1. Please describe your educational and training background.

Medical School: Guy's, King's & St. Thomas' School of Medicine, University of London
Residency: University of Arizona
Fellowship(s): Beth Israel Deaconess Medical Center

2. How did you become interested in Sports & Exercise Cardiology?

I have always been an active individual, whether it has been playing sports for fun, competing, or exercising on my own. Within medicine, I became really interested in cardiovascular performance and finding out what are the things driving my own performance in the gym, or cycling, or whatever it might be. I guess I drifted towards the field of sports cardiology before I even realized it was a field.

During training I sought out clinical and research opportunities within sports cardiology and have been fortunate to work with leaders in both the UK and the US. My first clinical exposure involved seeing athletes in clinic, and performing pre-participation cardiovascular screening. Many of these athletes were professional, elite, famous athletes so there was an initial novelty that I really enjoyed. But I think what kept me curious and interested in the field was that the shape and function of their hearts were so different from yours and mine. Athlete hearts are really the epitome of form and function! I think there is a lot to learn from the way that athletes have remodeled their hearts from chronic exercise training and how you can apply that to patients with heart disease. Ultimately it comes down to performance, whether that's about getting an athlete to perform better in competition or getting your heart failure patient to be able to walk further. I like to refer to the specialty as sports and exercise cardiology because exercise is a fundamental part that pertains to everyone, not just athletes.

3. What are your future career plans and/or goals?

My future career plans are to build on my interest in sports cardiology. Ideally, I would like to head a sports cardiology clinic seeing highly active individuals, athletes, and referrals from other physicians for exercise recommendations and risk stratification. I'd like also to oversee cardiopulmonary exercise tests, while maintaining my academic and research goals. At this stage, I still find it difficult speculating exactly how my career will pan out, particularly because I enjoy so many aspects of cardiology. That said, my overarching aim is to make a meaningful contribution to the field of sports and exercise cardiology, with the objective to improve the cardiovascular health and fitness of our communities.

4. Can you tell us about your research interests.

For the next two years I will be on an NIH T32 grant under the mentorship of Dr. Robert Gerszten investigating the various factors that mediate cardiovascular remodeling to exercise using multi-omic technologies including metabolomics and proteomics. Essentially, we will look at how exercise provides all its cardio-metabolic benefits and why some people may derive more benefit from exercise than others. In reality, I'd like to understand why, given how much I train, I'm not an elite athlete!

I do think the value in being trained as a physician, and genuinely interested in the field of proposed research, is that you can ask the right questions. There is a lot of value in bringing together personal interests and interactions with patients to help identify the evidence gaps and ask the right questions. I think it's a great place to start and then collaborate with others with different skills to figure out how best to address those questions.

5. What is the most challenging aspect of your career path?

Those who go into sports cardiology first and foremost need to be excellent general cardiologists. One of the most challenging aspects of sports cardiology is in applying general cardiology principles to a field which has relatively less data. We need to be able to think about what principles can be extrapolated to athletes and where we may need to use more caution. For example, one of the interesting developments in the field of sports cardiology is the management of coronary disease in older athletes. We know that the risk of coronary disease increases with age and that even these highly fit individuals are not immune from developing atherosclerotic heart disease. But I think it's important to exercise caution when extrapolating research findings that have been derived from the general population to the highly fit and athletic population. I do believe you have to think differently about an individual who wants to push themselves hard in training on a regular basis, or compete in a marathon, compared to someone with a sedentary lifestyle, even if they both have the same degree of coronary disease on an angiogram. The issue is that there are not much data to guide athlete specific management as it relates to common cardiovascular conditions like coronary disease or atrial fibrillation. While this presents a challenge to many sports cardiologists, it also provides ample opportunities for those interested in this field to conduct research to help push the boundaries of our understanding.

6. How did you identify your mentor(s) and develop a successful mentor/mentee relationship?

I think mentors can come in many different forms. They can provide a range of different perspectives whether it is research, clinical, or life mentorship. I think it's also OK to have more than one mentor to look to for different counsel. For example, my mentors in England gave me my first research experience, exposure to sports cardiology, and without them I would not have been able to develop the interests I have today. In the US, mentors have provided me with incredible research opportunities, whether it's been involving me with important and really cool projects, invitations to co-author reviews or recommending me to speak at national conferences. From a clinical standpoint, there've been numerous occasions when mentors have set an example through their interaction with patients that has inspired me to be a more thoughtful, compassionate and curious physician –these observations continue to motivate me to do better. Above all though, getting to know a few of my very close mentors on a more personal level, for example outside of the hospital, whether it's at lunch, dinner or even at their homes has meant the most to me and speaks to their warmth and generosity. This is an aspect of mentorship that I've really come to appreciate and hope to emulate in the future.

7. What advice would you give residents interested in pursuing cardiology/ sports cardiology?

I think if you're going to jump into something, especially if it's something niche like sports cardiology, then you have to give it your all so you can get the most out of it. In my case, it has opened doors to some incredible opportunities in the US and elsewhere. At this early stage in our careers, it's crucial to take advantage of every opportunity to expand your knowledge.

In terms of cardiology in general, it's so important to love what you do, and there are so many things to love about cardiology (but of course I'm biased). There are many different routes to take in this field, all of which are rewarding and impactful. It caters for all personalities and people from all different backgrounds. This is why residents and medical students interested in cardiology shouldn't be put off because they don't see themselves "fit in". Social media and twitter in particular have provided greater public visibility to many cardiologists, and have provided an accessible platform to connect with them. I strongly encourage those interested in cardiology to take that brave step to connect with some of my really supportive colleagues through any platform with which they feel comfortable. To bring this back to sports and cardiology — "You miss 100% of the shots you don't take."