What influenced your choice to become a doctor?
My father’s a physician who still remains enthusiastic about serving his patients, about the bonds you nurture with them and the detective work it takes to figure out what might be going on with their health. It all wore off on me at an early age. I still share his passion.
Why did you choose this specialty?
As a resident in the early 1990s, the understanding and treatment of heart attacks was undergoing a tremendous change, becoming increasingly effective with new drugs and techniques. Clinical trials and evidence-based medicine were rapidly growing our understanding of how to manage patients. It was an exciting time to be able to have a significant impact on such a deadly disease.
How does cardiovascular disease differ between men and women?
It’s the most common killer of both men and women over age 65, but it generally starts a decade earlier in men. The risk gap begins to close, and women catch up to men by age 75. In the 35- to 55-year-old age group, incidence of heart attacks is rising in women, whereas it is falling in men.
Heart attacks in women are often missed. How are their symptoms different than those in men?
Presenting symptoms in women are less typical, with shortness of breath on exertion, chest pressure, heaviness or tightness more common than the more common chest pain in men. My sense is that more typical roles for women demand they be caregivers; they are more habituated in leaving less time and attention for themselves. When symptoms set in, they are less likely to seek attention promptly as they are accustomed to putting themselves last.
What’s the most surprising thing about your practice of cardiology?
It’s baffling to me that one patient can be much more responsive to the same therapy than another patient. For example, for any given dose of a cholesterol medication, one person’s response can be dramatic, but another’s is more modest. It’s humbling how much we still don’t know and inspiring how far we’ve come in the 22 years I’ve been in practice.
What’s the most exciting recent development in your field?
A new class of cholesterol-lowering medication has recently been proving itself to be effective. There has not been a new class since the statins, so as experience grows with this, hopefully we find better drugs with less side effects.
What’s the biggest misconception people have about what you do?
That cardiology and cardiac surgery are not separate specialties. Cardiology is the diagnosis, medication management, catheter-based treatments, treatment of rhythm abnormalities, risk factors and prevention of heart disease. Cardiac surgery does the surgical repair of valves, aneurysms and bypass surgery.
Is there a patient behavior you wish you could change?
As our workforce is becoming increasingly more stressed and sedentary, and our diets higher in salt and saturated fat, the conscious effort toward improving diet, exercise and improving healthy destressing strategies will be big payoffs for our future.