Cardiovascular Medicine Facilities

Catheterization Laboratories

The Division of Cardiovascular Medicine at the University of Arkansas for Medical Sciences provides complete Invasive and Interventional cardiology services at the University Hospital and the adjacent Veterans Hospital.

At the University Hospital, the 3094 sq. ft. catheterization facility, completed in 1990, is contiguous with both the Intensive Care Unit and the Operating Rooms and includes an 894 sq. ft. catheterization laboratory with separate patient holding and monitoring areas. In February 2002 our UAMS cath-lab underwent major renovation with the installation of a GE Innova 2000 equipment with state of the art digital flat panel technology and a new GEMENT IV archiving system for storage of digital images.

The Veterans Hospital catheterization facility occupies approximately 2100 sq. ft. near the contiguous 16-bed Coronary Care and Intensive Care Units. It includes two laboratories, which store digital images in a server which can be reviewed from a different location within the hospital facility, and separate patient holding and monitoring areas. A 650 sq. ft. Siemens laboratory is due for renovation this year. The second laboratory equipped with Phillips INTEGRIS 5000 equipment was completed in August 1998.

Both the University and Veterans Hospital laboratories operate on a Marquette MACLAB hemodynamic monitoring system, which provides complete hemodynamic and oximetric monitoring, individual patient data storage, and an internal permanent database. The two systems interface freely. Both laboratories possess dedicated, on-site intra-aortic balloon equipment.

Invasive and Interventional services are provided by four Interventional Cardiologists with focused interests in clinical, cardiac catheterization and interventional-based investigation.

Electrophysiology

The Electrophysiology service is responsible for consultations in patients with arrhythmias and pacing or defibrillator problems. The clinical service also supervises the Arrhythmia and Pacemaker clinics at the University and Veterans Hospitals. Non-Invasive procedures include tilt table testing, Holter monitoring, and signal average ECG interpretation. Invasive Electrophysiology studies include diagnostic as well as interventional procedures and cardioversions. The projected volume of clinical procedures and visits is approximately: clinic visits/UAMS 700, clinic visits/VAMC 1000; non-invasive EP 1200; invasive EP studies 150; pacemaker/AICD implantations 100; consultations 400. A new Electrophysiology Laboratory is being built at the Veterans Hospital, which will give the electrophysiologists a static location for performing procedures.

The Electrophysiology rotation includes clinical evaluation of arrhythmias as well as direct experience in interrogation and programming of pacemaker and defibrillators, pacing techniques and catheter placement for Electrophysiology studies, and interpretation of multi-catheter electrode recordings

Non-Invasive Laboratories

There are two Non-Invasive laboratories in the Division of Cardiovascular Medicine, one at the University Hospital and another at the Veterans Hospital. Each facility offers state-of-the-art equipment and experienced technicians.

Both Non-Invasive laboratories provide facilities for transthoracic echocardiography, transesophageal echocardiography with multi-plane probes (Hewlett-Packard Omniplane), stress echo cardiography, 24 hour Holter monitors, treadmill stress tests, and signal-averaged ECG. Each non-invasive laboratory averages 200 transthoracic echoes each month and over 4000 non-invasive procedures annually.

All first year cardiology fellows are assigned to the non-invasive laboratory for 2 months. During this two-month rotation, a progressive exposure to non-invasive testing is planned. The fellow is expected to perform a minimum of two echocardiograms daily, as well as all measurements and calculations for each study. They are also expected to provide preliminary reports on all echos done in the lab for the attending physician's review and approval. Additionally, they are responsible for all treadmill stress tests and their preliminary interpretation as well as assisting in all other procedures that the non-invasive laboratory provides. The fellows are encouraged to take the initiative to familiarize themselves with all procedures and to actively learn these procedures through a guided, "hands on" approach. This approach enhances their learning experience and promotes an improved skill level when they return to the laboratory for another rotation in their third year of fellowship.

Intensive Care Units

Dedicated Cardiac Intensive Care Units at the University and Veterans Hospitals are capable of caring for all cardiac emergencies. The cardiac intensive care units have modern state-of-the-art patient monitoring systems and are well equipped with facilities for dual chamber temporary pacemaker and intra-aortic balloon pumps. The patient beds are compatible for fluoroscopy guided insertion of right heart catheters, pacemakers and balloon pumps.

The nursing staff is ACLS certified and receives periodic education in the use of balloon pumps, recognition of arrhythmias, and research protocols.

Daily teaching rounds are made by the cardiology attending where patient problems are discussed at length with residents and fellows on the rotation. The concept of team care is followed in the care of patients. Fellows rotating through the cardiac intensive care unit are an integral part of the team and facilitate the practice of evidence-based cardiology.

The cardiology staff participates in a number of Phase II/III clinical trials as well as investigator initiated research.

Cardiovascular Clinics

Cardiovascular clinic is conducted at the Veterans Hospital each Friday. Fellows see established cardiology patients as well as new consult clinic patients. Three Cardiology faculty members conduct clinic during the same hours as the fellows' clinic and are available for consultation. There are approximately 40 established patients and 15 new consult patients seen in clinic each Friday. All fellows excluding the senior fellow on the cardiac catheterization service at the Veterans Hospital and the first year fellow assigned to the cardiac catheterization service at the University Hospital attend clinic each Friday.

The University Hospital Cardiovascular fellows' clinic is held biweekly on Tuesdays and Thursdays. Four to five fellows attend on Tuesday and four to five others attend on Thursday. There are approximately 35 established patients and 8 new consult patients seen in each clinic on either day.

Heart Failure Program

The Heart Failure Program at UAMS is a comprehensive, multidisciplinary program to treat heart failure. Heart failure specialists, nurse coordinators, social workers and dieticians work closely to render state-of-the-art care to patients with heart failure. The outpatient clinics form an important part of the program with emphasis on aggressive outpatient management including telephone contact to provide the best quality of life and prevent readmission. Patients with advanced heart failure are treated with tailored management guided, when necessary, by hemodynamic monitoring. Heart transplantation is offered to select candidates with advanced heart failure who fail medical management.

The program is heavily involved in education of cardiovascular medicine fellows and physicians in the community to improve care of patients with heart failure, with special emphasis on aggressive neurohormonal blockade. Basic and clinical research is an integral part of the program, with a focus on attenuation of myocardial remodeling. Several innovative approaches are being pursued including biventricular pacing in advanced heart failure.

Heart Transplant Program

The heart transplant program at UAMS/CAVHS began in 1992 and today Arkansans are able to remain instate and obtain quality care for heart transplantation. Both hospitals offer highly qualified personnel and use state-of-the-art equipment in caring for heart transplant patients. The University of Arkansas for Medical Sciences and its transplant physicians are UNOS certified.

The program has transplanted 17 patients at UAMS and the success of the program is evidenced by survival rates that parallel national averages. A multidisciplinary team cares for transplant and pre-transplant patients.

UAMS/CAVHS offers top of the line facilities, including outpatient clinics, modern biopsy laboratories, ultra-modern transplant units, and highly specialized operating rooms. The recent acquisition of the "Heart Mate" left ventricular assist device offers another dimension of care to the pre-transplant patient. With state-of-the-art equipment and highly qualified physicians, nurses, and other truly dedicated personnel, heart transplantation will continue to be an important treatment modality for cardiac patients in and around the state of Arkansas.

The trainees have the opportunity to work extensively with the heart transplant team. They are involved in patients' pre-transplant work-up and follow-up of post-transplant patients. Duties include invasive and non-invasive diagnostic testing; following inpatients; and working with critically ill heart failure patients.