCI for these patients?

I am a first year fellow at a community cardiology program with interest in applying for EP fellowship. Would like to know the competitiveness and how much research is involved in securing a spot. I also intend to apply broadly. Thank you

Hi there.

I have read that amiodarone should be avoided in pre-excited atrial fibrillation due to a potential AV nodal blocking effect which may excacerbate the problems causing even faster ventricular rate and possibly degeneration to VF, the same argument for not using other AV nodal blocking agents such as beta blockers. However, I have asked some of my older colleagues some of which are quite competent in arrhythmias and they do not show this concern and say amiodarone is OK. Do any of you have any thoughts / experience / input towards this? I know flecainide can be used, and often these patients are younger without concerns of structural heart disease but flecainide is more finicky than amiodarone. Of course, there is still DC cardio version but if we want to use drugs. I have never had such a patient in real life.

Hypothetical question: Is a research year at an academic institution the best move that would significantly help a community IM resident grad match cardiology? Or is taking a hospitalist job at an academic hospital and networking with their cardiology department a better move?

Hey cardiology friends,

Anesthesiologist here. Have had a situation arise a few times over the past year and was hoping to get some expert input:

Elderly patient (~70y/o) shows up with little/no prior medical care, found to have a large (7cm or more) AAA which requires relatively urgent repair (~25% or higher chance of rupture in 6 months, so not looking to delay surgery by much if at all). Either low functional capacity, or unable to assess due to mobility. EKG with some chronic looking changes, maybe LBBB, but nothing acute. Echo largely unremarkable. Maybe some DOE but otherwise no acute symptoms. Can be either open AAA or endovascular repair.

My questions would be:

1. Would this patient benefit from cardiac consult prior to their surgery? If so, what would that look like? According to these guidelines from Society for Vascular Surgery, this patient would qualify for cardiac risk stratification: "In patients with significant clinical risk factors, such as coronary artery disease, congestive heart failure, cerebrovascular disease, diabetes mellitus, chronic renal insufficiency, and unknown or poor functional capacity (metabolic equivalent [MET] < 4), who are to undergo OSR or EVAR, we suggest noninvasive stress testing."

2. What sort of workup/eval would you do? What questions would be important from a risk stratification standpoint?

3. Can you actually stress test patients with large AAAs? Literature shows 6-7cm seems to be safe, but not much data on anything above 7cm. Or would you go straight to angio if concerned?

4. Other thoughts/things to know?

Thanks ya'll!

Hi, I'm a first year med student, wanting to learn more about cardiology. I've loved everything about cards, the ability to have meaningful procedures and medicine, the mix of complex and more straightforward patients, and the impactful patient interactions you can have. The only thing I really wonder about is the problem solving in cardiology.

I've really liked the kinds of things where you are given a bunch of info about a patient and its up to you to figure out what is going on and how to treat them. Is there much of that in cardiology? From my extremely limited exposure to the field I haven't seen too much of that aspect which is why I ask. Additionally, what types of problems are cardiologists generally solving? Are they complex and requiring some real thought or are many of them just routine? Thanks so much!

Does anyone have a log-in that they would be willing to share with me? Trying to do some last-minute board prep but the price for the subscription is crazy. Would be willing to pay you some amount to get access to it. Thanks!

TL;DR: How much dexterity is necessary to be successful in interventional fields?

I'm nearing the end of my studies and am increasingly focused on choosing my medical specialty.

Cardiology has brought me a lot of joy during my studies, so it's likely my first choice. In particular, I was fascinated by the catheter lab, where I spent a week during an internship. I got to see everything from heart valves to stents.

I feel the same fascination for interventional radiology, although I generally prefer cardiology outside of interventions. But that's not the main focus here.

I’m aware that interventions in both fields are popular bottlenecks, and it may take a long time before you can actively work in them. This makes me worried about working toward something that I might not be good at or may not be able to properly learn.

I would describe myself as only averagely dexterous or skillful, and I’m concerned that I won’t be able to get the hang of it, or that I’m not suitable for the training. Also I'll be 31 when I start residency, I'm a little bit afraid that that age will be a factor also.

Perhaps some of you can share your experiences – I’d greatly appreciate your responses.

Hello, I am a perfusionist and trying to better understand the IABP wave form. I understand the basics but I just want to have a better grip on the cause and effect. Here is one example waveform and if someone could help me understand what would be the difference between lack of trigger and no augmentation that would be great. I assume early inflation and late inflation are incorrect assumptions based of the position of dicrotic notch? The Arterial wave seems to been unaltered so i would assume there is simply no augmentation occurring? if there is, i'm not sure what would cause this appearance besides lack of trigger possibly from failed to open balloon.

Any explanations are welcomed and appreciated thank you!

I am NOT looking for abcd answers, I have a key. Just want to understand because there's no explanations.

Hey everyone,

I’m a PGY1 at a mid tier academic IM program. I have no research on my resume. Was wondering how much cardiology research someone at a mid tier program needs to have a high chance at matching, assuming everything else on my resume is average?

Hi, I’m a PGY 2 IM resident interested in cardiology. I was wondering if anyone knew good/free resources to learn cardiac imaging modalities including echo, ct , mri and nuclear tests

Hello,

Cardiology fellow here. I've wanted to do IC since end of medical school. However, after a couple of years of rotations with wearing lead, I've developed some back pain. Usually 2 or 3 out of 10, but 5 or 6 when it flares after a long case. My MRI showed osteophytic complexes and multilevel facet arthrosis. Didn't know what to make of it. I'm in my 30s. My PM&R doc said I have signs of arthritis and that it could get better with strengthening exercises.

So I find myself at a crossroads. On one hand, I don't want to make a rash decision and not do IC when this could get better with improved conditioning and better posture. On the other hand, part of the lack of conditioning is the time demands of the training. And if I'm already showing signs of arthritis at this age, is it worth it?