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Could you share how you became a cardiothoracic surgeon and what inspired you to choose this field?
I went to Duke University Medical School, where the Chairman of the Surgery department, Dr. David Sabiston, was the first person to do a Coronary bypass. He built a department heavily slanted toward heart surgery and innovative techniques. Many of the other people he brought in were also very dynamic, which resulted in a large portion of my medical school class focusing on heart-related topics such as cardiovascular surgery, cardiology, and related subjects.
So, my interest in the field was mainly motivated by the mentoring of people who were very dynamic and very good at what they did. They made the field look very exciting and interesting. They fixed people that nobody thought could be fixed.
What are the most common cardiac and vascular conditions that you come across?
If you examine the most common conditions that lead to someone’s death in the United States, they are heart attacks and heart-related conditions. Almost everyone is familiar with a relative who has died due to a heart condition; it is extremely common. Other vascular-related illnesses associated with this are stroke and aneurysm, which are also very common. Consequently, we all encounter cardiovascular conditions. This is not limited to what I see but expands to our experiences with our families, relatives, and friends.
Could you tell me what warning signs we should look for in these conditions?
I think that's one of the things that people don't quite understand. They all think it's just chest pain. And while many people will experience chest pain, it differs depending on the person you're talking about.
Some people, particularly women, might feel pressure or a sensation like a band across their chest. Some might describe it as feeling like a little elephant is sitting on their chest—I heard this just last week-. Symptoms can also include pain in the jaw, left shoulder, left arm, and in the back. So, the symptoms can be very variable.
Do these symptoms usually appear suddenly on the same day of the event, or do they develop over several days or weeks?
Well, it can occur on the same day of the event, but more commonly, when you talk to the person, and they're honest, they often had some sort of clue that something wasn't right in the weeks leading up to the event. Typically, they had attributed it to something like, " I thought it was just heartburn," or "I thought I was getting older," or "I believed it was related to something I ate." They recognized that something was off, but they didn't seek medical attention.
Usually, at what ages do these types of conditions happen most?
Up until 2020, the answer would have been that individuals over the age of 50 would be the most likely to suffer cardiovascular illnesses. But since 2020, in the pandemic, we’ve seen a startling number of individuals between 20 and 50 experiencing sudden episodes of cardiac or vascular-related illnesses. And so now it seems like this is something that everyone must be aware of.
Recently, there have been some media reports about cases of cardiac arrest, especially among young people. How frequently does this occur?
Before the pandemic, cardiac arrest among the young was very rare and almost always comprised of individuals who had a type of enlarged heart, in which the section of the heart that was enlarged was impeding the blood flow into the heart. When teenagers are required to get physicals before entering school or competing in sports, that's what the doctors were checking for. And so that's been the norm.
But more recently, we're seeing a startling rise in the number of young people suffering from cardiac arrest. And honestly, nobody knows exactly what's causing it. We all think it has something to do with the pandemic because it didn't exist before. There's a lot of speculation, some of which is politically motivated, some of which is data-based, but no one has a clear answer for why we're seeing this. But we are seeing it.
How does a cardiac arrest differ from a heart attack?
The difference between a cardiac arrest and a heart attack is as follows: A heart attack is linked to a particular blood vessel in the heart being blocked. These are the coronary arteries. When these blood vessels are blocked, the heart muscle doesn't receive enough blood to function properly. And if it becomes severe enough, the muscle starts to die, resulting in a heart attack.
On the other hand, a cardiac arrest can be caused by two different factors: one, a coronary vessel is blocked by spasms – the vessel constricts – and the other is when the rhythm of the heart becomes abnormal, either too slow or too fast, leading to an inability to support blood flow through the heart, causing the blood pressure to drop suddenly. This is referred to as a cardiac arrest.
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