As some of you may already know, Date with a Doctor is a series on the blog where I chat with doctors and surgeons from different specialties about what they do, common questions they are asked and what’s new within their specialty.
In this series of Date with a Doctor, I spoke to Cardiologist, Dr Sarah Gutman to find out more about her research in using cardiac MRI in the selection of patients for defibrillator implantation. Her research was recently named finalist, for the Ralph Reader prize at the annual Cardiac Society of Australia and New Zealand meeting.
As a clinician and as a researcher, Dr Sarah Gutman is a cardiologist who wears two hats. To her, the two ways of working have very different rhythms, “With clinical medicine you get the instant gratification from helping patients in that moment. Research is very slow. Although you might inform clinical guidelines from your study, it takes a long time to get there.”
As she explains, one discipline feeds into the other and this can provide inspiration: “When you’re treating patients, you start to ask why we do certain things and this curiosity leads me to want to investigate, rather than just following trends.”
Her speciality within cardiology is non-invasive imaging, and she works with ultrasound and magnetic resonance imaging (MRI) technologies. These are tools which can be used to help diagnose a wide range of cardiac conditions.
Dr Gutman was recently named a finalist in the Ralph Reader prize for a paper which was published in the European Heart Journal. The research made a case for using cardiac MRI in the selection of patients for defibrillator implantation.
Dr Gutman presenting her research at the 66th Annual Scientific Meeting of the Cardiac Society of Australia and New Zealand.
She explains: “Defibrillators are used to treat patients’ risk of sudden cardiac death. After someone has had a heart attack, as a result, their heart muscle becomes severely weakened, we have great evidence for their utility. If the heart muscle is weakened for another reason, we’ve never had firm proof that a defibrillator provides any survival benefit.” This led to confusion in interpreting guidelines, which meant some patients weren’t receiving this treatment because there was nothing to suggest it would help to lengthen their lives, while others were undergoing unwarranted defibrillator implantation which comes with a host of risks including infection and psychological trauma from unnecessary shocks.
Dr Gutman continues: “We thought we could identify a subset of patients who could benefit using cardiac MRI and this is what was borne out in our study”. This group were patients that had scarring in their ventricles. Scars tend to form after a heart attack, but can also be present with some other conditions, like cardiomyopathy, a disease of the heart muscle.
Adding to a busy schedule, Dr Gutman is also working towards her PhD. Her area is the diagnosis of rheumatic heart disease in Indigenous populations. Rheumatic heart disease is “a completely preventable disease, spread by overcrowding and poor sanitation, basically third world conditions.” It might be surprising to hear that a disease which takes hold in developing countries is prevalent in parts of Australia, and this is something Dr Gutman is passionate about ending.
The treatment for rheumatic heart disease relies on patients coming in to a clinic for a regular injection. For the populations that Dr Gutman works with, this can prove tricky. It’s not just that the patients can be quite itinerant, but that this condition often impacts children and teenagers. And there aren’t many kids who are keen on the prospect of a regular injection.
Currently, patients who don’t have a clear diagnosis will still receive treatment. A more precise system needs to be developed to limit treatment only to people who need it. Dr Gutman is examining the diagnostic criteria to find out whether MRI can help to make a call in these borderline cases.
Her advice for thinking outside the box, challenging accepted wisdom, and making change? “You’ve got to follow your curiosity, you don’t know what will come of it.”