Cook County Health offers a fully accredited, three-year fellowship training program.
John H. Stroger, Jr. Hospital of Cook County Fellowship Program in Cardiovascular Disease is a three-year program designed to train clinical cardiologists. The curriculum is organized to provide increasing levels of responsibility for trainees with respect to patient care and procedure performance. Adequate progression thorough the curriculum is assessed by evaluating each fellow’s clinical judgment, clinical skills, medical knowledge, procedural skills, professionalism, communication skills, leadership ability, and continuing scholarship.
Busy inpatient services (the coronary care unit and the consult service) as well as the outpatient clinics offer fellows ample opportunity for personal experience in the diagnosis and treatment of virtually every sort of cardiovascular condition. In addition, didactic sessions, conferences, teaching rounds, one-on-one experience with cardiology faculty, and external rotations at Rush University Medical Center and Advocate Christ Medical Center ensure that fellows receive a thorough education in cardiovascular disease.
To provide excellent training in all aspects of inpatient and outpatient clinical cardiology.
To provide excellent training in the selection, performance, and interpretation of noninvasive and invasive diagnostic techniques.
To provide fellows with the opportunity to perform a large number of diagnostic cardiac catheterization procedures as first operator during their training at Cook County Health, and also to participate in all percutaneous coronary interventional procedures.
To provide experience in the planning, performance, and interpretation of cardiovascular research.
Rami Doukky, MD, MSc – Chairman, Division of Cardiología
Bosko Margeta, MD – Director, Cardiology Fellowship Program
Tareq Alyousef, MD – Director, CCU and Medical Education
Vamsi Kodumuri, MD – Director, Peripheral Interventions
Yasmeen Golzar, MD – Director, Non-Invasive Imaging
Javier Gomez, MD, MSc – Director, Stress Testing Laboratory and Cardio-Oncología Clínica
Saurabh Malhotra, MD, MPH – Director, Advanced Cardiac Imaging
Victor Pelaez, MD – Hospital Providente
Grzegorz (Greg) Pietrasik, MD, PhD – Director, Electrophysiology
Nataliya Pyslar, MD – Director, Lipid Clinic
Abhimanyu Saini, MD – Director, Structural Interventions
Jonathan Tottleben, MD – Director of the Heart Station and Cardiac Computed Tomography
Neha Yadav, MD – Director, Cardiac Catheterization Laboratory
Henry Huang, MD – Electrophysiology
Karolina Marinescu, MD – Advanced Heart Failure
Clifford Kavinski, MD, PhD – Structural Heart Disease
Kousik Krishnan, MD – Electrophysiology
Parikshit (Parik) Sharma, MD – Electrophysiology
Tisha Suboc, MD – Advanced Heart Failure
Richard Trohman, MD – Electrophysiology
Cardiac Critical Care Unit and Cardiac Consult Service
All fellows have three months of CCU and three months of consult service experience during their fellowship. One CCU rotation and one consult service rotation are spent at Rush University Medical Center. The cardiac critical care rotation, in conjunction with the consult service, provides direct exposure to the essential evaluation and management of patients with acute, life-threatening cardiovascular disease and conditions. The fellows will achieve competency in appropriate and safe transitions of care in critical care environment and out of critical care environment. This rotation provides the opportunity for fellows to participate in interdisciplinary care teams.
Cardiac Catheterization Laboratory
All fellows must have a minimum of four months (majority have eight months) of direct cardiac catheterization experience. During this rotation, fellows are responsible for pre-procedure assessment, they are the primary operators from access until the end of the diagnostic procedure, they participate as a secondary (and sometimes primary operators) in coronary intervention as well. Fellows average 300 to 400 cases during their fellowship.
All fellows have a minimum of six months of echocardiography experience (majority have eight months). The objective of this rotation is to provide a broad exposure to the field including an understanding of the fundamentals of cardiac ultrasound imaging and image acquisition, the approach to obtaining and optimizing images, as well as accurate interpretation of transthoracic, transesophageal, and stress imaging. All fellows would be prepared to sit for and pass the National Board of Echocardiography certification examination by the end of their second year of fellowship training.
Stress Testing and Nuclear Cardiología
All fellows receive two months of dedicated nuclear cardiology training at Rush University Medical Center and three months of training at Stroger Hospital of Cook County. The latter experience is combined with training in Cardiac CT and Cardiac MRI. The nuclear cardiology rotation provides direct exposure to the fundamentals of all aspects of nuclear cardiology, including SPECT / SPECT-CT myocardial perfusion imaging, SPECT 99mTc-PYP cardiac amyloid imaging, PET-CT myocardial perfusion Imaging, left ventricular radionuclide angiography (MUGA), PET-FDG inflammation imaging, and PET-FDG viability imaging. Fellow training encompasses the ordering and administration of radioisotopes, along with acquisition, and interpretation of nuclear cardiology studies. Furthermore, fellows are trained on employing best practices in radiation reduction. With our curriculum, fellows are credentialed to appear for and pass the Certification Board of Nuclear Cardiología (CBNC) by the middle of their third year of fellowship training. Fellows are expected to complete an 80-hour Authorized User course, as per NRC requirements, to be eligible for CBNC examination.
Advanced Cardiac Imaging
All fellows must complete a minimum of three months experience in Cardiac CT and Cardiac MRI, combined with nuclear cardiology training, at Stroger Hospital of Cook County. Additional months of experience is encouraged for those interested in achieving COCATS level II training in cardiac CT and cardiac MRI. Fellows are expected to critically evaluate clinical indication and appropriateness of testing, and protocol the studies to acquire diagnostic images. Fellows are required to actively participate in pharmacologic intervention, image acquisition and reporting of all studies, along with facilitating a monthly advanced imaging conference with the Department of Radiology.
All fellows have two months of electrophysiology experience, completed at Rush University Medical Center. During these two months, fellows develop an essential understanding of noninvasive and invasive electrophysiology techniques, arrhythmia management, and pacemaker interrogation. Under the supervision of the electrophysiology faculty, fellows are responsible for inpatient consultations, and help in the outpatient clinics. Starting in 2019, fellows will have the opportunity to participate in electrophysiology procedures at Stroger Hospital of Cook County.
Heart Failure and Transplant
This rotation is done at Advocate Christ Medical Center. The heart failure service rotation provides the opportunity to diagnose, evaluate and treat patients with a broad range of heart failure disorders. This rotation will allow the trainee to acquire the appropriate foundational tools to care for this unique population including knowledge pertaining to medical management, procedural techniques and advanced heart failure therapies including mechanical circulatory support. The rotation will also provide exposure to transplant medicine and management of patients both pre- and post-transplant.
los cardiology fellow is responsible for the evaluation and ongoing care of patients referred to the fellow in the outpatient clinic (half a day per week). Fellows will acquire the necessary skills to diagnose and manage patients with coronary artery disease, valvular heart disease, disease of the myocardium, disease of the pericardium and congenital heart disease, cardiac arrhythmias, conduction disorders and syncope. The Cardiología Clinic at Stroger is unique by allowing the fellows to deliver care, as primary providers, for their own panel of patients, where patients identify the fellow as their cardiologist, whereas in most other programs, fellows simply “tag along” in the clinic of a faculty member.
As there is high volume of acute presentations (including STEMI, post trauma cardiac tamponade) to our hospital, fellows do in-house calls.
During the call, the fellow would be responsible for supervising CCU residents.
The research experience provides the ability for cardiology fellows to directly participate in cardiovascular research and scholarly activity.
This includes exposure to conducting research, increasing knowledge of scientific methods and enhancing ability to critically evaluate published scientific data.
Each fellow selects a faculty mentor during his first year and initiates a research project depending on his/her interest. It is expected that these projects are presented at a national or international meeting or submitted to a refereed journal.
A series of didactic research lectures are delivered on a monthly basis, covering basic concepts in clinical research, such as writing a research proposal, organizing a database, data exploration, principles biostatistics, data presentation, and manuscript writing.
Some of the full journal articles or textbook chapters published by our fellows in the past two years:
- El Hangouche N, Gomez J, Asfaw A, Teshome M, Vij A, Campagnoli T, Matar R, Ali A, Doukky R. Impact of Pre-Transplant Mitral Annular Calcification on the Incidence of Cardiac Events After Renal Transplantation. Nefrología Dialysis Transplantation 2019; in press.
- Doukky R, Improvola G, Shih MJ, Costello BT, Munoz-Pena JM, Golzar Y, Margeta B, Bai CJ. Usefulness of Oximetry Paradoxus to Diagnose Cardiac Tamponade. Am J Cardiología 2019 Feb 1; 123(3): 498-506.
- Nigatu A, Yap JE, Lee Chuy K, Go B, Doukky R. Bleeding risk of Transesophageal Echocardiography in Patients with Esophageal Varicies. J Am Soc Echocardiography. 2019; in press.
- Doukky R, Nigatu A, Khan R, Anokwute C, Fughhi I, Ayoub A, Iskander F, Iskander M, Kola S, Sahyouni M, Karavatos K, Hota BN, Gomez J. Prognostic significance of ischemic electrocardiographic changes with regadenoson stress myocardial perfusion imaging. J Nucl Cardiol. 2018; in press.
- Ravi V, Iskander F, Saini A, Brecklin C, Doukky R. Clinical predictors and outcomes of patients with pericardial effusion in chronic enfermedad del riñon. Clin Cardiol. 2018 May; 41(5): 660-665.
- Lee Chuy K, Hakemi EU, Alyousef T, Dang G, Doukky R. The long-term prognostic value of highly sensitive cardiac troponin I in patients with acute pulmonary embolism. Clin Cardiol. 2017 Dec; 40(12): 1271-1278.
- Vij A, Golzar Y, Doukky R. Regadenoson use in chronic enfermedad del riñon and end-stage renal disease: A focused review. J Nucl Cardiol. 2018 Dec; 25(6): 2058-2068
- Kodumuri V, Balasubramanian S, Vij A, Siddamsetti S, Sethi A, Khalafallah R, Khosla S. A Meta-Analysis Comparing Percutaneous Coronary Intervention with Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Disease. Am J Cardiolog. 2018 Apr 15, 121(8):924-933.
- Vij A, Kodumuri V. Bivalirudin versus Heparin Monotherapy in Myocardial Infarction. N Engl J Med. 2018 Jan 18;378(3):298.
- Siddamsetti S, Balasubramanian S, Yandrapalli S, Vij A, Joshi U, Tang G, Kodumuri V. Meta-Analysis Comparing Dual Antiplatelet Therapy Versus Single Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation. Am J Cardiolog. 2018 Oct 15, 122(8):1401-1408.
- Hedayati T, Yadav N, Khnagavi J. Non-ST –Segment Acute Coronary Syndromes. Cardiol Clin. 2018 Feb; 36(1):37-52.
- Ravi V, Rodriguez J, Doukky R, Pyslar N. Acute Mitral Regurgitation: The Dreaded Masquerader. CASE (Phila). 2018 Jan 3;2(1):12-15.
- Doukky R, Fughhi I, Campagnoli T, Wassouf M, Kharouta M, Vij A, Anokwute C, Appis A, Ali A. Validation of a clinical pathway to assess asymptomatic renal transplant candidates using myocardial perfusion imaging. J Nucl Cardiol. 2018 Dec;25(6):2058-2068.
- El Hangouch N, Doukky R. Myocardial Perfusion Imaging for Transplant Evaluation. Hage (editor). Myocardial Perfusion Imaging (MPI): Performance, Potential Risks and Outcomes. Nova Science Publishers, Inc. 2018. Chap 7. 178-214.
- Aviral Vij, Neha Yadav. Optimal femoral artery puncture technique. In Large Bore Arterial and Venous Access: Best Practice, Advanced Techniques, Complications by Shroff and Pinto, editors. In press.
Conferences & Lectures
Daily morning conference. This covers a series of lectures that represents core structure for teaching. Lectures are given by Cook County Health faculty and select invited faculty.
Weekly collaborative conference with cardiothoracic surgery.
Monthly case-conference, focusing on management of interesting cases and challenging fellows with optimal management. Dr. Margeta with chief fellows prepare this conference to gain the most teaching value.
Grand rounds conference: every Friday at the Cardiología Conference Room at Rush University Medical Center, cases would be presented by Rush and Cook County Health fellows in the presence of faculty from both hospitals.
M&M conference: Once a month, a fellow would present a case that had a major complication to discuss implications and ways of improvement.
Journal Club: Once a month. During this conference a fellow presents one of the new articles and discussion would focus on clinical aspects as well as statistics.
Research Lectures: a series of didactic research lectures are delivered on a monthly basis, covering basic concepts in clinical research, such as writing a research proposal, organizing a database, data exploration, principles of biostatistics, data presentation, and manuscript writing.
In-service ACC exam – every year
For the past 10 years, our fellows’ mean score consistently ranked in is the top 2.5 percentile among > 200 program across the nation
In-service EKG exam – every year (Rush University and Stroger Hospital of Cook County fellows participate)
National Board of Echocardiography (NBE) – all of fellows are Echo Board Certified by their third year
For the past 10 years, our fellows had 100% participation with 100% passing rate
Nuclear Boards – nearly all fellows are Nuclear Board Certified (CBNC) by their third year
For the past 10 years, our fellows had 95% participation with 100% passing rate
ABIM Cardiovascular Medicine – all fellows take the Cardiología Boards immediately after fellowship
For the past 10 years, our fellows had 100% participation with 100% passing rate