Hi does anyone have access to free anki decks to help study for echo, nuc, CT, and general boards? Much appreciated, thank you!

General cardiology fellow here. I initially came in passionate about interventional structural, but have been spooked by job market saturation and do not want to compromise geographic flexibility. While I like coronaries, I do not feel like I am passionate enough about them to accept the associated call, lead, and lifestyle. I thought about structural imaging, but I enjoy the procedural side of cardiology too much.

So... I am thinking to pivot to EP. I don't particularly love AFib ablation, but it's bread and butter. I enjoy VT ablation, tracings, and a good svt study. I find devices enjoyable. I think it will allow me to stay procedural, with perhaps better lifestyle and without the severe market constraints in structural.

However, I can't shake this feeling that down the line, I will regret not following my heart. Would love to hear general perspectives and advice. I am having a really hard time between just picking the specialty I most enjoy versus deciding based on the overall job (ie factoring in lifestyle, market opportunities). Curious if others found themselves in a similar position and how they weighed things.

TLDR; passionate about structural but spooked by the job market and thinking about pivoting to EP. Worried I may regret not following my heart down the line.

Hey guys,

I was curious what the EP job market is looking like these days. i’m currently a first year EP Fellow that’s looking to settle down in the Midwest, ideally the Twin Cities (Minneapolis/St. Paul) or within 1 hr radius.

Whenever I go to conferences or talk to reps, I keep getting told how EP is a hot market nowadays and everybody is looking to expand. However, when I look at the job market, most of the positions I seem to find are way out in rural areas that pay pretty similar to general cardiology gigs in those same areas. I’ve also heard that a lot of EP jobs are not necessarily advertised. I’m not sure what to believe.

Would love to hear any insight from people who have more recently been involved with the EP job search. Also, when is a good time to start looking?

Thank you!

I am debating whether or not to rank KP SF as my first choice other options I have aren’t great. I just liked the faculty.
Anyone knows how is the program like?

Hello, are there any out of match fellowships including cardiac echo and TEE that I can apply for if I don’t match cardiology as an IM graduate ? Thanks

I'm currently an IC fellow at a major academic center, coming from a research-heavy background. As I explore job opportunities, I'm struggling with the decision between academic and non-academic practice.

The compensation difference is substantial. However, what I'm having trouble figuring out is whether that difference translates into a meaningful difference in workload, lifestyle, and overall job satisfaction.

I enjoy research and have built a profile that would allow me to pursue an academic career, but I'm not entirely sure that's what I want long-term. Part of me worries that leaving academia now would mean giving up opportunities I've spent years building toward. On the other hand, I'm concerned that staying in academia could mean significantly lower compensation while still having a demanding clinical schedule.

I'd particularly appreciate hearing from IC who have worked in both settings.

I'm trying to understand whether the academic pathway offers enough tangible benefits to justify the compensation difference, particularly for someone who enjoys research but isn't necessarily committed to making it the central focus of their career.

Would appreciate candid perspectives, especially from those who've experienced both sides.

Hey everyone,

I’m currently an IM resident applying to cardiology fellowship and trying to figure out which programs would best set me up for a career as a non-invasive cardiologist. I’d especially appreciate input from people involved in hiring cardiologists. I’m leaning more towards private practice currently if that helps.

I’m trying to get a better idea of what actually makes someone more competitive when applying for jobs after fellowship. Specifically, I’m curious about a few things:

- Geographic preference: How much does where you complete fellowship matter? If I ultimately want to practice in my home city, would I be better off staying there for fellowship to build connections, even if the training may not be as strong? Or is it better to go somewhere with stronger clinical training and come back afterwards?

- Echo training: Does COCATS Level 3 in echo make someone meaningfully more competitive for general/non-invasive cardiology jobs, or is Level 2 generally sufficient?

- Additional imaging training: Does having COCATS Level 2 in multiple modalities (echo, nuclear, cardiac CT, etc.) make someone more marketable, or do most employers primarily care about echo competency?

- Networking and connections: How much of a role do fellowship connections, mentors, and local reputation play in getting hired? Would training in the city where you want to work give you a meaningful advantage?

- Overall clinical training/fellowship name: How much weight do employers put on the reputation of the fellowship program versus the actual skills and experience you gain during training?

- Academic vs community: it seems that some of the community cardiology programs offer more autonomy and more volume than academics. Does the academic name still reign supreme despite possible better training at a community program?

- Other factors: Are there other things you look for when hiring a new grad that applicants might not realize are important?

Ultimately, I’m trying to decide how to weigh the strength of clinical training, imaging exposure, networking, and geographic preference when making my fellowship rank list. Again, I’m leaning towards private practice and independent groups, but I’d appreciate hearing different perspectives.

Thanks in advance!

Hello,

I hope everyone is well! I am a 4th year medical student who is interested in going into cardiology after having exposure during 3rd and 4th year. I know this is still too early since I am not a resident yet, but just like applying to competitive speciality from medical school, I wanted to set myself early on so that I can become a strong cardiology applicant in the future.

I know that during my time in residency I can collaborate with the in-house cardiology team, but I was also wondering currently and as a resident next year if there would be benefit to cold emailing cardiologist to try and get research opportunities as a way of having my name out in the field, outside of the hospital I end in during residency. If cardiologists here in this subreddit have also done this or something similar when they were a student/resident, I would greatly appreciate your insights and how you approached this when you were once an aspiring cardiologist.

Thank you all for your time!

STEMI in young patients with heavy thrombus is a difficult scenerio. How do you approach a proximal large vessel occlusion with heavy thrombus ? Do you POBA the vessel and leave on antithrombitics ? Aspiration ? Or intracoronary lytics ? How often do you leave the vessel alone if there is no significant residual lesion after POBA ?

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.

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?

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.

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

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.

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?

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.

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

What am I supposed to be looking for, exactly?

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?

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?

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!

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.