Dr. Mandeep Mehra, head of cardiology at the University of Maryland Medical Center in Baltimore and a professor of medicine and head of the cardiology division at the University of Maryland School of Medicine, specializes in advanced heart failure and cardiac transplantation. Mehra, who took over the post almost four years ago, spoke with The Examiner about what motivates him and how doctors are working on ways to help the heart heal itself.
How did you get into this field?
When I was training in cardiovascular medicine in New Orleans, in the first year I was fascinated by transplantation. The notion that you could take a heart out of someone and put a new one in. It was my first exposure to transplantation, and it just seemed to me like it was so fascinating. Everything else in medicine seemed so mundane and routine, and this seemed miraculous. I spent the last 15 years basically doing more and more in the field of advanced heart failure and transplantation medicine.
How much has it changed since then?
A lot has changed… One area we are now focusing on is developing new cardiac support devices. For example, it is very much a toss-up whether a patient who is listed for a heart transplant will receive an appropriate donor in a timely fashion before they die.
One in five people [die] even before we can find them a good heart.
One advance that has occurred is the use of ventricular assist devices. There are mechanical heart support devices we can use as a bridge to transplantation.
So you can put this in while they are waiting for a heart?
Yes, and now these devices have become so small, they can literally fit in the palm of your hand and can support the heart for up to a year.
But they aren’t as good as a transplanted heart?
Nothing so far has been created [that matches] the engineering sophistication and durability of the human heart.
What is the future? Are we leading toward an artificial heart?
We see the field getting to a point where these devices will become more durable, and I think where we will make the most progress is in the notion of heart healing.
In other words, people have always thought these devices are nothing more than a bridge to the eventual replacement. And now we are thinking, what if we took over the function of the heart and allowed it to rest for several months and then had the opportunity of pushing heart healing medicines on top for four or six months. Then you could over time remove these devices. So forget about doing a heart transplant — talk about a bridge to recovery rather than a bridge to replacement.
Patients keep their hearts and they would be healing themselves?
Exactly, because no one has made anything better than nature has.
Can you give me an idea of when there is the need for a heart transplant?
Heart transplantation is done in both young and old, however we try not to do it once the age exceeds about 70. We typically ask that transplantation be considered for those people who have less than a 50 percent chance of surviving the next 12 months. There are different ways for us to tell that. These are people who have a certain amount of heart damage that reduces the pump function, if medications stop to work, they require frequent hospitalizations or medicines continuously all day and night long.
Those are the easy cases.
I read you’ve always wanted to go into medicine. Is that right?
I have never been able to think of anything else. My father was a businessman. I am an only child, and this is my grandmother who did this to me. I often think about why this happened to me. Why could I never make a choice? I just couldn’t fathom anything else.
I remember all the way back to age three that I just wanted to do nothing but medicine. And I think it’s because my grandmother brainwashed me.
Because she wanted you to be a doctor?
She wanted me to be a doctor. I remember every moment I was in her lap, even as a two year old, she would keep saying, ‘My grandchild is going to be a doctor. My grandchild is going to be a doctor.’
I am sure there are a lot of grandmothers that do that and it’s not as effective.
This was effective. I was literally brainwashed. And she was right. I have absolutely no regrets.
What are your days like and what do you do when you are not working?
I have no structure to my job. There is no 9 to 5. I basically work literally all the time. I am a workaholic, which is not a good thing. I have family and I spend a lot of time with my family. … My mother died of sudden cardiac death in my arms, before I moved here. In fact that might have been one of the reasons that helped me make the decision.
As I was being recruited to Maryland, my mother was really enthused about this job. She was encouraging me to make the move. Then on Oct. 3 of 2004, she knocked on my door at about 10 minutes to 6 in the morning. She said she wasn’t feeling well, and within three minutes she was dead.
How did that change you outlook?
That is what turned me on to this issue of women with heart disease and this so-called gender gap. It’s real. She had complained of tiredness and fatigue for the month preceding. Her sleep patterns had changed.
One of the consistent things we see in women who are about to have a heart attack is that their sleep patterns change, and they start to exhibit mood swings for weeks before that. These are such imprecise symptoms that are easy to ignore.
I don’t know why my mother died, but I am not going to ever ignore symptoms — however imprecise the symptoms sound.
I am less inclined as a clinician to ignore symptoms and just wave them away now. I think it also made me more empathetic and I have stopped taking anything for granted.
Up close with Dr. Mandeep Mehra
» Career: Chief of Cardiology at the University of Maryland Medical Center
» Age: 43
» Hometown: Columbus, Ohio
» Current home: Baltimore County
» Family: Married to Gayatri; son Anshul, 17, daughters Lushna, 14, and Rishka, 11
» Hobbies: Creative writing, chess, yoga
» What he’s reading: Outliers by Malcolm Gladwell
» Philosophy: Inspired by love, guided by knowledge and chiseled by resolve (modified from Bertrand Russell)
