Departments

Covering every aspect of health care for adults, Internal Medicine is the largest department in the Yale School of Medicine, and the largest clinical service at Yale New Haven Hospital. We provide comprehensive and specialized services in all areas in a variety of outpatient settings as well as the Veterans Affairs (VA) Connecticut Health Care System campus in West Haven. Our culture of collaboration and research gives patients access to expert opinions from nearly 1,000 doctors, as well as opportunities to get tomorrow’s health care today through more than 100 clinical trials. Most importantly, we attend to our diverse community of patients with compassionate, thorough care. Specialized care is offered in the following areas: Allergy & clinical immunology Cardiovascular medicine Digestive diseases Endocrinology General internal medicine Geriatrics Hematology Infectious diseases Medical oncology Occupational health & environmental medicine Nephrology Pulmonology, critical care & sleep medicine Rheumatology International reputation for work in understanding function, independence, and quality of life in older persons Key research breakthroughs of the past decade that include the development of a protective Lyme bacillus disease vaccine, exploration of the underlying causes of allergic disease, and the discovery of novel inherited immunological diseases Largest interventional cardiology program in Connecticut Major referral center for patients with type 1 and type 2 diabetes, as well as other metabolic conditions Nationally ranked program in kidney diseases and the largest kidney transplant program in New England, with multidisciplinary care clinics One of the largest peripheral vascular programs in the country, with leadership and participation in multiple new percutaneous device trials Once of only a few motility centers in Connecticut to provide all motility procedures and services Unique medical forensic exams for individuals with claims of torture who are seeking asylum in the U.S.

Our highly skilled cardiologists expertly treat and diagnose heart failure—a chronic, progressive condition in which the heart muscle can’t pump enough blood to meet the body's needs. In addition to caring for cardiac patients at Yale New Haven Hospital, we provide treatment to the rapidly growing number of outpatients living with heart failure in the community. We treat each patient with a personalized plan, carefully monitoring medications on an ongoing basis while minding other issues that affect cardiac health. We also educate patients and their families about lifestyle changes, prescribe and oversee exercise rehabilitation programs, and facilitate communication between the many professionals involved in outpatient care. Our physicians work as part of a multidisciplinary team to offer patients comprehensive care with the goal of prolonging their life and improving its quality. Treatment options may include medications, short- or long-term mechanical support, or heart transplant. Before treatment begins, we perform cardiac diagnostic procedures, such as stress tests, catheterization, and biopsies. We collaborate with cardiac-trained radiologists to provide noninvasive imaging studies including positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI), and 2D and 3D electrocardiography. At the Center for Advanced Heart Failure at Yale New Haven Hospital, we treat the full continuum of heart failure and offer a variety of medical and surgical treatment options. The center cares for patients with an LVAD (left ventricular assist device), a battery-operated mechanical pump that is surgically implanted and helps maintain the heart’s pumping ability when it can’t work effectively on its own. This is the only long-term mechanical circulatory support for patients otherwise ineligible for heart transplant. Our surgeons regularly perform heart transplants and LVAD implantations, and our heart transplant survival and post-LVAD rates are among the best in the region.

The Advanced Heart failure Program is a rapidly expanding service at the front lines of treating heart failure. Launched in 1988, the program builds upon decades of experience treating failing hearts. In 2019, we performed 49 heart transplants, putting us among the top centers of the country. Our left ventricular assist device program treats more cases than any other program in the Northeast. It provides heart pumps for patients who need support while they are waiting for a donor heart or who are ineligible for a transplant and need another permanent solution. Heart transplants are the gold standard treatment for patients with end-stage heart failure. But many face a long, difficult wait for a donor heart, and some don’t survive. Yale Medicine is one of a handful of centers in the country to push existing boundaries in heart transplant by aggressively seeking out donor hearts other centers turn down even though they may be suitable for some patients. This process, using what’s called “donation after circulatory death” (DCD) organs, is helping more of our patients get heart transplants sooner. What’s more, our one-year survival rates for heart transplants—93%—are better than the national average. Multi-organ transplants People who live with heart failure have a high likelihood of also having kidney dysfunction from a variety of causes, and this can be a limiting factor in being able to get a heart transplant. For these patients, our heart specialists collaborate with Yale Medicine’s world-class abdominal transplant team and have achieved a robust volume and successful track record in performing heart-kidney transplants. Pioneers in LVAD Yale Medicine helped to pioneer the use of left ventricular assist devices (LVADs), providing patients whose hearts are too weak to function on their own with implantable devices that can pump blood for them. Yale Medicine is one of the leaders in the Northeast in volume and outcomes with LVADs and is certified by the Joint Commission, the nation’s predominant standard-setting and accrediting body in health care. Each one of our patients is treated by a team that includes cardiologists, transplant surgeons, infectious disease specialists, nephrologists, critical care doctors, nurses, pharmacists, social workers, nutritionists, and transplant coordinators, among others. Transplant doctors at Yale are national leaders in the field. Currently, the presidents of United Network for Organ Sharing (UNOS) and the American Society of Transplantation are at Yale, and they have helped to write the guidelines for how to treat patients after solid organ transplants as the field advances. Outcomes above average Patients whose future once seemed difficult have survived for decades after a heart transplant or LVAD implant. The average one-year survival after a Yale Medicine heart transplant is 93%, which is higher than the national average. This is partly due to meticulous follow-up care that includes treatment with immunosu

At Yale Medicine, our cardiovascular physicians specialize in all types of heart conditions. Our expert teams focus on heart-related health issues, such as heart disease genetics, heart rhythm problems, heart failure, heart and blood vessel conditions, and heart transplants. Our cardiologists do more than just see patients; they also conduct research to learn more about the complexities of various heart diseases and investigate better ways to treat them. Through their work in five research centers at Yale our cardiologists participate in major research initiatives focused on all aspects of heart health. Our research teams are comprised of experts from all over the world—eight different countries and four continents, to be exact! Specialized care is offered in the following areas: Adult congenital heart disease Arrhythmia Cardiac imaging Cardiomyopathy and congestive heart failure Coronary heart disease General cardiology (including stress tests and holter monitoring) Peripheral vascular heart disease Vascular heart disease

We have a robust history in advancing the practice of cardiovascular catheterization and intervention, and we offer a full spectrum of cardiac care in our state-of-the-art facilities. We care for patients throughout the region at locations throughout Connecticut, and are a national and international referral center for specialty percutaneous interventional procedures, commonly known as angioplasty. Our physicians specialize in complex coronary disease, structural heart disease, and peripheral vascular diseases, and we operate one of the largest carotid artery disease programs in New England. We also have a Comprehensive Coronary Physiology Program that provides care for patients with chest pain that is chronic, unexplained or difficult to manage. Our interventions include: Transradial coronary intervention Coronary chronic total occlusion recanalization and coronary reentry transcatheter aortic valve implantation Intravascular ultrasound and physiologic translesional pressure assessment Rotational atherectomy Thrombectomy Proximal and distal embolic protection Drug eluting stents Advanced hemodynamic support Atrial septal defect, patent foramen ovale, and ventricular septal defect closure Alcohol septal ablation for hypertrophic cardiomyopathy Aortic and mitral valvuloplasty Left main and multivessel percutaneous coronary intervention (PCI) Various peripheral vascular interventions

Our program is a unique collaboration between Yale and University College London Heart Hospital that offers patients the highest level of care and international expertise. We provide evaluation of patients and families with inherited cardiomyopathies, arrhythmias, vascular diseases, and coronary and metabolic syndromes. The complexity of inherited cardiovascular disease often outweighs the resources of traditional medical specialty practices. Using detailed clinical evaluation to inform genetics and vice versa, we offer a patient-centered approach that employs a care and treatment plan that matches the intricacies of each patient’s disease and his or her needs. We see a wide array of patients from across Connecticut and beyond. Our expertise includes treating such conditions as: Hypertrophic cardiomyopathy Familial dilated cardiomyopathy Sudden death syndromes Arrhythmogenic right ventricular cardiomyopathy Our services include state-of-the art cardiac imaging, metabolic stress testing, genetic testing and counseling, and a full spectrum of treatment options, including: Septal myectomy and ablation Analysis of genetic mutations Complex electrophysiologic ablations Assessment of risk factors for sudden cardiac death Pacemaker and implantable cardioverter defibrillator (ICD) implantation

The Preventive Cardiovascular Health Program at Yale (PCHPY) brings a personalized approach to cardiovascular disease prevention. Patients referred to the program meet with one of our cardiologists for an in-depth consultation that takes into account their biology and biography, along with information from advanced diagnostic testing. This approach leads to a more personalized, evidence-based approach to cardiovascular risk assessment. Using this information, and in partnership with patients, we design tailored programs to reduce cardiovascular risk and improve well-being. PCHPY brings together experts in cardiovascular disease prevention, including cardiologists, nutritionists, exercise physiologists and health psychologists. We also work together with Digital Technology Solutions (Information Technology) and digital health companies to offer high-tech/low-burden approaches to cardiovascular care. Our team is highly attuned to the challenges of maintaining a healthy lifestyle and taking medication, and understands that a one-size-fits all approach often falls short. Instead, we strive to understand and integrate each person’ priorities, preferences and goals into the care plan. This program is particularly focused on people who are: At increased risk for cardiovascular disease, including people with: Severe hypercholesterolemia or familial hypercholesterolemia or elevated Lp(a) Family history of premature coronary artery disease (before the age of 60) Poorly controlled hypertension Underlying inflammatory condition (e.g., rheumatoid arthritis, HIV) A diagnosis of ischemic heart disease or coronary artery disease Women with cardiovascular disease Individuals seeking a more personalized approach to cardiovascular health PCHPY additionally works with communities to identify and address barriers to cardiovascular health, focusing on environmental and social factors that contribute to disparities in health outcomes.

The Cardiac Amyloidosis Program provides highly specialized care to people with cardiac amyloidosis. Cardiac amyloidosis is a group of diseases caused by abnormal protein deposits in the heart. These protein deposits can also harm other organs, including the gastrointestinal tract and nerve tissue. We use a multi-disciplinary team approach to evaluate, diagnose, and treat amyloidosis and provide comprehensive, patient-centered care. Our team includes experts in cardiovascular medicine, advanced cardiac imaging, electrophysiology, heart failure and transplant, gastroenterology, hematology/oncology, and neurology. Diagnosis: Our clinicians may perform an ultrasound of the heart (echocardiogram) or an electrocardiogram (ECG) to check for signs of cardiac amyloidosis. Doctors may order more tests to determine if a patient has cardiac amyloidosis or to identify the type: AL (light chain) amyloidosis vs. transthyretin (ATTR) amyloidosis. The treatment for each type of amyloidosis is different, which makes it critical for patients to get a precise diagnosis. Diagnostic tests may include: State-of-the-art cardiac imaging (cardiac MRI, nuclear scans like PYP or HMDP SPECT/CT) Tissue or bone marrow biopsy Genetic testing may also be recommended when inherited cardiac amyloidosis is suspected. Treatment and Care Management: We develop comprehensive, personalized treatment plans for each patient based on their type of amyloidosis and other patient preferences. Treatments may include: Advanced medication therapies to treat the underlying condition Medical therapies, including diuretics, to alleviate symptoms of heart failure, like fatigue, shortness of breath, or leg swelling In some cases, patients with cardiac amyloidosis may be candidates for heart transplantation. Patient education to help patients make lifestyle and diet changes to help improve their quality of life. Outpatient Specialty pharmacy and social worker services Access to Novel Treatments: Our patients can access novel treatments through various academic and industry-supported clinical trials. For Referring Providers: We pride ourselves in having robust relationships with our referring colleagues in the co-management of patients with cardiac amyloidosis. Please feel free to refer your patients for complete work-up, initiation of specialized therapies, or to learn more about our clinical trials and ongoing research.

Capturing and interpreting images of the heart are essential to successfully managing cardiac conditions. Our program features advanced technology to capture images of the heart, which allows our physicians to make accurate diagnoses and determine the best course of treatment. Among the techniques we use are nuclear cardiology, echocardiography, and cardiac CT (computed tomography) imaging, a diagnostic method that allows us to take images of blood vessels, bones, and internal organs. Our nuclear cardiology laboratories offer such state-of-the-art imaging techniques as single-photon emission computed tomography (SPECT), positron emission tomography (PET), and SPECT-CT, and our team has a long history of groundbreaking research in cardiovascular nuclear imaging. Our echocardiography (ultrasound) laboratories provide a comprehensive array of 2-D and 3-D transthoracic (chest wall) and transesophageal (through the esophagus) imaging options, as well as intracardiac echo imaging (ICE), an imaging technique that allows physicians to get a clear picture of the inner workings of the heart.

Our highly skilled and experienced team specializes in electrophysiology, or the diagnosis and treatment of heart-rhythm abnormalities, also known as arrhythmias. We treat complex arrhythmias and structural heart disease at Yale New Haven Hospital and through several outpatient office locations. At Yale New Haven Hospital, our physicians operate Connecticut’s largest and most comprehensive program for ventricular tachycardia ablation, a procedure that eliminates the heart tissue that causes arrhythmia. Our Complex Ablation Program offers epicardial ablation to treat ventricular tachycardia and atrial fibrillation that originates from the outer surface of the heart. Our operating suites are equipped with cutting-edge technology, including three-dimensional mapping systems, intracardiac ultrasound, and robotics. We offer a full range of device therapies, including pacemakers, defibrillators, and cardiac resynchronization therapy (CRT). We routinely monitor implantable devices using remote technology to ensure patients’ safety, wherever they are. We also offer a clinic in which doctors from electrophysiology and geriatrics work together to manage patients with recurrent falls and syncope, or fainting caused by low blood pressure. Additionally, Yale New Haven Hospital runs the only Atrial Fibrillation Support Group in the state. The group is for all patients and their families and aims to help individuals and their loved ones cope with the psychological and emotional burdens of their disease. For patients at Yale New Haven Hospital, an advanced nurse practitioner dedicated to arrhythmia management is ready to assist, working closely with physicians to ensure a seamless inpatient to outpatient transition.

Scleroderma (or systemic sclerosis) is a complex disease which results in chronic hardening and tightening of connective tissues, and patients can experience many different symptoms involving different organs. Our multidisciplinary team of doctors and nurses with expertise and an interest in scleroderma, including specialists in rheumatology, allergy and clinical immunology, pulmonary and critical care, cardiology, gastroenterology, nephrology, and dermatology, provide care for patients. The team provides coordinated, multidisciplinary, and compassionate care for patients and all the parts of the body scleroderma affects, including the skin, lung, heart, kidneys, and gastrointestinal system. We also address functional, nutritional, psychological, gynecological, urological, and/or sexual health challenges. The goal is improved quality of life for our patients. We strive to ease the burden on patients and their families. Support staff help patients gather outside medical records and coordinate appointments with different specialists at Yale so that patients can get all their relevant medical care in one place. Doctors readily communicate about the plan of care through the electronic health record. We also actively participate in clinical research, to bring the most innovative treatments for the disease to our patients. Yale has been designated as a Scleroderma Center by the Scleroderma Foundation.

Sometimes, an athlete—seemingly in peak physical condition—experiences sudden cardiac arrest on the playing field due to an undiagnosed heart condition. Yale Medicine’s Sports Cardiology Program is dedicated to preventing such tragedies through comprehensive screening, evaluation, and management of cardiovascular disease in athletes. The Sports Cardiology Program brings a multidisciplinary approach to the identification and treatment of potentially life-threatening cardiac abnormalities in athletes. The program provides two distinct services: Pre-participation screening of college and university athletes to detect any potential abnormalities before they compete Consultation and care for athletes of any age who either have known cardiovascular disease or who have symptoms that could be related to cardiovascular disease Yale Medicine specialists begin with an electrocardiogram (ECG), which records the electrical activity of the heart, to check for a variety of cardiac conditions. When screening college and university athletes, Yale experts interpret the ECG, offer recommendations for follow-up care, if needed, and work closely with the school to monitor and advise the athlete going forward. Yale physicians have been performing ECG screenings for Yale University athletes since 2015. With the launch of the Sports Cardiology Program, Yale Medicine is now performing screenings for athletes at three local universities, as well as the Connecticut Whale women’s professional hockey team. In addition to a pre-participation screening of college athletes, the Sports Cardiology Program provides ongoing clinical care for athletes of any age (including children) who have a known cardiac condition or symptoms that may indicate cardiac abnormalities, such as passing out or palpitations. In both cases, the goal is to develop an effective diagnosis, treatment, and management strategy for the athlete and provide recommendations on whether and how the athlete can safely participate in competitive sports. The foundation of Yale Medicine’s program is its multidisciplinary approach to these issues. A team of experts from many specialty areas works together to provide comprehensive, integrated services and holistic care for athletes. The program’s director, Rachel Lampert, MD , is a sports cardiologist, electrophysiologist, and arrhythmia specialist who frequently writes and speaks on preventing sudden cardiac arrest in athletes. Dr. Lampert has conducted extensive research in this area, including studies on whether athletes with implanted defibrillators can safely participate in sports. The Sports Cardiology Program also features imaging teams that use highly specialized diagnostic tools such as cardiac MRIs and echocardiography. The team also includes experts in adult and pediatric arrhythmia, cardiac channelopathies, cardiomyopathy, genetic cardiovascular diseases, and more. In addition, Dr. Lampert and her team frequently partner with Yale’s Sports Medicine Pro