The rotations are structured to help fellows build their clinical skills, knowledge, and acumen across the spectrum of cardiology and to gain exposure to the inner workings of multiple hospitals in the Los Angeles area. Each fellow will also be able to structure additional rotations of interest on their own for their elective months.

The CCU is a 6-bed Unit which oversees critically ill patients presenting with a multitude of cardiac pathology, many of which are newly diagnosed. The CCU team is called the “C-team” and consists of 1 attending, 1 general cardiology fellow, 1 senior internal medicine resident, and 4-5 interns.

Harbor-UCLA also acts as a referring center for Olive View Medical Center as well as other centers who do not have capacity for complex percutaneous coronary interventions (PCI) or cardiac surgery. Harbor-UCLA is also a full time ST-elevation Myocardial Infarction (STEMI) Receiving Center (SRC) operating 24 hours a day providing primary PCI; as a result, post-PCI care as well as post-MI complications are treated in the CCU. Harbor-UCLA also receives referrals for advanced cases of Pulmonary Hypertension.

The C-team provides the following care:

• For patients in the CCU, telemetry, and stepdown beds
• For patients with critically decompensated congestive heart failure, patients requiring mechanical and pharmacologic inotropic support, cardiogenic shock, acute coronary syndromes, and malignant arrhythmias
• Periprocedural care of patients undergoing cardiac catheterization, structural heart procedures, and cardiac device implantation
• Patients with significant symptomatic coronary artery disease, congenital structural disease, severe valvular disease, or endocarditis

As the C-team fellow, you will:

• Head the C-team and teach residents and interns
• Insert pulmonary artery catheters for hemodynamic monitoring
• Interrogate implanted pacing devices
• Oversee cardioversion of arrhythmias (both electrical and medical)
• Interpret cardiac diagnostic studies
• Evaluate Emergency Room patients for admission
• Work with other departments on multidisciplinary care of complex patients

The cath lab offers the full complement of advanced coronary, structural, and valvular interventions and serves as a center for research in novel interventional and pharmacotherapies. Harbor-UCLA serves as a referral center for patients from across Los Angeles who need interventional care. Harbor was one of the first STEMI Receiving Centers in Los Angeles and remains one of the busiest SRCs in the county. Harbor has had a robust transcatheter valve replacement program since 2011 and was one of the first hospitals in the area to perform TAVR. Facilities include two state of the art Philips cath lab systems.

As the Cardiology fellow in the cath lab at Harbor-UCLA, you will:

• Participate in all aspects of procedural care, including getting arterial/venous access, engaging coronaries, deploying closure devices, wiring lesions, inflating balloons and more
• As the senior general cardiology fellow, essentially act as the interventional fellow
• Gain exposure to the following cath lab procedures:
  • Diagnostic coronary angiography/cardiac catheterization
  • Hemodynamic assessment of valve disease, structural heart defects
  • Coronary interventions including primary PCI, atherectomy, and thrombectomy
  • Percutaneous VAD and Intra-aortic balloon pump (IABP) placement
  • Physiologic Assessment (FFR, iFR) and Intracoronary Imaging (IVUS)
  • Peripheral vascular angiography and interventions
  • Percutaneous balloon valvuloplasty
  • Transcatheter valve replacement (TAVR)
  • Septal Defect Closure (ASD, PFO, VSD, PDA)
  • Alcohol Septal Ablation
  • Pericardiocentesis and Pericardiotomy
  • Pulmonary Angiography and Thrombectomy

The Heart Station provides high-quality noninvasive diagnostic testing for our patients including transthoracic echocardiography, transesophageal echocardiography and exercise and pharmacologic stress testing. The lab is equipped with state-of-the art ultrasound machines including Philips Epiq and IE33s systems. The lab performs over 6000 TTEs and TEEs per year and procedures include 3D echocardiography, intraoperative TEE, and TEE guidance for structural heart disease.

The Heart Station is accredited by the International Commission for the Accreditation of Echocardiography Laboratories (ICAEL), indicating a high level of quality care and standards for its patients.

As the Heart Station fellow, you will:

• Be exposed to a diverse range of cardiac pathology, often newly diagnosed
• As a first year fellow you will acquire and interpret TTEs
• As a senior fellow you will acquire and interpret both TTEs and TEEs
• Give a lecture once a month at echo conference

The CORE Unit is a 4 bed unit that was established by Dr. Charles McKay in 2008, with the purpose of acting as an extension of the emergency department. Fellows and Faculty in the CORE Unit work to provide same day, evidence-based quality cardiovascular care for a variety of cardiac pathology and risk stratification.

Although predominantly low and intermediate-risk chest pain patients are evaluated and risk stratified in the CORE Unit, a variety of other treatments are performed for patients that require same day treatment but would otherwise be admitted to an inpatient setting. As a result of this new model, the CORE Unit has enabled the hospital to appropriately admit more acutely ill patients and reduce ED wait times.

As the CORE fellow, you will:

• Risk stratify chest pain with exercise treadmill testing, nuclear imaging, and dobutamine stress echocardiography (referral to Heart Station and Nuclear Radiology)
• Treat decompensated heart failure requiring intravenous diuresis and same day/early discharge
• Perform echos for suspected structural/valvular disease
• Perform elective electrical/chemical cardioversion for arrhythmias
• Refer for same day cardiac catheterization for patients with high-risk findings or stress test results
• Monitor for arrhythmias
• Interrogate permanent pacemakers, implantable defibrillators, biventricular pacemakers for arrhythmias or suspected malfunction
• Establish continuity of care for patients who have been lost to follow-up, or require new cardiology care due to various circumstances (i.e., loss of insurance, relocation, etc.)

The EP lab is focused on both ablations of aberrant rhythms of the heart as well as device implantation. Harbor-UCLA is equipped with an advanced electrophysiology study (EPS) and ablation system, capable of performing complex ablations that present as de novo arrhythmogenic disease in the Los Angeles area. Cardiology and EP fellows are able to participate in device implantation, as well as being involved in catheter placement and interpretation of EP studies in order to build their understanding of the pathophysiology and treatment of arrhythmias.

As the Cardiology fellow on EP at Harbor-UCLA, you will:

• Participate in implantation of devices, including permanent/temporary pacemakers, Implantable cardioverter-defibrillators (ICD), and biventricular pacemakers/ICDs
• Place catheters and interpret EP studies localizing and terminating a multitude of disease states of both atrial and ventricular origin, including atrial tachycardia, atrioventricular nodal re-entry tachycardia (AVNRT) accessory bypass tracts (Wolff-Parkinson-White syndrome), atrial flutter, fascicular ventricular tachycardia, and right ventricular outflow ventricular tachycardia
• Be involved in other EP-related procedures, such as
  • Non-invasive Programmed stimulation (NIPS)
  • Transseptal puncture and retrograde approach for left-sided arrhythmias
  • Pulmonary vein isolation for atrial fibrillation
  • Elective electrical or pharmacological cardioversion
  • Procainamide challenge

The CT Scanner, or the Diagnostic and Wellness Center, has been a major center of research and development in the field of coronary artery calcium and cardiac computed tomography angiography (CCTA). Helmed by Dr. Matthew Budoff, it holds one of the most experienced research teams in the world and has been performing CT interpretation and has paved the way for the role of CCTA in the noninvasive diagnosis of coronary artery disease and anatomical visualization for over 20 years.

As the Cardiology fellow on Advanced Imaging at Harbor-UCLA, you can:

• Participate in the acquisition and interpretation of coronary CTAs, over 100 of which are done monthly
• Gain exposure to multimodality advanced imaging, including when performed by Dr. Jina Chung
• Correlate findings from echocardiography, CT, angiography and cardiac MRI through image acquisition, case interpretation, and teaching conferences
• Explore research opportunities with the CCTA team
• Enroll and participate in the Cardiac CT Training Certification course run by Dr. Matthew Budoff

The Liu Center for the Study and Treatment of Pulmonary Hypertension currently follows about 250 patients with pulmonary hypertension, and under the direction of Dr. Ronald Oudiz, has made invaluable contributions in improving our understanding of the complex pathophysiology that is responsible for the multiple forms of pulmonary hypertension. The Liu Center actively recruits patients for clinical trials of innovative treatments and participates in studies that drive guidelines for diagnosing and managing patients with pulmonary hypertension.

About 100-150 cardiopulmonary exercise tests are performed on these patients yearly, as well as 75-90 right heart catheterizations in which fellows get to participate in managing and diagnosing.

During their ambulatory PH Clinic rotation, Cardiology fellows can:

• Participate in Pulmonary Hypertension Clinic
  • Participate in the workup of patients with known/suspected PH
  • Become familiar with PH-specific therapies
  • Learn the risk assessment and participate in serial monitoring of PH patients on treatments
• Actively refer patients for evaluation of potential treatments

The cardiac catheterization laboratories at Good Samaritan are home to a high volume of some of the most cutting-edge interventional therapies in California. Fellows are able to participate in high level interventions that range from complex coronary, endovascular, structural and valvular interventions. There are four cardiac cath labs including modern hybrid rooms, and Good Samaritan participates as a STEMI Receiving Center in the Los Angeles County system.

As the Cardiology fellow on cath at Good Samaritan, you will:

• Participate in all aspects of procedural care
• Gain exposure to cath lab procedures at Good Samaritan not routinely performed at Harbor-UCLA, including novel structural heart disease cases, dialysis fistula diagnostic/therapies, and peripheral vascular interventions

The UCLA Cardiac Arrhythmia Center offers one of the most comprehensive programs in the United States to treat complex arrhythmias. You will get the opportunity to rotate with this team of electrophysiologists who are performing the most advanced procedures to diagnose and treat cardiac arrhythmias.

As the Cardiology fellow on EP at UCLA, you will:

• Participate in implantation of devices, including permanent/temporary pacemakers, Implantable cardioverter-defibrillators (ICD), and biventricular pacemakers/ICDs
• Place catheters and interpret EP studies localizing and terminating a multitude of disease states of both atrial and ventricular origin, including atrial tachycardia, atrioventricular nodal re-entry tachycardia (AVNRT) accessory bypass tracts (Wolff-Parkinson-White syndrome), atrial flutter, fascicular ventricular tachycardia, and right ventricular outflow ventricular tachycardia
• Gain exposure to how EP procedures are done at UCLA, including advanced VT ablation procedures, cardioneuro ablations, sympathetic ganglionectomies, laser lead extractions.

UCLA has a dedicated and integrated heart failure/mechanical circulatory support/heart transplant clinical service. The HF/MCS team evaluates 150-500 new patients for heart transplantation each year and performs approximately 40-100 heart transplants and 25-50 mechanical circulatory support device implants including Total Artificial Hearts each year.

As the Cardiology fellow on HF/MCS at UCLA, you will:

• Round on pre-transplant patients, post-transplant patients, patients on mechanical circulatory support devices, and patients presenting with graft rejection
• Participate in transplant selection committee meetings and discuss patient’s awaiting listing for transplant
• Scrub into right heart catheterizations and endomyocardial biopsies with the heart failure fellow and attending
• Have the opportunity to go on an organ procurement with the transplant surgeons
• Gain familiarity with different Mechanical Circulatory Support (MCS) devices, including normal function and how to troubleshoot device issues
• Learn how to manage post-transplant immunosuppressive therapy in both newly transplanted patients and patients who have developed rejection