How I Stumbled Upon the Field of Cardio-Obstetrics

"I have no chest pain or shortness of breath." I stared back at the patient as she said those words, dazzled for a second on how to proceed with the encounter. It was a typical weekday morning on the antepartum floor, and I was pre-rounding as part of the maternal fetal medicine (MFM) team. I was with a patient who had been transferred the night before from an outside hospital after being found to have an ejection fraction of 25-30%.

I proceeded to ask her all the other standard questions on the antepartum daily progress note. However, my mind was stuck on her earlier statement. How could you have such a low ejection fraction and not have any symptoms? She continued to answer my questions, and I learned that she had no history of hypertension or cardiac disease.

I moved onto the physical exam, but felt even more perplexed as to how everything in this patient encounter was unfolding. I did not have much clinical knowledge about heart disease in pregnancy, but I did remember some physiology lectures from preclinical years. Could she be denying any symptoms because it was hard for her to differentiate abnormal symptoms from symptoms that she thought were just due to being pregnant?

Whenever I heard someone talk about their research interests, I always wondered how they chose that topic. That topic amongst all the other topics in the field. Out of all those disciplines. I wondered how investigators found their topic of interest since I often found myself being interested in everything. However, that day on the floor during my MFM rotation, I learned the value of clinical experience guiding research interests. The conversations with my team during the rest of that day were enlightening; I learned much more about peripartum cardiomyopathy, and how it can be a difficult diagnosis and have many phenotypic presentations.

This particular patient had a preterm delivery the next day, and fortunately had a smooth postpartum recovery in the hospital. However, the team shared with me other experiences with patients who had cardiomyopathy during pregnancy, some of whom had adverse fetal outcomes or needed intense measures of life support. And that is how I stumbled upon the field of cardio-obstetrics.

I attended the American Heart Association's Scientific Sessions a few months after that and had the pleasure of hearing a talk from Uri Elkayam, MD, FACC – a pioneer in the field of peripartum cardiomyopathy. Flash-forward several months later during the virtual ACC.20 Together With World Congress of Cardiology meeting, I was able to learn more about the field through the cardio-obstetrics intensive sessions on maternal cardiovascular mortality.

During all of this, I dug into the literature and was able to work with mentors in the Cardiology Department and Maternal Fetal Medicine Department at my home institution to create a retrospective research project. If you are looking to do research in medical school, I encourage you to take the initiative to design research projects yourself based on clinical experiences, as it makes the project much more meaningful. If you are attending a scientific conference in medical school, it can often be overwhelming since so many sessions are happening simultaneously and everything sounds interesting. Take a step back, reflect on meaningful clinical experiences, and use that as a guide to seek out ways to learn more about that specific topic at the conference.

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This article was authored by Gurleen Kaur, medical student at Albany Medical College in Albany, NY. Kaur is part of the physician/scientist program and will be graduating in 2021. She is interested in pursuing residency in internal medicine and a future career in academic cardiology. Kaur has been involved with both basic science cardiovascular research and clinical research projects in cardiology during her time in medical school. Follow her on Twitter: @Gurleen_Kaur96.