Interview with Consultant Cardiologist Sabiha Gati

Dr Sabiha Gati, how is it different working with a young population with cardiac conditions?

A typical day’s work involves assessing patients aged between 18 and 25 years old. The vast majority of individuals admitted or investigated in heart clinics are usually in their sixth decade onwards. Most of these individuals have age-related problems such as high blood pressure, narrowing of the blood vessels supplying the heart, or, a weak heart muscle. All of these are extremely important causes of feeling unwell or even dying. Fortunately, deaths in young people (under the age of 35 years old) are much less common than in the older population, nevertheless, they are associated with a loss of several decades of life. Most deaths are from diseases that run in families and there are several treatments available to doctors to change the natural course of the disease and save young lives.

One of the main differences with working with young people affected by these diseases is that I am dealing with individuals who often believe they are invincible due to lack of symptoms and the inner energy as a result of their youth, hence they do not always appreciate the dangers of the underlying disease. The main challenge is to allow as normal a life as possible and to promote aspirations and goals without increasing the risk of a potentially dangerous heart rhythms.

Many young people enjoy participating in competitive sport which may increase the risk of sudden death. We are all aware that the exercise is one of the best therapies known to medicine and one of the challenges is to provide a safe exercise prescription which is sometimes considerably less than the young individual performed.

I often find myself talking to the young about the dangers of substance abuse including alcohol. There is a link between alcohol bingeing and sudden death from Brugada syndrome. Stimulants such as ecstacy or cocaine may provoke sudden death in individuals with long QT syndrome. Young people also frequently delve in activities associated with a surge in adrenaline that can also provoke serious rhythm disturbances in some people with long QT syndrome. In such cases, I find myself trying to provide the best advice about engaging in bungee jumping or speak rollercoaster rides.

I enjoy discussing issues with our young team and learn a lot from them about the apprehensions some of these people have that they may not feel comfortable discussing with their local cardiologists.  The questions these individuals pose often leave me thinking about the best approach to managing a situation where the evidence is rather limited compared with cardiac diseases that I encounter in my day to day practice.

What do you find most interesting about attending myheart meetings for young individuals with cardiac conditions?

myheart’ sessions are a great forum for young people with (usually inherited) cardiac conditions. These sessions allow the nurses/physiologists and the cardiologist to spend more time with young people discussing the impact of their condition on their everyday lives and psychological issues relating to coping with disease and its management, such as fears about a shock from an implantable cardiac defibrillator (ICD). These individuals also worry about relationships and concerns about having affected children in the future. In general the clinic consultations in the NHS do not always allow for very lengthy conversation about psychological issues.

Sabiha with myheart members at a myheart meeting

Furthermore, young patients do not always feel comfortable discussing them in such a forum.   The myheart meetings allow clinical staff and affected young patients to become more acquainted with each other and permit a more relaxed and reassuring environment.  It’s also good to hear from them what they would like more from us as clinicians in our clinics. My group members get to know me as a person rather than the ‘doctor’ who simply manages their heart condition. I have a mantra, “the purpose of life is to make a difference to the life of others”. After ‘myheart’ sessions, I feel invigorated and go home feeling I have made a genuine difference.  

What new research are you working on?/ what new research should young individuals with cardiac conditions look forward to in the near future?

The CRY research team are currently working on several very interesting ideas including formulating exercise programmes for individuals with Hypertrophic Cardiomyopathy. A greater understanding of Hypertrophic Cardiomyopathy has translated to improved medical care and better survival of affected individuals. Previously these individuals were considered high risk of sudden cardiac death during exercise and therefore, sedentary lifestyle was often promoted by clinicians. However, the work by Dr Joyee Basu (CRY research fellow) suggests that exercise in Hypertrophic Cardiomyopathy of moderate intensity has a favourable effect on the cardiovascular system and is safe. 

I also very much look forward to seeing the results Dr Gemma Parry-Williams projects on the veteran female athlete’s heart. It’s really good to see ‘women in cardiology’ having a significant impact at CRY.

In terms of new research, I’m looking forward to setting up a project at the Royal Brompton Hospital supported by CRY funding. The plan will be to evaluate young individuals with specific changes on their electrocardiogram and to identify whether they harbour subtle structural changes including myocardial scar using cardiovascular magnetic resonance. Based on our analysis we will be able to create new recommendation on ECG interpretation in young people and athletes. This will have major impact on the cost effectiveness, sensitivity and specificity of our cardiac screening programme.

What advice will you like to give to young individuals with conditions with regards to exercise?

The benefits of regular exercise are irrefutable. All doctors should promote exercise. In young individuals affected by genetic diseases affecting the heart muscle of the electricity of the heart, the aim is to strike a balance between the multiple benefits of exercise such as reducing obesity, high blood pressure, diabetes and the small risk of sudden cardiac death. A moderate amount of exercise is generally safe. The current exercise recommendation for all individuals include at least 150 minutes of moderate intensity exercise per week. Among individuals affected with heart diseases, I would advise exercising to a point there are no symptoms and generally not above 80% predicted for age (generally 80% of 220-age) or above 70% for those who are treated with beta-blockers. It is also important to tone the muscles and the recommendations are to push no more than 50% of the body weight with the arms and no more than 100% on the body weight with the legs. All individuals should warm up well and cool down. It is not advisable to exercise in extreme climates without acclimatisation. I would discourage exercise at a temperature above 25oC. Individuals should avoid exercise if they have a fever or diarrhoea. Certain exercises and sports should be avoided with some diseases, for example people with long QT syndrome should not dive into cold water and people with Brugada syndrome should avoid long lasting sports such as marathon running or triathlon where the body temperature  may exceed 40oC and promote dangerous cardiac rhythm disturbances.

What are your plans for the future?

I am looking forward to starting my new Consultant Post at the Royal Brompton & Harefield NHS Foundation Trust. I will be involved with the Inherited cardiac conditions service to support patients with genetic cardiac diseases and cardiac magnetic resonance imaging required for diagnosis at the Hospital. I also have the pleasure of establishing a sports cardiology service dedicated to individuals with cardiovascular conditions who want advice on exercise and sports participation, a project which I’m very excited about and cannot wait to get stuck in! I am looking forward to supervising my first CRY funded research fellow who will be trained in inherited cardiac conditions, cardiovascular magnetic resonance and sports cardiology. The CRY fellow will be supporting the CRY screening program and will be supervised in the PhD program.

From L-R: Dr Sanjay Sharma, CRY Founder Alison Cox MBE, Sabiha Gati and CRY CEO, Dr Steven Cox

How is it different working with a young population with cardiac conditions?

A typical day’s work involves assessing patients aged between 18 and 25 years old. The vast majority of individuals admitted or investigated in heart clinics are usually in their sixth decade onwards. Most of these individuals have age-related problems such as high blood pressure, narrowing of the blood vessels supplying the heart, or, a weak heart muscle. All of these are extremely important causes of feeling unwell or even dying. Fortunately, deaths in young people (under the age of 35 years old) are much less common than in the older population, nevertheless, they are associated with a loss of several decades of life. Most deaths are from diseases that run in families and there are several treatments available to doctors to change the natural course of the disease and save young lives.

One of the main differences with working with young people affected by these diseases is that I am dealing with individuals who often believe they are invincible due to lack of symptoms and the inner energy as a result of their youth, hence they do not always appreciate the dangers of the underlying disease. The main challenge is to allow as normal a life as possible and to promote aspirations and goals without increasing the risk of a potentially dangerous heart rhythms.

Many young people enjoy participating in competitive sport which may increase the risk of sudden death. We are all aware that the exercise is one of the best therapies known to medicine and one of the challenges is to provide a safe exercise prescription which is sometimes considerably less than the young individual performed.

I often find myself talking to the young about the dangers of substance abuse including alcohol. There is a link between alcohol bingeing and sudden death from Brugada syndrome. Stimulants such as ecstacy or cocaine may provoke sudden death in individuals with long QT syndrome. Young people also frequently delve in activities associated with a surge in adrenaline that can also provoke serious rhythm disturbances in some people with long QT syndrome. In such cases, I find myself trying to provide the best advice about engaging in bungee jumping or speak rollercoaster rides.

I enjoy discussing issues with our young team and learn a lot from them about the apprehensions some of these people have that they may not feel comfortable discussing with their local cardiologists.  The questions these individuals pose often leave me thinking about the best approach to managing a situation where the evidence is rather limited compared with cardiac diseases that I encounter in my day to day practice.

What do you find most interesting about attending myheart meetings for young individuals with cardiac conditions?

myheart sessions are a great forum for young people with (usually inherited) cardiac conditions. These sessions allow the nurses/physiologists and the cardiologist to spend more time with young people discussing the impact of their condition on their everyday lives and psychological issues relating to coping with disease and its management, such as fears about a shock from an implantable cardiac defibrillator (ICD). These individuals also worry about relationships and concerns about having affected children in the future. In general the clinic consultations in the NHS do not always allow for very lengthy conversation about psychological issues. Furthermore, young patients do not always feel comfortable discussing them in such a forum.   The myheart meetings allow clinical staff and affected young patients to become more acquainted with each other and permit a more relaxed and reassuring environment.  It’s also good to hear from them what they would like more from us as clinicians in our clinics. My group members get to know me as a person rather than the ‘doctor’ who simply manages their heart condition. I have a mantra, “the purpose of life is to make a difference to the life of others”. After ‘myheart’ sessions, I feel invigorated and go home feeling I have made a genuine difference.  

What new research are you working on?/ what new research should young individuals with cardiac conditions look forward to in the near future?

The CRY research team are currently working on several very interesting ideas including formulating exercise programmes for individuals with Hypertrophic Cardiomyopathy. A greater understanding of Hypertrophic Cardiomyopathy has translated to improved medical care and better survival of affected individuals. Previously these individuals were considered high risk of sudden cardiac death during exercise and therefore, sedentary lifestyle was often promoted by clinicians. However, the work by Dr Joyee Basu (CRY research fellow) suggests that exercise in Hypertrophic Cardiomyopathy of moderate intensity has a favourable effect on the cardiovascular system and is safe. 

I also very much look forward to seeing the results Dr Gemma Parry-Williams projects on the veteran female athlete’s heart. It’s really good to see ‘women in cardiology’ having a significant impact at CRY.

In terms of new research, I’m looking forward to setting up a project at the Royal Brompton Hospital supported by CRY funding. The plan will be to evaluate young individuals with specific changes on their electrocardiogram and to identify whether they harbour subtle structural changes including myocardial scar using cardiovascular magnetic resonance. Based on our analysis we will be able to create new recommendation on ECG interpretation in young people and athletes. This will have major impact on the cost effectiveness, sensitivity and specificity of our cardiac screening programme.

What advice will you like to give to young individuals with conditions with regards to exercise?

The benefits of regular exercise are irrefutable. All doctors should promote exercise. In young individuals affected by genetic diseases affecting the heart muscle of the electricity of the heart, the aim is to strike a balance between the multiple benefits of exercise such as reducing obesity, high blood pressure, diabetes and the small risk of sudden cardiac death. A moderate amount of exercise is generally safe. The current exercise recommendation for all individuals include at least 150 minutes of moderate intensity exercise per week. Among individuals affected with heart diseases, I would advise exercising to a point there are no symptoms and generally not above 80% predicted for age (generally 80% of 220-age) or above 70% for those who are treated with beta-blockers. It is also important to tone the muscles and the recommendations are to push no more than 50% of the body weight with the arms and no more than 100% on the body weight with the legs. All individuals should warm up well and cool down. It is not advisable to exercise in extreme climates without acclimatisation. I would discourage exercise at a temperature above 25oC. Individuals should avoid exercise if they have a fever or diarrhoea. Certain exercises and sports should be avoided with some diseases, for example people with long QT syndrome should not dive into cold water and people with Brugada syndrome should avoid long lasting sports such as marathon running or triathlon where the body temperature  may exceed 40oC and promote dangerous cardiac rhythm disturbances.

What are your plans for the future?

I am looking forward to starting my new Consultant Post at the Royal Brompton & Harefield NHS Foundation Trust. I will be involved with the Inherited cardiac conditions service to support patients with genetic cardiac diseases and cardiac magnetic resonance imaging required for diagnosis at the Hospital. I also have the pleasure of establishing a sports cardiology service dedicated to individuals with cardiovascular conditions who want advice on exercise and sports participation, a project which I’m very excited about and cannot wait to get stuck in! I am looking forward to supervising my first CRY funded research fellow who will be trained in inherited cardiac conditions, cardiovascular magnetic resonance and sports cardiology. The CRY fellow will be supporting the CRY screening program and will be supervised in the PhD program.

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