Conversations With Cardiologists: Annapoorna S. Kini, MD, FACC

Dr. Kini, you are an inspiration to a legion of aspiring fellows. Can you tell us about your journey from Mangalore to Manhattan?
Ever since I was a child, I envisioned myself as a doctor. I always wanted to do something using my hands. I was the only sibling who wanted to pursue medicine and my father supported me. So, despite the tremendous competition, I worked hard and was accepted at the prestigious Kasturba Medical College, Mangalore based on my merit. Throughout medical school, I worked hard to stay at the top. After graduating, I married my husband, a surgeon. We decided to pursue further training in the UK and that is when I became interested in cardiology. During my cath rotation, my mentors were very encouraging and told me that I was gifted with hand skills and should train at a center that would expose me to the best in the field. That is how I came to Mount Sinai. After fellowship, I stayed on as an attending, and through the years, rose through the ranks to eventually become the director of the cath lab.

You are the program director of one of the most coveted fellowships in the country and have reviewed countless applications. What are the traits in a strong interventional cardiology applicant that set them apart?
The interviewee must have a good grasp of the subject (cardiology and cath lab basics), thus we ask medical and cardiology related questions. When you are interviewing someone, you get a sense of their passion for the field and how dedicated they are. They meet our fellows and see first-hand what the program is about. They appreciate the volume of procedures we do and understand that ours is a rigorous program, requiring a lot of hard work in return for stellar training.

What impact do you think the COVID-19 pandemic will have on the application season this year?
It is difficult to predict how things will pan out. Having done multiple video conferences and seen Zoom meetings work so efficiently, I am positive that if interviews are conducted over videoconferencing, we will be able to assess candidates equally well. We interview in the early part of next year and I hope that by the end of the year, things change for the better and interviews can take place in person.

You have been an advocate for the practice of yoga for well-being. What got you interested?
Our job entails wearing lead and standing for long hours. You need to take care of yourself and have fun doing it. That is how I got passionate about yoga. I started simple, but I am the kind of person who likes to challenge myself, so I pushed myself to do tougher postures and go to the next level. It does not have to be just yoga – there's Pilates, HIIT or spin classes. If you do not take care of yourself, how can you instruct your patients to do so? One cannot preach without practice! I also make sure I drink enough water and eat healthy. That is a part of living a healthy lifestyle. I am working on wellness app intended to improve and promote health and fitness among health care workers.

What was the motivation behind your first app that started you down this digital path?
I used to travel to attend national meetings and grand rounds because teaching was and still is my passion. However, when my children were young, I decided to stop traveling. It got me thinking about how I could continue teaching and disseminate what I have learned and studied, and that is how we started the CCC live cases, which is almost 11 years old now. Writing books requires a lot of work and takes a long time. To then update to a new edition, the whole process repeats. Digital platforms were just coming in. I liked the idea and that is when we thought: why don't we create an app? When I was in training, we used to carry several pocketbooks around, but now you always have your phone and when you have 10 minutes you can quickly read and brush up. That was my motivation to do this! There are three tribulations for an interventional cardiologist: Bifurcation lesions, calcium and CTOs. We first started with BifurcAID. It was a very challenging topic. At scientific meetings, there is no one method of treating a bifurcating lesion so we thought of condensing the knowledge and creating an app. It was a huge success with more than 15,000 downloads. It is used by cath lab personnel, nurses, technicians and even industry folk. It is free for all and available around the globe.

The most recent app that we are working on is a communication platform for STEMIs. It is something I am very proud of because I think it is going to be a game-changer. I hope the cardiology community will embrace it. Thirty percent of STEMI activations are false alarms. For every activation, a fellow has to come to the ER and review the ECG. With this platform, if there is a STEMI activation, the ER physician will take a photo of the ECG and transmit it via the secure app to the on-call cath attending. They will then have a video conference with the patient and take a brief history. With this app, you thoroughly review the case, either call it a STEMI or call off the code, and save on resources. If it is a true STEMI, then the whole team gets a notification. They can also learn about the patient. The whole team is on one platform which is HIPAA compliant, unlike WhatsApp or text messaging which are commonly used.

Where can people learn more about your applications?
We have a website, All the applications are listed there with descriptions. The most recent release is ComplicAID. It was developed to understand the various complications that you see during PCI. We made ComplicAID a website and not an app because there are close to 800 angiograms. However, it is programmed for mobile viewing as well. The one thing to note is that we did not shy away from sharing our own complications. We have gone through them and learned the hard way. The smartest person is the one who learns from others' mistakes. That's ComplicAID!

For interventional fellows, we have developed five applications: treatment of complex bifurcation (BifurcAID) and calcified (CalcificAID) lesions, use of OCT in PCI (OCTAID), transseptal puncture techniques for various procedures (TranseptAID), and re-access of coronary arteries after TAVR (TAVRcathAID). All applications are free for download on the Apple App Store and Google Play and have more than 28,000 downloads from cardiologists, fellows, medical students and technicians. We are currently working on a 3D version of BifurcAID, a new guidewire application and many other exciting projects.

Interventional cardiology is a hands-on specialty, but is there a role for teaching outside the cath lab?
One hundred percent! We review a case with the fellows and ask them how they would proceed in a step-by-step fashion. By preparing for and anticipating the next step, that is how one learns. I also encourage the fellows to take notes so that they can review them later. We provide them with lots of written material, as well, and have a handbook we distribute to our fellows. I tell them to review things several times over so that if you are woken up in the middle of the night and the situation demands it, you know what to do reflexively.

Yuvraj Chowdhury, MD

This article was authored by Yuvraj Chowdhury, MD, chief cardiology fellow at SUNY Downstate Medical Center in Brooklyn, NY. Twitter: @YChowdhuryMD