Transcription:
Cardiology

Amanda Wilde (Host): Interventional cardiology as a cardiac specialty that has evolved from advances in the diagnosis and treatment of heart disease. Interventional cardiologists can stop a heart attack, repair heart defects, and address heart issues with minimally invasive procedures. Let's learn more with Dr. John Ulahannan, Interventional Cardiologist at Crouse Hospital. This is Crouse HealthCast. And today we're talking about treatment and techniques in Interventional Cardiology. I'm your host, Amanda Wilde. Dr. Ulahannan, thank you for being here. Please explain what is an Interventional Cardiologist versus a Cardiologist?

John Ulahannan, MD (Guest): Thanks for having me Amanda. An Interventional Cardiologist, as opposed to a what we say in noninvasive cardiologist, we are a sub-specialty of cardiology that performs minimally invasive procedures in order to, to change outcomes for patients. So, traditionally our field involves stent placement, catheter-based procedures. But nowadays it's actually evolved to do just bigger, more involved procedures. Lately we've been doing valve replacements, valve repairs, alongside surgeons and all to make patients feel better to lengthen lifespans.

Yeah, the getting back to your original question, we're all cardiology trained. We all do three years of cardiology fellowship after internal medicine training. But then we do one to two years of extra training after that, in order to get that degree, that certification.

Host: And then do you have to continue training as the advances are made in technology?

Dr. Ulahannan: Yeah. It's not traditional training, like you would think. I'm not sitting with an instructor and taking tests, but it's really on the job training, I mean, and that's not a requirement. But the way I teach my own learners, and when I have students with me, I usually say it's when you're in the field of medicine, you really need to just have that hunger for knowledge and to continue to better yourself by learning newer techniques. And that can be a challenge sometimes, you know, cause life changes. Right? But that's something that's very important for all of us, or it should be. Even my senior most partners, they're still training. So, I don't think the training ever really stops. And that's whatever field you go into.

Host: And with the formal education side of it, you did need additional education, you mentioned to become an interventional cardiologist. How did you become interested in interventional cardiology?

Dr. Ulahannan: That's a good question. I think I've always been interested in cardiology. I knew that even starting my internal medicine residency program and that was here in Syracuse. So, I was always interested in cardiology. I always tried to keep an open mind, but I think the thing that attracted me about interventional cardiology is, it is very gratifying. Just like you said, we can take a patient who's actively having a heart attack and heart attacks are caused by blood clots in your heart arteries. And they're in a large amount of pain. They're very scared. And really within minutes of ballooning open the blockage, normalizing blood flow, they really do feel better almost instantaneously. So, I think that's the, probably the best part of my job.

Host: To get more of a sense of interventional cardiology, who are your patients? Active heart attack patients obviously are one. Who else benefits from seeing an Interventional Cardiologist?

Dr. Ulahannan: I get referrals from my partners as well as seeing my own patients in the out patient setting. So, a lot of the times someone is having some sort of exertional issue, whether that be chest pain or shortness of breath or fatigue, and non-invasive workup starts to point toward blocked arteries and blocked arteries come in two flavors. They're either stable cholesterol deposits. Those are not causing heart attacks so that you're not having resting chest discomfort, but they are causing exertional chest pain. So, that's one type of patient I see. And then you said it's the patient who is having active chest pain at rest. Those are heart attacks. Those are coming from blood clots, not stable cholesterol plaque.

Host: Well that leads me to wonder what kind of procedures exactly do you perform as an Interventional Cardiologist?

Dr. Ulahannan: All of my procedures are catheter-based. So, I spend the most of my time in the catheterization lab doing coronary angiograms. And so, what is that? That's where we put a small catheter in either the artery in the wrist or the artery in the leg. More often, it's the artery in the wrist and we thread the catheter over a wire. We stop right outside the heart. We inject contrast into the heart arteries, the coronary arteries. And then we really just look for luminal narrowing. We look for the plaque deposition. So, that's the procedure I perform the vast majority of the times, but my partners and I, we all do a vast, like a variety of procedures.

So, my two partners who are in electrophysiology, they do pacemakers. They do defibrillator implantations, ablations. One of my partners does something called the Watchman procedure closing off defects just like you said, and myself and another one of our partners, we do minimally invasive valve replacements. So, we do a variety of different procedures on the heart.

Host: Can you talk a little bit too about the team approach to care for cardiac patients at Crouse?

Dr. Ulahannan: There's a few different aspects just to kind of keep in mind. Cardiology is so fast moving. It's very hard to keep track of all of the advancements yourself and keep sane at the same time, so things change very rapidly. And what ends up happening is you start to develop kind of a niche, a little portion of cardiology that you are just good at. And with my partners and I, we know each other's strengths. We turn to each other for advice all the time. And then we trust each other. Trust is a big aspect of that. And it's not just what the cardiologists, our support staff are very important. Our nurses, our sonographers, our schedulers, the people we work with in the hospital; all of that is very important to take care of one single patient.

And I think trust is probably the most important part of that. We really do trust each other. We trust each other's opinion. If someone is telling me something doesn't seem right or something's wrong or take a look at this one more time; I really, you know, I really do trust the people I work with to take that second look.

Host: In the team approach, what can the patient do as part of the team to ensure the best outcomes?

Dr. Ulahannan: Again, I think understanding that it's a team approach to their care, that their doctor is in charge. But at the same time there's a lot of different moving parts. And they just have to trust us that we are really doing everything in their best interest. The other thing is, I think with my own patients education is so important. I really do like to keep them involved. Most of my patient encounters, end with are there any questions or do you have any questions for me? Or do you have anything to ask? I rarely just run out of the room.

I can't remember the last time I actually rushed out of the room without giving them the opportunity to ask something. I think that is probably one of the more important aspects of getting taken care of because there are a lot of moving parts. It's very easy to get lost. Most of the time, if there's a procedure that needs to be done, it's because I've given them just some bad news about what's going on. Right? So, I think asking questions and not being afraid to ask questions are also very important.

Host: You mentioned it's a fast moving field. What are some of the advances you've seen recently?

Dr. Ulahannan: The hot topic recently in my field is something called structural heart disease where we're making advancements treating valve disease. About 10 years ago, it was very difficult to treat any sort of structural issue with the heart valves. Those usually required some open surgery and there's a subset of patients, usually people who are a bit older, they're a bit more frail, maybe they have more medical issues; surgery is not an option. So, now we're seeing what the advancements that surgery, these minimally invasive procedures, patients who are older, a bit more frail, they are able to make it through the surgery itself and make it through the procedure and then leave the hospital in a couple of days, actually. It's, it's quite amazing.

Host: Wow. It's really exciting to think what this integrative and minimally invasive approach plus emerging technology might mean for the future. Well, thank you, Dr. Ulahannan for this discussion on matters of the heart. And thank you for listening to the Crouse HealthCast.

Amanda Wilde (Host): to learn more or request an appointment. Visit Crouse.org/.

Host: I'm Amanda Wilde. Be well.