Welcome to the Ohio-ACC FIT Bootcamp, chaired by Dr. Marissa Edmiston and Dr. Salvatore Savona. Here’s what you can expect:

• A new, focused topic each week
• Concise, high-yield teaching points
• An exclusive video for in-depth learning

This carefully curated content allows you to learn at your own pace, fitting seamlessly into your busy schedule. This Bootcamp is your launchpad to excellence in cardiology. Get ready to embark on this exciting journey of growth and discovery.

EPISODE 1 – Things I Wish I knew in the Beginning of Fellowship

We kick things off with a candid look at what it’s really like to be a first-year cardiology fellow—straight from those who have been there. In this episode, you will hear from three senior fellows, each now pursuing different subspecialties, as they reflect on their early days. They share valuable insight on time management, ways to utilize resources, staying open to every learning opportunity, and tips to explore subspecialty interests while staying grounded.Teaching points:

• Embrace the learning curve. Be humble and proactive. Ask questions early.
• Structure your learning. Try to utilize high-yield resources such as ACC question banks, podcasts, concise textbooks.
• Leverage all your learning opportunities. But remember, there is no one better to learn from than the patient.
• Seek mentorship and build your professional network. Stay open and flexible with where your career is going to go.
• Don’t forget to focus on wellness and personal growth.

EPISODE 2 – Basics of Coronary Angiography

As you start fellowship, two of your core early rotations will be in the cath and echo lab. The next video introduces key coronary angiography concepts- standard views and essential nomenclature. STEMI and cardiogenic shock will quickly become familiar territory, so this video also includes an overview of cardiogenic shock and mechanical support strategies including impella and intra-aortic balloon pump.

Teaching points:

• Learning coronary angiography nomenclature is the first important step of your cath lab rotation
• Basic orthogonal projections are essential to assessing coronary arteries and stenosis severity- typically a combination of RAO/LAO and cranial/caudal.
• Identify standard views for coronary arteries and understand how to utilize creative angulations to enhance visualization of specific vessel segments.
• Identifying signs of shock such as hypotension, low output, and organ hypoperfusion is critical when deciding on the need for mechanical support.
• Understanding the physiology behind mechanical support devices like Intra-Aortic Balloon Pump (IABP) and Impella is foundational for device selection and escalation. Equally important is appropriate device positioning, familiarity with device interfaces and the ability to troubleshoot common issues.

EPISODE 3 – Basics of Echocardiogram

One of the most challenging and essential skills to develop during fellowship is learning how to perform and interpret transthoracic echocardiograms. Early on, your focus will be on mastering basic image acquisition, probe manipulation and identifying standard views. This next video introduces those foundational concepts to set the stage for your growth during the echo rotation. The goal is for you to gain the confidence and skill to independently perform an emergent echo- especially while on call overnight- to rapidly assess critical pathology at the bedside.

Teaching points:

• Sonographers are excellent resources to learn the basics of image acquisition and probe manipulation.
• Start with gaining an understanding of probe movements such as angulation, rotation, tilting to obtain images.
• The foundation of echocardiography is knowing the standard acoustic windows (parasternal, apical, subcostal) and identification of all structural visualized. Small adjustments to the transthoracic probe can be utilized to get core echocardiogram imaging views.
• Emergent echocardiograms are used for rapid bedside assessment to answer a particular question. Common indications for emergent echocardiography include: myocardial ischemia, ventricular rupture, outflow tract obstruction, cardiac tamponade, ascending aortic dissection, acute mitral regurgitation, pulmonary embolism, hemodynamic instability.
• Ultrasound enhancing agents can be used to further define endocardium and evaluate thrombus.

EPISODE 4 – Vascular Access & Related Complications

Vascular access is fundamental to cardiac procedures. Patient-related factors, including the type of procedure, can help guide the choice of vascular access. An awareness of potential vascular complications and prompt management are paramount to appropriate cardiac care.

Teaching points:

• Radial access for cardiac catheterization results in improved clinical outcomes and lower bleeding complications.
• Micropuncture access and ultrasound guidance helps to prevent access-related complications.
• Perform an angiogram prior to proceeding with an invasive procedure when using femoral access.
• Common complications include hematoma, pseudo aneurysm, retroperitoneal bleed, and AV fistula. Management of each is of utmost importance.
• Acute management of hypotension post procedure includes holding pressure at access site, reversing anticoagulation, resuscitation, etc.
• Radial access complications are rare, though include compartment syndrome.

EPISODE 5 – My On-Call Nightmares

This video goes through three separate cases with scenarios commonly encountered as an on-call fellow.

Teaching points:

• Learn how to triage acuity of patients and manage time early
• Become comfortable with all the tools necessary to manage cardiogenic shock, and act early
• Do not feel afraid to ASK FOR HELP!
• Hemopericardium should always have aortic dissection on the differential- perform a TEE emergently if too unstable for CT, call surgery immediately
• VT storm and have many etiologies (ischemic, electrolytes, etc), which should be pursued while stabilizing the patient (early cardioversion/defibrillation->BB->AAD->intubation/sedation->hemodynamic support)

EPISODE 6 – Arrhythmia Differentiation & Management

This lecture provides a foundation for the mechanisms and differential diagnosis of arrhythmias. It also explores the management of arrhythmias.

Teaching points:

• The main mechanisms of arrhythmias include reentry, automaticity, and triggered activity.
• First assess the hemodynamics, and if unstable perform prompt cardioversion/defibrillation.
• Determine if regular/irregular and narrow/wide to hone diagnosis.
• Narrow irregular- AF, MAT.
• Narrow regular- AVNRT, ORT, AT. Adenosine can be very helpful.
• Wide irregular- AF w/ BBB, pre-excited AF, PMVT/Torsades.
• Wide regular- antidromic tachycardia, SVT w/ BBB, ventricular pacing, MMVT.
• Become familiar with the ECG findings of pre-excited AF, as adenosine, AV nodal blockers, amiodarone should not be given. The patient should be promptly defibrillated if unstable, can consider procainamide or ibutilide if stable.
• When performing ATP/ventricular overdrive pacing of VT, be prepared to promptly defibrillate the patient if VT deteriorates to VF/PMVT.
• Follow ACLS if unstable.