Division of Cardiovascular Disease Fellowship Training
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As a regional tertiary care facility, DHMC serves as a resource to regional hospitals and health care providers throughout New Hampshire, eastern Vermont and parts of western Massachusetts. In its role as an academic medical center, DHMC is a significant contributor to ongoing research in the field of cardiology as well as many other areas of medical science.
The cardiology division participates as a key component of the Dartmouth-Hitchcock Heart and Vascular Center which offers coordinated patient care, training and research across the disciplines of cardiology, vascular surgery, cardiothoracic surgery and cardiovascular interventional radiology and imaging. Aligned with the clinical enterprise is the Heart and Vascular Center Basic Science Research Laboratories which conduct bench and animal preclinical research studies. Other areas of research interest include cardiac epidemiology, outcomes and decision-analysis, therapeutic catheterization, device development, echocardiography and electrophysiology.
Facilities
Cardiology fellows do most of their training at the Dartmouth-Hitchcock Medical Center main campus in Lebanon, NH. This state of the art facility opened in 1991 and has been substantially expanded since that time. The campus includes the inpatient hospital towers, operating rooms, diagnostic laboratories and critical care areas of Mary Hitchcock Memorial Hospital, the Dartmouth-Hitchcock Clinic offices, the Norris Cotton Cancer Center, Borwell Research building and conference facilities. The only other training site for cardiology fellows is the VA Medical Center in White River Junction VT. The VA rotation is a noninvasive consultative cardiology and ambulatory experience directed by VA-based cardiology faculty.
General Fellowship Structure and Curriculums
The ACGME-accredited training program in Cardiovascular Diseases at Dartmouth-Hitchcock has several fundamental goals:
- Achieve clinical excellence for all fellows in the diagnosis and management of the wide spectrum of cardiovascular disorders.
- Provide all fellows with complete familiarity in the performance and interpretation of diagnostic techniques and imaging modalities essential to current and future cardiological practice.
- Ensure that fellows obtain core knowledge in the areas of endothelial biology, cardiovascular genetics, pharmacotherapeutics, cardiac and vascular pathophysiology and cost-effective treatment strategies.
- Proved all fellows the opportunity and resources to engage in productive clinical or basic science research leading to publication.
Fellows are assigned clinical or laboratory rotations that accomplish the American Board of Internal Medicine requirement for 24 months of training experience. In addition, all fellows receive dedicated research time, varying from 6-10 months, assigned according to project viability. The rotation structure and associated curriculum statements for the general fellowship are as follows:
Clinical rotations:
- Cardiovascular critical care (CVCC): 2-3 rotations
- Intermediate coronary care unit (ICCU): 2-3 rotations
- Consultation service: 2 rotations
- VA Medical Center, White River Junction, VT: 3 rotations
- Vascular medicine: 1 rotation
- Congenital heart disease: 1 rotation
- Cardiothoracic surgical rotation: 1 rotation
- Ambulatory Clinic: one half day per week throughout fellowship.
Laboratory rotations:
- Cardiac catheterization laboratory: 4-6 rotations
- Cardiac electrophysiology laboratory: 2 rotations
- Echocardiography: 4-6 rotations
- Imaging (nuclear, CT, PET, MRI): 2-3 rotations
- Heart Station (electrocardiography, arrhythmia monitoring): 1 rotation
- Research curriculum: 6-12 rotations
Detailed documentation about the curriculum:
- Ambulatory Clinic
- Cath Lab
- Congenital Heart Disease
- Consultation
- Cardiac Surgery
- Coronary Care Unit
- Echocardiography
- Electrophysiology
- Heart Station
- Imaging
- ICCU
- Research
- Vascular Training
- VA Cardiology Training
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Cardiovascular Faculty
All of the faculty in the section of cardiology are full-time, salaried staff who are required to have ABIM certification in the subspecialty of Cardiovascular Diseases. The faculty have been selected because of their high-caliber clinical skills and dedication to teaching and research. All faculty participate to various degrees in the training and support of our cardiology fellows and they foster a collegial approach at all times. Staff cardiologists have acquired and maintain distinct skill sets as part of their contribution to fellow education and are listed below according to their areas of expertise. For a list with links to individual faculty members, please visit out staff page.
General Cardiology Staff
Bruce Andrus, MD, FACC
John Butterly, MD, FACC
Edward Catherwood, MD, MS, FACC (Section Chief and General Cardiology Fellowship Director)
Douglas James, MD, FACC
Alan Kono, MD, FACC
Daniel O’Rourke, MD, FACC (White River VA Medical Center)
Andrew Torkelson, MD, FACC
Jon Wahrenberger, MD, FACC, FAHA
Echocardiography Staff
Timothy Beaver, MD, FACC
Salvatore Costa, MD, FACC
Armin Helisch, MD, FACC
David Malenka, MD, FACC
Alan Opsahl, MD, FACC
Robert Palac, MD, FACC (Director, Echocardiography Lab)
Justin Pearlman, MD, PhD, FACC
Interventional Staff
James DeVries, MD, FACC
Bruce Friedman, MD, FACC
Bruce Hettleman, MD, FACC
John Jayne, MD, FACC (Director, Interventional Fellowship Program)
Aaron Kaplan, MD, FACC
Nathaniel Niles, MD, FACC
John Robb, MD, FACC (Director, Cardiac Catheterization Lab)
Electrophysiology Staff
Mark Greenberg, MD, FACC (Director, Clinical EP and EP Fellowship Program)
Barbara Gerling, MD, FACC
Peter Holzberger, MD, FACC
Rajj Sangha, MD, FACC
Paul Steiner, MD, FACC (Director, Electrophysiology Lab)
Associated Staff
Julianna Czum, MD (Radiology, Director of Cardiac Imaging)
The Cardiovascular Disease Fellowship offers a robust, multidimensional conference structure that supplements the core educational experience of the clinical, laboratory and research rotations. Conferences are held daily and are required attendance for trainees and specified faculty mentors.
Monday: Imaging (ECHO, MRI, CT, PET, perfusion) conference. Series covers the procedural aspects, indications, contraindications, case studies, interpretation.
Tuesday: Electrocardiography and electrophysiology, cardiac catheterization and hemodynamics
Wednesday: Interventional conference, morbidity and mortality
Thursday: Prevention series (lipid management, secondary prevention), Board review topics
Cardiology Grand Rounds (wide spectrum of topics from basic science to clinical, visiting professors and DHMC faculty)
Friday: Journal Club, Evidence-based case conference
Core competency series (Professionalism, Systems-based practice, Communication, Practice-based Improvement)
Mentored Research and Research Productivity
All cardiology fellows are required to participate in clinical or basic science research as part of their training experience. We offer structured mentoring and connection to a variety of established research enterprises. The goal is to ensure that fellows have a productive academic experience leading to the publication of book chapters, review articles, and abstracts and full manuscripts in high-quality journals. The following are some of the research components aligned with the cardiology fellowship at Dartmouth:
- Heart and Vascular Center Research faculty (formerly the Angiogenesis Research Center) (http://www.dartmouth.edu/~angio/)
- Northern New England Cardiovascular Study Group (http://www.nnecdsg.org/)
- Dartmouth Dynamic Registry (cardiac catheterization database approaching 20,000 patient entries)
- The Dartmouth Institute (http://tdi.dartmouth.edu/excellence.php)
ECHO-HeartLab Database
lReview-Andrus BW, O'Rourke DJ. Aortic Stenosis:An Update on Current and Emerging Therapeutic Options. Cardiology International 2007; 9(3):99-104.
lAndrus, O'Rourke DJ. Percutaneous and Surgical Treatment of Aortic Stenosis. Cardiovasc Ther 2006; 4(2):203-209.
Andrus BW, Baldwin JB. Valvular Heart Disease. London, Blackwell Publishing, 2006.
Zlotnick DM, Axelrod DA, Friedman SE, Chobanian MC, Catherwood E, Costa SP. Preoperative Echocardiographic Evidence of Pulmonary Hypertension in Deceased Donor Renal Transplant Recipients is an Independent Predictor of Early Graft Dysfunction: A Novel Oberservation. In press, Circulation. Fall 2008.
Olson JJ, Costa SP, Young C, Palac RT. Early Mitral Filling/Diastolic Mitral Annular Velocity Ratio Is Not a Reliable Predictor of Left-Sided Ventricular Filling Pressure in the Setting of Severe Mitral Regurgitation. J of Am Echocardiogr 2006; 19:83-87.
Fruechte EM, O'Mara JE, Burdulis E, Gama MA, Palac RT, Costa SP. A Comparison Study of
Reproducibility of Quantitative and Qualitative Echo-Derived Indices of Dyssynchrony. ACC, Chicago, 2008.
O'Mara JE, Palac RT, Fruechte EM, Greenberg ML, Gama MA, Costa SP. Regional Location of LeftVentricular Dyssynchrony is Associated with Extent of Reverse Modeling. ACC, Chicago, 2008.
Zlotnick, DM, Axelrod DA, Friedman SE, Chobanian MC, Costa SP. Pulmonary HTN Predicts Poor Outcome Following Renal Transplantation:Clinical and Echocardiographic Characterization. Amer J Transpl 2007; 7(s2):290.
Pastel L, Cardello A. Curcio N, Costa SP. Can a Calculating LDL and BP Goal per ATP III and JNC VII just prior to an Office Visit Help Close the Gap between Guidelines and Practice? ACC, Atlanta, 2006.
Helisch A, Wagner S, Khan N, Drinane M, Wolfram S, Heil M, Ziegelhoeffer T, Brandt U, Pearlman JD, Swartz HM,Schaper W. Impact of Mouse Strain Differences in Innate Hindlimb Collateral Vasculature. Arterioscler Thromb Vasc Biol 2006; 26:520-526.
Rajashekhar , Willuweit A, Patterson CE, Sun P, Hilbig A, Breier G, Helisch A, Clauss M. Continuous Endothelial Cell Activation Increases Angiogenesis:Evidence for the Direct Role of Endothelium Linking Angiogenesis and Inflammation. JVasc Res 2006; 43:193-204.
Nguyen LT, Murakami M, Zhang ZW, Ko I, Moodie KL, Helisch A, Deutsch U, Simons M. The Fibroblast Growth Factor System Promotes Arteriogenesis. Circulation 2006; 114:230.
Kim RJ, Gerling BR, Kono AT, Greenberg ML. Precipitation of Ventricular Fibrillation by Intravenous Diltiazem and Metoprolol in a Young Patient with Occult Wolff-Parkinson-White Syndrome. PACE 2008; 31:776-779.
Lin GA, Dudley RA, Lucas FL, Malenka DJ et al. Frequency of Stress Testing to Document Ischemia Prior to Elective Precutaneous Coronary Intervention. JAMA 2008; 300:1765-1773.
Brown JR, Malenka DJ et al. Transient and Persistent Renal Dysfunction Are Predictors of Survival After Percutaneous Coronary Intervention:Insights from the Dartmouth Dynamic Registry. Cardiac Cath Interven 2008; 72:347-354.
Zacharski LR, Chow BK, Howes PS, Shamayeva G, Baron JA, Dalman RL, Malenka DJ et al. Decreased Cancer Risk Following Reduction in Iron Stores in Patients with Peripheral Arterial Disease. J Natl Cancer Inst 2008; 100:996-1002.
Malenka DJ, Kaplan AV, Lucas FL, Sharp SM, Skinner JS. Two-Year Outcomes of Coronary Stenting in the Era of Bare Metal versus Drug Eluting Stents:Analysis of the Medicare Claims Made Data Base. J Amer Med Assoc 2008; 299:2868-2876.
Fitts JM, VerLee PM, Hofmaster P, Malenka DJ. Fluoroscopy-Guided Femoral Artery Puncture Reduces the Risk of PCI-Related Vascular Complications. J Interven Cardiol 2008; 21:274-278.
O'Connor GT, Olmstead EM, Nugent WC, Leavitt BJ, Clough RA, Weldner PW, Charlesworth DC, Uhlig PN, Sisto D, Nowicki ER, Cohn WE, Malenka DJ. Appropriateness of Coronary Artery Bypass Graft Surgery Performed in North New England. JACC 2008; 51:2323-2328.
Likosky D, Dacey LJ, Baribeau Y, Leavitt BJ, Clough RA, Cochran R, Quinn R, Sisto D, Charlesworth DC, Malenka DJ et al. Long-Term Survival of the Very Elderling Undergoing Coronary Artery Bypass Grafting. Ann Thorac Surg 2008; 85:1233-1238.
Brown JR, DeVries JT, Piper WD, MacKenzie TA, Robb JF, Hearne MJ, VerLee PM, Kellet MA,, Watkins MW, Ryan TJ, Silver MT, Ross CS, O'Connor GT, Malenka DJ. Serious Renal Dysfunction After Percutaneous Coronary Interventions Can Be Predicted. Amer Hrt J 2008; 155:260-266.
Goodney PP, Lucas FL, Likosky DS, Malenka DJ, Cronenwett JL, Fisher ES. Changes in Utilization of Carotid
Revascularization in the Medicare Population. Arch Surg 2008; 143:170-173.
Brown JR, Cochran RP, Leavitt BJ, Dacey LJ, Ross CS, MacKenzie TA, Kunzelman KS, Kramer RS, Hernandez Jr F, Helm RE, Westbrook BM, Dunton RF, Malenka DJ, O'Connor GT. Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery. Circ 2007; 1161:I139-I143.
Dacey LJ, Likosky D, Ryan TJ, Robb JF, Quinn R, DeVries JT, Hearne MJ, Leavitt B, Dunton R, Clough R, Sisto D, Ross CS, Olmstead EM, O'Connor GT, Malenka DJ. Long-Term Survival After Surgery versus Percutaneous Intervention in Octogenarians with Multivessel Coronary Disease. Ann Thorac Surg 2007; 84: 1904-1911.
Radford MJ, Heidenreich PA, Bailey SR, Goff DC, Grover FL, Havranek EP, Kuntz RE, Malenka DJ, Peterson ED,Redberg RF, Roger VL. American College of Cardiology/American Heart Association Task Force on Clinical Data Standards. Circ 2007; 115:936-943.
Zacharski LR, Chow BK, Howes PS, Shamayeva G, Baron JA, Dalman RL, Malenka DJ, Ozaki CK, Lavori PW. Reduction of Iron Stores and Cardiovascular Outcomes in Patients With Peripheral Arterial Disease. JAMA 2007; 297:603-610.
Sherman JA, Hall A, Malenka DJ, DeMuinck ED, Simons M. Humoral and Cellular Factors Responsible for Coronary Collateral Formation. Amer J Cardiol 2006; 98:1194-1197.
Kaplan AV, Mehran RR, Malenka DJ, Gross T, Baim DH. Post-Market Surveillance for Cardiovascular Devices:A Comprehensive Approach. Circ 2006; 113:891-897.
Lin GA, Dudley RA, Lucas FL, Malenka DJ, Vittinghoff E et al. Frequency and Predictors of Stress Testing Prior to Elective Percutaneous Coronary Interventions in a Medicare Population. J Am Coll Cardiol 2008 (Supple A); 51:A379.
Likosky DS, Dacey LJ, Baribeau Y, DiScipio AW, Leavitt B, Hernandez Jr F, Cochran R, Quinn R, Helm R, Charlesworth D, Malenka DJ et al. Development and Validation of a Prediction Model for Strokes Following Mitral Valve Surgery. J Am Coll Cardiol 2008 (Supple A); 51:A271.
Ryan TJ, Robb JF, Kellet MA, Hearne MJ, Silver TJ, Phillips W, Wharton TJ, Piper WD, Malenka DJ.
Angiographic Success Rates with Chronic Total Occlusions-Little Change Despite a Decade of Experience. JACC 2006;47:252A.
Fitts JM, Silver TM, Hearne MJ, Ryan TJ, Robb JF, Kellett MA, Wharton TP, Phillips W, Piper WD, Malenka DJ.Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in Women versus Men 1995-2004. J Am Coll Cardiol 2006 (Supp A); 47:184A.
Tirziu D, Chorianopoulos E, Moodie KE, Palac RT, Zhuang ZW, Tjwa M, Roncal C, Erikson U, Fu Q, Elfenbein A, Hall AE,Carmeliet P, Moons L, Simons M. Myocardial Hypertrophy in the Absence of External Stimuli Is Induced by Angiogenesis in Mice. J Clin Invest 2007; 117(11):3188-3197.
Chittenden TW, Claes F, Lanahan AA, Autiero M, Palac RT, Tkachenko EV, Elfenbein A, Ruiz de Almodovar C, Dedkov E, Tomanek R, Li W, Westmore M, Singh JP, Horowitz A, Mulligan-Kehoe MJ, Moodie KL, Zhuang ZW, Carmeliet P,Simons M. Selective Regulation of Arterial Branching Morphogenesis by Synectin. Devel Cell 2006; 10(6):783-795.
Olson JJ, Costa SP, Young C, Palac RT. Early Mitral Filling/Diastolic Mitral Annular Velocity Ratio Is Not a Reliable Predictor of Left-Sided Ventricular Filling Pressure in the Setting of Severe Mitral Regurgitation. J of Am Echocardiogr 2006; 19:83-87.
Iqtidar AF, O’Rourke DJ, DiScipio AW, Palac RT. Hyperlipidemia, coronary disease, and aortic stenosis severity are important predictors of rapid aortic dilatation in adult patients with bicuspid aortic valve disease. Circ 2006; 114 (Suppl II):III-366.
Iqtidar A, O'Rourke DJ, Arbuckle BE, Discipio AW, Palac RT. Rapid Aortic Dilatation in Adult Patients with a Bicuspid Aortic Valve Is Associated with Risk Factors for Coronary Artery Disease. Circ 2006; 114(Suppl II):III-366.
Opsahl AR, Costa SP, Yang RC, Burdulis E, Pullen RJ, Palac RT. Left Ventricular Wall Motion Analysis:Are Current Generations of 3D Echocardiography Technology Adequate Substitutes for 2D Imaging? Circ 2006; 114 (Suppl II):III-366.
Huang H, Shen L, Zhang R, Makedon F, Saykin A, Pearlman JD. A Novel Surface Registration Algorithm with Biomedical Modeling Applications. IEEE Trans Inf Technol Biomed 2007 Jul;11(4):474-482.
Post MJ, Sato K, Masahiro M, Bao J, Tirziu D, Pearlman JD, Simons M. Adenoviral PR39 Improves Blood Flow and Myoardial Function in a Pig Model of Chronic Myocardial Ischemia by Enhancing Collateral Formation. Am J Physiol Regul Integr Comp Physiol 2006;290(3):R494-R500.
Huang H, Shen L, Ford J, Gao L, Pearlman JD. Early Lung Cancer Detection Based on Registered Perfusion MRI. Oncology Reports 2006;15:1081-1084.
Shen L, Zheng W, Gao L, Huang H, Makedon F, Pearlman, JD. Spatio-Temporal Modeling of Lung Images for Cancer Detection. Oncology Reports, Special Issue on Computational Analysis and Decision Support Systems in Oncology,2006;15:1085-1090.
Huang H, Shen L, Makedon F, Hettleman BD, Pearlman JD. Cardiac Motion Analysis to Improve Pacing Site Selection in CRT. Acad Radiol 2006;13(9):1124-1134.
See our current fellow roster for detailed information
For more information about cardiology fellowship at DHMC or for application and eligibility information, please select from the menu to the right.
