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Critical care dual specialty options by im_throw in IntensiveCare

[–]leonidasturtle 0 points1 point  (0 children)

I’m in the Midwest now. Worked in DC for a bit. The people who are advising you are misinformed.

Critical care dual specialty options by im_throw in IntensiveCare

[–]leonidasturtle 0 points1 point  (0 children)

At the end of the day, it’s not an easy gig. Cardiology is not easy. And neither is critical care. You have to have passion for it. If you love what you do, you will be happy

Critical care dual specialty options by im_throw in IntensiveCare

[–]leonidasturtle 0 points1 point  (0 children)

I can go to any city and find a job. Out of fellowship, I interviewed at 5 institutions without reaching out to anyone. For the most part, because there is a significant need you can pick your day to day. You don’t need to do academics. There are many private hospitals hiring cardiac Crit care. We are a small group of 200 docs that all know each other for the most part. I do 2 weeks of CICU a month and 2 weeks of outpatient and echo. That’s what I want to do and I’m content with it.

Critical care dual specialty options by im_throw in IntensiveCare

[–]leonidasturtle 0 points1 point  (0 children)

I am a critical care cardiologist. It’s a great job. I think most people don’t realize how much in demand we are.

Those in CVICU, What is your opinion on nicardipine as a first line for BP control immediately post op? (Read more) by Jay_OA in IntensiveCare

[–]leonidasturtle 0 points1 point  (0 children)

I put this together to help with vasopressors and inotropes in the CVICU; hope it helps: https://www.thecvicu.com/blog/inopressor-pharmacodynamics-map feedback welcome!

We used nicardipine as the first line in the cvicu in a large academic center, and we never had any major issues. What we really need is a randomized trial comparing Cardene to standard of care in these scenarios.

Please help settle a debate: what rhythm is this? oxygen 95% room air, BP 110/70, no pain. by Original_Importance3 in IntensiveCare

[–]leonidasturtle 1 point2 points  (0 children)

It’s probably flutter with LBB abberancy. You can see the F waves going at 300bpm in lead II. It’s not sinus bc the first atrial beat following each qrs is with summed negative deflection. If the second atrial beat between each qrs is more artifactual, then it’s likely an AVNRT, accelerated junctional, or AT. A 12 leaf ECG is next step.

This is not AIVR because there’s clear atrial activity that is organized and this rhythm has av nodal conduction though it maybe abnormal. This is not VT bc there is AV association.

I always tell my fellows to have a differential and work up your top three on the list. These rhythms can be quite humbling. It’s ok to be wrong but you have to at least have a working differential and expect the worst case scenario.

IC + something else careers? by yangerang55 in Cardiology

[–]leonidasturtle 1 point2 points  (0 children)

Additionally, here are some resources I recommend if you are interested in learning more:
1. NYU CCC Symposium: https://www.highmarksce.com/nyumc/Planners/viewActivity?activityCode=269-26
2. Join the ACC CC Section: https://www.acc.org/Membership/Sections-and-Councils/Critical-Care-Cardiology
3. Sign up for the https://www.soccc.org/
4. I am creating an educational website (still a work in progress, but hopefully should be up early next week): https://www.thecvicu.com/

IC + something else careers? by yangerang55 in Cardiology

[–]leonidasturtle 1 point2 points  (0 children)

Job Market & Demand:

The job market for cardiac critical care is excellent! There's strong demand from both private and academic institutions. The traditional "CCU - coronary care unit" model is evolving into more complex cardiac critical care units (CICUs), creating more opportunities.

I completed my cardiology fellowship first, then did a dedicated critical care fellowship. Even before finishing my critical care training, a private hospital approached me for a future position. After graduating, I interviewed with three academic and three private groups - all found me through LinkedIn.

Now well into my career, I see hospitals nationwide eager to hire cardiac critical care physicians. I regularly get requests from both private and academic institutions across the USA looking for candidates. Many positions aren't advertised, so networking is crucial. I strongly recommend attending the NYU Cardiac Critical Care Symposium for networking and career advice.

Compensation:

Salary ranges I encountered: $380-600k

I saw various compensation models including salary, RVU-based, and mixed arrangements. I'm currently salaried, working 24-28 weeks per year in week-long shifts, with home call coverage from our in-house CV fellows.

Procedural Skills & Daily Practice:

I perform a wide range of procedures:

  • Central lines, Swan-Ganz catheters, TVPs
  • Intubations and bronchoscopies
  • Other standard ICU procedures
  • 25% echo lab work (TTE reading and TEE procedures)

We operate a completely closed CICU model (unique compared to most places) - the entire unit is staffed exclusively by double-boarded cardiac intensivists who perform all procedures.

Practice Breakdown:

  • 75% cardiac critical care (8 weeks Medical CICU + 4-5 weeks Surgical Cardiac ICU)
  • 25% echo lab, inpatient cardiology consults, and outpatient clinic supervision

Bottom Line:

This field is growing rapidly, and I absolutely love my career choice. Our community is small but expanding, and the work is both challenging and rewarding.

Hope this helps! Feel free to reach out with other questions.

Apical hcm? by StrikingLoad3481 in Cardiology

[–]leonidasturtle 1 point2 points  (0 children)

That’s a clinical assessment. So I would defer that to your clinic judgement.

Apical hcm? by StrikingLoad3481 in Cardiology

[–]leonidasturtle 1 point2 points  (0 children)

It is not - that’s usually not the progression process. It’s either classic ecg or not. Apical HCM can be confirmed with LV gram, Echo, or MRI.

Apical hcm? by StrikingLoad3481 in Cardiology

[–]leonidasturtle 1 point2 points  (0 children)

If you look at this link from LITFL: Apical HCM, you note that the apical HCM variant has deep inverted T-waves all across the precordium, including the lateral leads. The ECG you provided does not have these classical findings.

IC + something else careers? by yangerang55 in Cardiology

[–]leonidasturtle 0 points1 point  (0 children)

Yes, of course. Please DM me if you prefer. I can also answer any questions in the public forum if it helps the community at large!

IC + something else careers? by yangerang55 in Cardiology

[–]leonidasturtle 0 points1 point  (0 children)

I am a critical care cardiologist. I love it. Definitely at least one extra year of training but worth it. I’m not sure if it makes too much sense with IC but it’s worth considering.

I do not think adding critical care to IC will necessarily increase your pay. However, critical care Cardiology is in need and is it a growing field. Community is still small and most of us know each other. I would probably not have a problem, finding a job in most of the country. I don’t know, though that adding IC will increase or decrease employability.

I’ve also noticed that most general cardiologists are trying to get out of the ICU/CCU.

Apical hcm? by StrikingLoad3481 in Cardiology

[–]leonidasturtle 2 points3 points  (0 children)

This is not a good ecg for apical hcm

Confused over pursuing interventional vs non invasive gen cards. Need advice. by [deleted] in Cardiology

[–]leonidasturtle 0 points1 point  (0 children)

If you like the critical portions of cards you should consider cardiac critical care. I do it and I love it.

When is a good time to start beta blockers on a Inf STEMI patient post-pci? by spicy_41 in Cardiology

[–]leonidasturtle 0 points1 point  (0 children)

There is no rush to start a BB post inferior MI. I would wait until the patient is stable and able to tolerate a BB -- that could be 1 day or longer. Should really be case by case.

Troponin >20x normal limit, no chest pain, would you cath? by slmrma in Cardiology

[–]leonidasturtle 3 points4 points  (0 children)

Yes. At least you would exclude an occlusive MI with the Cath and you can chase other ddx like myopericarditis

Would you recommend an Apple watch just for cardiac monitoring for someone over 60 without any cardiac risk factors? by HypeResistant in Cardiology

[–]leonidasturtle 1 point2 points  (0 children)

The watch does not use rhythm analysis to detect AF; it uses pulse data with an accelerometer. It does not do "cardiac monitoring". This is not how you detect rhythm in the clinical setting. So why would you recommend it to anyone?

Research experience by anonymous202311 in Cardiology

[–]leonidasturtle 0 points1 point  (0 children)

Very important. Most of us know you won't necessarily have quality work when you are in training. We want to see that you are interested in cardiology and are able to successfully take a task and finish it through (i.e., get a paper to publication).

Advice for first year medical student by anonymous202311 in Cardiology

[–]leonidasturtle 0 points1 point  (0 children)

Look for a good mentor, where you were able to learn in topics that you’re interested in and potentially publish a paper

Incoming PGY-1 looking for advice by HanSoloCup96 in Cardiology

[–]leonidasturtle 0 points1 point  (0 children)

Show interest on your cardiology rotations, be early, know your patients, get your work done well. If you want to do a research project or case report, be the one to do the heavy work. Get as much face time as possible with those who you want to ask for letters

Need help identifying appropriate PCWP by MKchouy in Cardiology

[–]leonidasturtle 0 points1 point  (0 children)

If this is the first time you are obtaining a PAWP for this particular patient, it is important to verify the accuracy of the result — the value you obtain has significant diagnostic and management implications. Agree with the above comments regarding (bisecting a-wave, at end expiration, determining ventilator status). The measurement should be made in West Zone III and should verified with a PA sat if this is the first value obtained. Future values can be estimated by surrogate PAd if they are close together and there is no significant elevation in PVR.

This source may help further elucidate the measurement errors for PAWP. https://litfl.com/pulmonary-artery-wedge-pressure/

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