Worried About Heart Health? Yale Medicine Expert Has Answers
BY KATHY KATELLA February 12, 2019
Colleen Pietras, MD, was born into an adventurous family that includes runners, climbers, mountain bikers, and skiers. Now that she is a busy cardiac surgeon, Dr. Pietras, a former professional ski instructor, gets up at 5 a.m. each morning to do at least 5,000 meters (about 3 miles) on her rowing machine.
Dr. Pietras says that the more she learns about the links between heart health and lifestyle, the more meticulous she is about her own health habits, which directly affect how she feels about her life. “For me, a happy life includes emotional well-being, putting better things into your body—including feeding your intellect—and a lot of exercise,” she says.
In 2018, Dr. Pietras became Yale Medicine’s first female cardiac surgeon. She cares for patients in Fairfield County and the New Haven area, and performs surgery at both Bridgeport and Yale New Haven hospitals. While she treats a variety of conditions, her specialty is adult cardiac surgery, with a special interest in complex reoperations. (Reoperations are performed for a variety of reasons. For instance, a patient may need surgery for newly acquired coronary disease, or the bioprosthetic valves, which typically last about 10 years, may need to be replaced.)
She talked to us about what patients need to know about cardiac surgery and keeping their hearts healthy.
What inspired you to become a cardiac surgeon?
I wanted to be a physician since I was 5 years old. I remember my pediatrician’s office clearly, which did not bring fear, but rather an interest that extended into instruments, books, and history. I followed a premedical path in college, but it wasn’t until after graduate school that I actually met a cardiac surgeon. He became a mystical figure for me and someone I often reflect back on when I want to stay grounded. He was articulate, thoughtful, and well-regarded. He was hard-working and dedicated. More than anything, he was passionate, and it showed.
As a medical student, I rotated with a general surgeon who, while we scrubbed, would ask me to memorize and recite brief histories of the lives of surgeons. I was again drawn to cardiac surgeons as their accomplishments, to me, were the most fascinating. I love the anatomy and physiology, and creative and visual aspects of surgery, and I am in absolute awe of the heart. It has the capability to overcome immense odds by developing, recovering, and compensating in the face of disease and failure. That I have the opportunity to do this work is an absolute gift—a privilege—and one that should not be taken for granted.
What types of heart disease patients do you care for?
I treat a wide range of cardiac conditions that include coronary artery disease, ischemic heart disease, valvular heart disease, pericardial disease, heart arrhythmias, heart failure, aortic disease, and pericardial tumors. Many patients come in with a symptom, such as shortness of breath, and they know that something is not right. We may end up with a diagnosis that is not related to their heart at all—it may be pulmonary-related, endocrine-related, or rheumatologic. Then, there are patients who have had shortness of breath for a long period of time, but they associate it with something else. They may think it’s because they have gained weight or developed thyroid disease, or they’ve had a lot of recent stress. Others have chest pain and think it’s just anxiety.
As the story comes together, you realize there is something more going on. We do their evaluation and a physical exam. We can diagnose a lot by listening to their heart with our stethoscope or doing an X-ray and looking at the size of the heart. We might do an electrocardiogram (EKG), which measures electrical activity, and find out there is an arrhythmia (an irregular or abnormal heart rhythm) of some kind. Eventually, we may get an ultrasound to look at the heart valves and wall or see if one of the heart’s chambers is unusually large. The evaluation for an actual heart attack can be as simple as getting blood work and an EKG.
What are the symptoms that lead people to see a cardiac specialist?
There are a number of things that may signal heart disease—palpitations, dizziness, weakness, or fatigue are a few. Uncommon ones that I’ve seen, particularly in women, are back pain and jaw pain, which may even appear as a toothache. Women having a heart attack can have an entirely different range of symptoms from men.
You’ve probably heard that the most common symptom of a heart attack is crushing chest pain—a patient might describe this as feeling like an “elephant on their chest.” Or pain radiating to their back, or they are short of breath. Or, if they’ve had asthma since they were a child, they may notice that the shortness of breath has changed. There is also a feeling of impending doom that many patients have before a heart attack. They just know something is wrong.
It must be difficult to tell someone they need heart surgery.
I try to make it as simple as possible. This is usually an overwhelming time for them. I might say, “You're having chest pain. We found a blockage in one of the arteries in your heart, which means a certain area is not receiving the blood, or oxygen, it needs. So, we are going to take an artery from your chest wall or veins from your leg and bypass that blockage so that your heart gets the blood supply it needs to avoid long-term damage.” It is important to be direct with patients.
Cardiac surgery is extremely dynamic, nothing is ever the same. Part of my responsibility is to stay up to date on ongoing trials and outcomes. A lot of our patients are doing their own research and there is an immense amount of information to sort through. This can lead to confusion and anxiety for patients and their families. Sorting through these options is challenging at times but helps to start a very genuine conversation. That’s why I think it is critical for me to be in love with the subject matter.
Is minimally invasive surgery making these procedures easier?
Minimally invasive surgery is changing things a great deal, and so is interventional cardiology (the branch of cardiac care that uses catheter-based treatment). Many patients tell us they want very small incisions, which is understandable. But to us it’s about treating them safely and with the fewest complications. We’ve learned that, depending on the patient, some interventions are safer than others. For example, if a patient is above a certain weight or has challenging anatomy, the surgeon may not have the best visualization with a specific approach. Or the heart may be abnormally large or tipped to one side and small incisions would make the operation difficult. So, we don't look at every patient and say, “We'll do minimally invasive surgery.” A lot of thought goes into choosing the best approach.
But you always emphasize a healthy lifestyle, whether they need surgery or not.
Of course. And I know it isn’t easy. As a cardiac surgeon I’m aware that facing heart surgery is stressful and it may not be the best time to completely eliminate habits like smoking and drinking, or to make a massive overhaul on your diet. It’s true that if you are not reliant on some sort of substance, you’ll heal better—people who don’t smoke are at lower risk for wound infections, for one thing. So, whatever stage you are at, I recommend taking small steps—even very small steps—in a healthy direction. Of course, talk to your doctor first. But provided you do not have any prohibiting factors, such as unstable chest pain, poor pulmonary reserve, or physical debilitation, it is a good habit to get your heart rate up for 30 minutes a day by walking, climbing stairs instead of using an elevator, or parking farther away from your building so you can walk a longer distance from your car. If you're not sure how to change your diet, you can seek out the help of a nutritionist, or get advice from someone you know who has a diet that actually works for them.
And this is true at any age, right?
Yes. It is important to educate young people about the importance of establishing healthy habits early on. What they do now can make a difference later, because, really, coronary disease starts at the age of 18. Borderline hypertension and high cholesterol are being diagnosed earlier, so we want young people to pay attention to diet and exercise and family history. At a certain age, we all think we’re indestructible. I know I did. You feel as though you aren't going to be affected by disease in any way for a very long time, and it can come as a shock when you hit 30 and then 40, and you have a serious health problem. So, the most important thing is to establish a solid foundation as early as possible.
Why did you come to Yale to provide cardiac care?
Yale is a well-established academic institution and the cardiac surgery program has a robust history. We see complex cases. We have specialists in heart failure, the aorta, the mitral valve, the coronary artery. We all do a wide breadth of surgeries, but each of us also focuses in one particular area. My recommendation to any patient is to go to a surgeon who specializes in the surgery you need, meaning he or she understands the disease process and the significance of your particular symptoms, and the surgeon has experienced a lot of repetition—he or she has performed the particular operation enough times that they have exceptional results.
What does it feel like to do this work every day?
I'm excited all the time about this profession. It's remarkable how patients can live a kind of sustained debilitating life, and then turn such a huge corner after surgery. Some of them don’t even realize how sick they have been until they come to us. They put a lot of trust in us. It’s just an amazing gift to be able to do this for people, and it's one I find personally fulfilling every day.