World Heart Day is a global campaign to raise awareness of cardiovascular disease and the importance of maintaining good heart health. In this blog consultant cardiologist Dr Shelley Rahman Haley shares what she loves about her job, her special interest in echocardiography and heart valve disease, advice for pursuing a career in cardiology, and more.
What do you enjoy most about your job?
There are quite a few aspects of my work as a diagnostic cardiologist that I particularly enjoy. The first is the detective work of making a diagnosis, which involves listening very carefully to the patient’s story as well as clinical examination, performing and interpretation of tests – there is nothing I enjoy more than getting to the bottom of a very complex problem, and seeing the relief on someone’s face when I tell someone that we know what is going on and can help them.
As an extrovert, I derive my energy from interacting with other people, so I love a long ward round where I can chat to lots of patients, share a few jokes with the nurses, teach the junior doctors and medical students and generally be sociable whilst simultaneously being a doctor! I always notice the books and pictures that patients have on their tables and like to ask them about their interests and their families. It doesn’t really feel like work, and the best thing of all is when the junior doctors tell me that they have had fun even though they are on call.
Finally, I do enjoy the science of medicine – I still hit the internet to get the latest papers in the evenings whenever I come across something I am not sure of. I never want to stop learning new things.
What inspired you to pursue a career in cardiology?
I’ve been asked this many times over the years and the best answer I can come up with is that I didn’t choose the heart – it chose me! From the very first lectures in anatomy, embryology and physiology, to the applied sciences of pharmacotherapy and pathology right through to clinical medicine and surgery, it was always the cardiovascular system that seemed to make sense to me – I never felt as though I had to work at it.
There is a saying, isn’t there, that if you find a job doing something you love, you will never work a day in your life? Well, that’s how I feel about my life as a cardiologist.
In 2007 you were appointed as the first clinical lead for echocardiography at Harefield Hospital. Tell us a bit about what this role involves and how it’s improved the service and care the hospital provides.
I was Harefield Hospital’s first full-time consultant for echocardiography, which is all about getting images of the heart with ultrasound, predominantly to look at the size and function of the heart chambers, how well they are pumping, and to look at the heart valves and whether they are working normally.
My particular interest is heart valve disease in adults so I learned very early on in my cardiology training to perform echocardiography so that by the time I became a consultant I would be an expert in interpreting the appearances of heart valve disease. I work very closely with the surgical team here, helping to manage patients before surgery, taking scans during the operation, and monitoring patients afterwards in the valve follow-up clinic.
Since I came to Harefield there have been very big changes in the way we make decisions regarding treatment in patients with heart valve disease. The most important change is that the whole heart team is involved – this means cardiologists, surgeons, nurses, intensive care doctors and anaesthetists, as well as greater involvement for the patient in their care. We call this a multidisciplinary heart team (MDT), and it means that all aspects of a patient’s care are taken into consideration when recommending and planning treatment.
I am proud that I have been instrumental in helping to set up, run and support some of the MDTs here at Harefield. During the Covid-19 pandemic, along with my surgical colleague Mr Mario Petrou, we provided an MDT service for both sites of the Trust and also for other hospitals across London to ensure that cardiac services continued to run as smoothly as possible.
What changes have you seen in cardiac care over your career? What do you see as the most significant development in cardiac care at the moment?
Many of the biggest discoveries and inventions that contributed to the development of modern-day cardiology as a medical specialty happened during the twentieth century, such as the ECG, (a simple test used to check your heart's rhythm and electrical activity), cardiac ultrasound (echocardiography) and of course, the heart-lung machine that allows us to stop the heart for cardiac surgery. However, the development of primary coronary angioplasty, where we open blocked arteries during a heart attack, certainly changed the landscape in the 1990s.
The twenty-first century has seen the exciting development of catheter-based valve implantation – where we can put in a new heart valve through a tiny hole in the groin and without open heart surgery – and this is likely to continue so that fewer and fewer invasive operations will need to be carried out.
What three tips would you give to people who want to better manage their cardiac health and look after their hearts?
The greatest three gifts anyone can give to their heart is exercise, exercise and exercise! That does not mean we all need to train for the London marathon – there is evidence emerging that even the regular stretching of blood vessels by exercises such as yoga and Pilates probably helps to keep the artery walls more elastic. For those who are not so mobile or strong on their legs, even exercising the arms can raise the heart rate enough to give the cardiovascular system a mini-workout. So keep moving as much as you can, and your heart will thank you.
In terms of diet, sugars are almost certainly worse overall for the metabolism than fats, so I tend to advise people to eat less processed and refined carbohydrate and more fresh fruit and vegetables and fibre such as oats. Finally, reducing animal fats by eating less red meat is almost certainly a healthy choice. On the other hand, the odd glass of wine or gin and tonic is definitely what the doctor orders!
What advice would you give to someone pursuing or starting a career in cardiology?
I would tell them that there is no medical specialty as rewarding as cardiology – whatever you like doing in medicine, whether that is talking to patients, performing procedures, looking at ECGs, interpreting tests, prescribing drugs, or even doing academic research, cardiology has something for you.
Don’t be put off by the thought of long hours or high stress – if you love the heart, just do it! But remember to warn your family and friends that once you’ve become a cardiologist, your heart will always be at the hospital!
Harefield Hospital is one of the largest and most experienced centres in the world for cardiac surgery and cardiology. It is renowned for its work in heart and lung transplantation, and also pioneered the use of ‘artificial hearts’ - left ventricular assist devices or LVADs. The hospital has the largest number of LVAD patients in the UK. At its dedicated heart attack centre, the hospital deals with heart attack emergencies from outer north-west London, providing primary angioplasty (a treatment to re-open a coronary artery when someone is having a heart attack) in its specialist catheter laboratories.