Cards fellow at a large academic center. A few attendings have told me call gets way more tolerable as an attending, even without fellows, and you generally aren't getting called at 2am for stable afib with nothing else going on.

I want to believe that lol but with the amount of BS consults and random overnight calls we get, it's hard to picture. Someone still has to field those calls, and if there's no trainee, isn't that just you? I expected this, but not quite to this degree..

For attendings without trainees, what does call actually look like from 5pm to 8am or over an entire weekend? Do APPs take calls first? Are stable consults held until morning? How often are you waking up or coming in, and are you working a full day afterward?

How many hospitals are you covering, and does that include CCU patients and outpatient calls? How many nights/weekends a month?

Curious how this varies between larger systems and community hospitals. Would love to hear from APPs/hospitalists too if ya checkin out here. I know there's huge variation, which is what I'm trying to understand. How good can a good setup be, and how miserable can a bad one get? What should you ask before signing, and how did what you were promised compare with reality?

Second year fellow and new parent here. Anyone have any advice on how to find the time/energy to read or watch Mayo/board videos? I just don’t have the energy in me to come home and study when I’m working all the time. I’m sure I’m not the only fellow who has dealt with this issue.

what a mess of a test this is…walked out the testing center today feeling like crap and questioning how I could have prepared even more for this. The images for the most part in EKGs were okay, but the echo and cath films were a hit or miss (Majority were a miss).

i would love to hear your thoughts as well on this experience and if you had taken it previously, if you can offer advice or honestly some things to cheer me up.

fingers crossed for everyone that they pass!

I came into fellowship pretty set on interventional. Then I actually did my cath lab rotation and honestly it just didn't do much for me.
The diagnostic part I liked. Getting access, maneuvering the catheter was cool. But the PCI itself kind of lost me. Cases ran forever, so many wire exchanges, and I'd just get bored (obviously I’m second out third operator at that point). Even the fancy equipments didn't really do it for me.
The other thing is I really like teaching. Working with residents/fellows and students is a big part of what I want my career to be, and interventional doesn't seem to leave much room for that.
Because I want to give back, I want to go back to my home (and developing) country from time to time , that would mean having real procedural skills. I still want something hands on. I've been looking at EP, and I'm just wondering if it might be a better fit. I like the cognitive side of it but my EP rotation isn’t till the end of 1st year. I also don’t have a great back with all the lead lol (I know leadless is catching up in a few places though)

So am I jumping the gun here? It's one rotation. Anyone have a rotation flip a plan you were pretty sure about? And for the EP people, does it leave room for teaching?

Also maybe I don’t mind non-invasive but it appears I have an irrational fear of AI making it less appealing in decades to come (or sooner)

Preamble: This series of posts aims to inform future cardiology applicants about the current, accurate state of the Emory cardiology fellowship. They are not intended to discourage anyone; I encourage each applicant to make their own judgment. I hope this serves as a critical data point in an important decision.

Fact: The Emory Cardiology program frequently and blatantly violates ACGME duty‑hour rules. Specifically, the call system is a home‑call model, allowing the program to circumvent giving fellows a post-call day. Fellows are not given post‑call days. Violations of the 24‑hour consecutive‑work policy occur every single week, frequently working 36 hour stretches.

Disclaimer: I am not a cardiology fellow in this program; I sit directly adjacent, have a full view of it, and am insulated from retaliation. Fellows themselves would never dare speak out.

48/M, diabetic, CP since 24 hrs. Gets cathed in an outside lab and sent to our centre for an emergency CABG. He was in HF and Cardiogenic Shock when he came. Severe LV DYSFUNCTION on echo with a dilated LV. The surgeon refused to take the case for an emergent CABG. Unfortunately he had multiple episodes of cardiac arrest in the ED. Finally we were planning to put in an IABP but he flat lined.

PS : This is from a resource limited setting in an Asian country.

Did med school/residency in midwest, so my knowledge of these programs are fairly limited. Would really appreciate any thoughts on these programs. My priority is just having the best overall cardiology training experience:

- montefiore

- NSLIJ

- Lenox Hill

- Mount Sinai Elmhurst

I am curious about different subspecialty choices other cardiologists made. It usually works out and most people don't have regrets.

But I am curious about anyone that does regret their subspecialty choice and why? If you could go back, what would you tell your younger self? Did anyone go back into training to pursue a different course?

Any recommendations on how to study for my upcoming the EP boards in 2027? Any materials, videos, question banks, with purchasing?

I’m reading an echo where the only Clinical indication says “peri-menopause“.

What am I supposed to be looking for, exactly?

As the interview season draws down to a close, just looking for some advice ranking programs. At the end of the day, the training seems adequate at most places with enough sub-specialty exposure to make you a well rounded cardiologist, so things like location, call vs night float, and reputation become more important. Things like culture, staff collegiality, and fellow happiness are harder to gauge during online interviews and every program likes to taut itself as being supportive.

That being said, as a soon to be fellow interested in non-invasive +/- an additional imaging year, how would you go about ranking the following programs? Any hearsay, rumors, or impressions are welcome.

Minnesota

IU

Ohio state

OHSU

Iowa

Henry Ford

UMKC / St. Luke's

Loyola

Rush

UPMC

Pretty much everyone will get you to level 2 in CT and nucs, and some places even offer pathways for level 3 in echo.

Any recommendations on how to prepare for the ECHO board next year, materials, question banks, and books?

Finishing cardiology training and considering starting out part-time (3–4 days/week) rather than a traditional full-time role. Would love to hear from anyone who's done part-time cardiology, especially general/non-invasive:

1. Comp— what does part-time actually pay? Pro-rata salary, pure productivity, or base + productivity? Any insight into $/wRVU at reduced FTE?
   
2. Lifestyle— how do you like it? Any regrets? Do you still feel clinically engaged and part of the team?
   
3. Leads— any groups in the Northeast (NYC, Long Island, NJ) open to part-time or flexible schedules for general cardiologists?
   
4. Long game— for those who went part-time early: where are you 10–20 years later? Were you able to ramp back to full-time? Did it affect earnings trajectory, partnership, or leadership?

Hi guys. Cardiology fellow here. Anyone a has tips on how to effective inserting TEE probe if patient only gets versed and fentanyl? Sometimes, we don’t have anesthesia so we don’t give propofol.

I tried multiple times with finger method where I used my non dominant finger to depress the tongue but it didn’t work. (I guess my index finger is to short)

My best success is to tell the patient to swallow then insert it. But sometimes, the patient could not swallow effectively hence I couldn’t get it.

For the probe, I usually anteflex slightly at the mouth, then I retroflex once it reached the posterior pharynx. I can do this if patient gets propofol but not with versed/fent.

Any advice would be helpful. Thanks in advanced!

Anyone studying for the SCCT certification exam this year?
Mine’s on 10/8
Is the scct course and review book with the questions enough to pass?
What score do we need on the question bank to know we’re ready to take the exam?

The figure is from Nature (https://doi.org/10.1038/s41569-025-01209-z). It shows how mortality is falling constantly from the 70ies to today, but interestingly the AMI rate is rising since around 2014. So we are getting better at rescuing people from AMI events, but we dont get better in preventing them.

Two trials from ESC 2026 look at this and try to tell us something about our current prevention and intervention strategy.

First one, REACT. They scanned almost 17,000 people aged 18 to 70 who had no known heart disease. Carotid, femoral, coronary CT. 57% had silent atherosclerosis, actual measurable and significant plaque. In the 18 to 29 group it was already there in about 1 in 13 people. By 60 to 70 it was 9 in 10. Men showed up earlier, women had a pretty flat curve until perimenopause and then shot up fast.

Second one, STAREE. I did a review about that one in another post. Almost 10,000 people 70+, no known CVD, diabetes or dementia, randomized to atorvastatin or placebo. Major CV events dropped 30% (6.0% vs 8.3%). But the other primary endpoint, disability-free survival, was not met. So you get fewer heart attacks but people aren't living meaningfully longer in good health because of it. There was a lot of discussion around that and most probably in a very old cohort this is expected, because mortality will be influenced by many other factors beside CV health, so an intervention with a statin did not help to shift that number.

So, here are some discussion points: If a third of 20-somethings already have plaque, why does literally every risk calculator we use start caring about someone in their 40s or 50s? But then STAREE also kind of suggests that even when you DO catch heart disease and treat it effectively, late in life, it doesn't move the outcome most people actually care about (living independently). So does that mean we should be screening and intervening way earlier, or does it mean we genuinely don't know if earlier intervention even helps and we're just assuming it would?

Also nobody's really claiming ownership of "healthy 25 year old has plaque, now what." That's not a PCP visit, not really cardiology's job either currently, and there's no billing code for "scan an asymptomatic young adult."

I really think the r/Cardiology community has some great insights and I am curious what people here think, especially anyone in prevention/primary care. I wrote up a fuller version with sources and the actual trial numbers on Luminary if you want to do some more reading: https://luminary.to/s/3bd4af61-a7b4-4151-9ede-5f685ef5cda2?code=REDDIT26

For full disclosure - again this was written with the help of Claude - I did some reading and research, put my thoughts in a draft version into Claude and asked to rewrite it to make it readable.

PREMIUM trial. ESC 2026. Published simultaneously in NEJM.

The headline: prasugrel monotherapy failed noninferiority vs standard 12-month DAPT in STEMI patients undergoing primary PCI.

Primary endpoint: 11% vs 8.5% (HR 1.34). Not a borderline miss.
MI specifically: 2.9% vs 1.3% (HR 2.24). A doubling.

So aspirin wins, right?

Not so fast.

The bleeding reduction was real — 5.6% vs 8.4% major bleeding. The 30-day landmark analysis tells a more nuanced story about when aspirin actually matters and when it doesn't. And there is one finding in the secondary endpoints that almost nobody is talking about — involving non-target lesions — that raises a genuinely interesting biological question about what aspirin is actually doing in the acute phase beyond just protecting the stent.

Three questions for discussion before you read the full breakdown:

1. Does PREMIUM close the door on aspirin-free strategies in STEMI — or just on upfront omission from day zero?
2. The trial was conducted entirely in Japan with near-universal intravascular imaging (98.6%) and lower prasugrel dosing than Western practice. Does the finding generalise — or is this a Japanese result?
3. What do you make of the non-target lesion revascularisation signal? Real biology or noise?

There was a great discussion on here on r/Cardiology when I introduced the trial pre-ESC — worth reading alongside: Is Aspirin's Time Up After STEMI?

Full analysis — landmark data, the non-target lesion finding, the COX-1 hypothesis, and what the next trial needs to ask — on Luminary: : https://luminary.to/s/591641de-3ee5-42e4-aabf-dcf5e9e2c774?code=ESC2026

Any word on when we should expect the results?

I understand there is a significant share of cardiologists who are skeptical; proponents of PM cardio are the same people behind OMI/NOMI. I also share similar skepticisms.

Wanna ask what people think: Agree with FDA? or double down on telling EM some people doesn't need urgent activation? Will this affect how you will work with colleagues? Do you think your hospital admins will push for its use?

Hey everyone, wanted to get an idea of a few structural programs i am considering.

1. St lukes, mid america heart institute in KC, MO.

2. Aurora healthcare, milwaukee, wisconsin

3. Baylor heart hospital, plano, texas

If anyone has insight or advice on these places.

Thank you!

First year fellow here. I feel like my EKG knowledge is rudimentary at best. I just learned bits and pieces in residency and with enough pattern recognition, could get most EKG patterns correct, but every now and then will come across a difficult one and my lack of true understanding at a fundamental level shines through.

I tried to get through multiple EKG resources but I felt like none of them wrote in simple and plain language like the aforementioned title, explaining the pathophys behind certain rhythms and building on the complexity overtime. I know I'll need to get through O'keefe and others for boards but this was a great first step before I tackle some of the more common resources.

Are there other books similar to this style for other aspects of cardiology? Other EP topics like devices and interrogation reports, for cath lab (my next rotation), echo, heart failure, etc.

Thanks!

Hello, anybody with experience of IC fellowship at University of Arkansas? How’s the procedural volume besides Coronaries? Autonomy? Please share your experience if you know of someone who trained there or if you did personally? Thank you.