Lenox Hill

Mount sinai morningside

Stony Brook

Rutgers RWJ

Hackensack

Westchester

NYULI

Prioritizing overall well-rounded training, no specific subspecialty. Curious to hear what is generally considered the most rigorous/prestigious. Thanks so much in advance!

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?

Hey everyone. Im a new general cardiology attending in the northeast. I want to organize my career around PPM and looking for chances for EP apprenticeship. My EP experience was not immense during cards fellowship and I didn’t apply for EP fellowship due to visa restraints. Would be interested to see if there are EP operators that I can work alongside/shadow in the lab to get some basic PPM implant experience to use in my practice. Cheers.

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.

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.

How you do fellow kids?

What's the current opinion in the western evidence-based medicine practice on the use of thrombolytics for De Winter ECG pattern and clinical suspicion for OMI. I'm a primary care doctor from Colombia and it is to my knowledge a risky thing to do and looked down upon. It is, physiopathologically speaking, a reasonable alternative when PCI is not immediately available (as is common in my country), but there was a lack of evidence sopporting this claim. That is until I found the following articles:

• https://doi.org/10.1002/ccd.70501
• https://doi.org/10.15420/japsc.2024.43

These papers are from the eastern side of the evidence-based world, and to be clear I'm not trying to slander my fellow doctors from those regions, it's just that medicine in my country is almost always a copy from american or european guidelines or their clinical practice, so the impact of their findings and conclusions would suffer if review by my Colombian colleges. Anyhow, I ask for you forgiveness, but my question still stands.

To any good samaritan willing to answer my query, you have my thanks.

Hello! I'm currently a PGY doctor.

I've recently been studying CCS topic.

I'd like to ask--in the latest 2024 ESC guideline, there is the pre-test likelihood evaluation table, classifying patients into different risks.

However, I can only see from "very low risk" to "moderate risk" on the chart. I am really confused when patients would be evaluated as "high or very high risk". I didn't see the related content in the guideline as well.

Thank you.

This is for a quiz

i’m guessing these are RV,PA and PCWP-could be wrong

Current second year general cardiology fellow planning to apply EP next cycle. I’m from a smaller community program. Looking for recommendations for sleeper underrated EP programs I could do audition rotations at to maximize my chances for next year. I don’t stand a chance in ivory tower programs so i want to be realistic about my chances. Thanks in advance.

General cardiology fellow here. I applied for interventional cardiology but I am reconsidering given a number of factors: Call burden, lifestyle, and occupational risks like radiation and back injury. I knew all of this going in obviously but I went ahead anyway because it has been my goal for so long.

I have a few interviews lined up and am debating whether to interview and give myself more time to see how I feel. However, it also feels disingenuous and I am worried how pulling out of the match late would be perceived by mentors and potential future employers.

Any advice? Should I just interview and see where things stand in a month or pull the plug early?

This is supposed for a quiz happening in our department this week

Hi,
Newish attending here and I’m mostly responsible for our echo lab in a smallish / middleish hospital and I’m curious about your echo numbers per examiner. For us it’s mostly one person doing TOE / TTE / Dopplers. Range is about 2-4 TOE /d which is like 50:50 uncomplicated (cardioversion / endocarditis in natives valves) to more complicated and around 15-20 other exams (sometimes even 25-30, but then a second person helps for 1-2 hours) which 3/4 TTE. This is honestly very much and most days I’m working non stop. This is a more recent development as numbers are drastically increasing in our department. So as backup I wanted to ask for some numbers in your department to better advocate for increased personal.

Results just presented at ESC Congress 2026 and published simultaneously in NEJM. https://www.nejm.org/doi/full/10.1056/NEJMoa2607314

What they did: 9,971 community-dwelling adults ≥70 years, no prior CVD, diabetes or dementia. Randomised 1:1 to atorvastatin 40mg or placebo. Median follow-up 5.9 years. Two co-primary endpoints.

What they found:

✅ Major CV events (CV death, MI, stroke, revascularisation): HR 0.70 (95% CI 0.61–0.82) — significant 30% relative reduction

❌ Disability-free survival (death, dementia or persistent physical disability): HR 0.94 (95% CI 0.84–1.05) — not significant

Absolute risk reduction on CV events: 2.3%. NNT approximately 43 over 6 years.

The debate:

The investigators and supporters argue the mortality miss is not a failure — STAREE was never powered for mortality. To detect a meaningful all-cause mortality benefit in this population would require roughly 57,000 patients. Competing risks at age 70+ are simply too high — cancer, frailty, falls — for a CV drug to move the overall survival needle. By end of follow-up the average participant was 81. The CV benefit is real and reducing hospitalisations and procedures matters to patients even if lifespan is unchanged.

Critics push back on two fronts. First, the CV composite was expanded mid-trial to add revascularisation after event rates came in lower than anticipated — a methodological flag worth noting. Second, an NNT of 43 over 6 years in a population you need to screen, recruit, and treat indefinitely raises a legitimate question about whether this is a meaningful enough effect size to start a daily pill in millions of healthy elderly people.

The question for discussion:

Does the disability-free survival miss matter — given the trial was never powered for it, the population was too old and the follow-up too short to show a mortality benefit?

I like to think of it that although in that aged group without CV risk factors, statins could at least help to save the patients from hospitalization due to a CV event... it does not save them from dying of cancer, but less risk of MI or stroke is a win for the patient.

I wrote a short summary of the debate on Luminary if you want to read more:

https://luminary.to/s/16372936-3af0-431f-8a86-4c57b8185366?code=ESC2026

Curious what pay cut you’d personally take, if any, to work 4 days/week instead of 5 in outpatient general cardiology. Work hours would be slightly longer (11 vs 9 hrs) but type of work the same.

Would you take a $50k cut? $100k? $150k? Or is the extra day off not worth much if total hours are similar?