The Heart of a Woman: Piedmont Healthcare

Her father was a psychiatrist, her mother a nurse. It’s no surprise that this childhood acclimation to the world of medicine was enough to lead Jyoti Sharma to medical school after she graduated from high school in Georgia, and then moved on to Atlanta’s Emory University.

She went to New York for her residency and joined the legions of newcomers changed by a sojourn in the Big Apple.

“New York blew me away,” says the woman born and raised in Tucker, Georgia. “It was so different from anything I had experienced before.”

Her internship and residency at Beth Israel Medical Center became one of her New York moments of discovery. She began with the idea of becoming a neurologist, but ultimately, it was cardiology that she found more hands-on, more exciting.

Exciting, perhaps; arduous, definitely. At the time there were lots of reasons for a woman to avoid cardiology. Training took longer. Most cardiologists were men. The pay was lower for women, and the hours weren’t exactly family-friendly. Even more forbidding to her was that most cardiac patients were usually sick in complicated ways, often struggling with other diseases like cancer or diabetes that exacerbate heart problems.

“Despite all that I just knew I had to be a cardiologist,” she says.

Even more certain was her drive to become a cardiologist for women. It’s a formidable task. In the minute or so it takes to read this far into the story, yet another women somewhere in the country has died of heart disease or stroke.

Every year since 1984, more women than men have died of heart disease. And the gap is likely to widen. In Georgia, heart disease and stroke account for 28.2 percent of all female deaths, the 12th highest in the nation. That’s about 27 women each day. By comparison, the unacceptably high death toll on Georgia’s highways is about four a day.

“Women’s heart health is more than a public health issue,” she says. “It’s a moral crisis.”

Indeed it is. That’s why Dr. Jyoti Sharma, a cardiologist at Piedmont Atlanta Hospital and co-director of Piedmont’s Women’s Heart Program, has taken on a simple mission:

Save lives one woman at a time.

She may have the requisite appearance of a physician — white lab coat, patient-friendly smile — but to overcome the grim statistics, she needs the skill and perseverance of a homicide detective stalking a serial killer. The perp in this case is heart disease. Tracking it down is deadly serious work, because heart-related diseases are the leading cause of death for women, taking one in every three who are diagnosed. The stat for breast cancer is about one in 36.

Ironically, it is a crisis to which women themselves contribute. Although heart disease threatens men and women about equally, far too many women perceive it as an illness for men. For example, the left anterior descending artery — often called “the widowmaker” — can cause a fatal heart attack for anyone, but the nickname reinforces the misleading notion among women that heart disease strikes only men.

To Dr. Sharma, it’s a frustrating and potentially deadly misconception, one she believes inhibits research, screening and treatment for women. More immediately, it causes women to hold back on complaints or fail to follow through with tests.

“By improving what we do for women we can improve care for everyone,” she says. “If we don’t improve, we’ll keep suffering losses we could have prevented.”

Deadly as they are, cardiovascular diseases are even more threatening when they interact with other illnesses. Takiyyah Hamilton, a 36-year-old mother and patient of Dr. Sharma, is a survivor’s story.

A few years ago, she had her dream career at the Centers for Disease Control, enjoying her life as the mother to a beautiful two-year-old daughter, Alexander Ann.

“When things are going well, no one ever thinks she is going to get breast cancer,” Takiyyah says. “It’s always going to hit someone else.”

Fortunately for Takiyyah, her mother, Catherine, a breast cancer survivor herself, impressed on her daughters the importance of doing self-exams regularly and correctly.  

Takiyyah was breast-feeding her daughter one day when she discovered a lump. It scared her, of course. When the biopsy confirmed the cancer, her oncologist decided to start the chemotherapy. A double mastectomy followed months later.

For a time it appeared that Takiyyah would quickly and happily join the ranks of cancer survivors. Instead, her life got more complicated and more dangerous. It’s not uncommon for cancer and its treatments to have collateral consequences on the heart, and it was discovered that one of the chemotherapy drugs Takiyyah was taking posed a serious risk to her heart.

“I was told that this could happen. I just dismissed it and convinced myself that it wouldn’t happen to me,” Takiyyah says. “When it did, it seemed like just one more thing I had to deal with. I gave myself a day to cry over it and then started with the heart treatment.”

That’s when Dr. Sharma joined the case. Together with the oncologist, she added heart medications and suspended chemotherapy. It worked. Takiyyah is now cancer-free with a very healthy heart that sustains her 70 miles a week in spin classes.

“We couldn’t have told this story 15 years ago,” Dr. Sharma says, reflecting on the joy of watching medicine advance. “Heart monitoring has become more sophisticated, treatment has become more regimented and technology has advanced along with better medications.”

But Dr. Sharma never strays far from alerting anyone who will listen about the dangers to the heart lurking in other diseases. “It’s not just cancer. Kidney patients are at risk, and so are diabetics and those with inflammatory diseases like lupus and rheumatoid arthritis. Women with endocrine or hormonal abnormalities like polycystic ovary syndrome (PCOS) should have cardiovascular screening, as should those with breast calcifications.”

She pauses, checking to see if her listener got the message. Her smile is friendly, but it masks a fierce determination to save lives any way she can. She is a woman with a mission.

What if she fails?

“What a horrible thought. I never think about not succeeding,” Dr. Sharma says. “This week I had some very sick patients, and it was very discouraging to think I can’t heal them all. But you do what you need to do and do it as well as you can.”

A resolute attitude, but her face and voice suggest that the idea of not succeeding is unsettling. “Fortunately, we have palliative care and end-of-life treatments,” she says. “We always want to treat the patient, not just the disease.” Her voice trails off as she confronts what every cardiologist must. Persistence is an option; perfection is not.

Dr. Sharma is driven because she understands what women are up against in the United States, where the 44 million women diagnosed with heart disease have a higher lifetime risk of stroke than men and a lower chance of surviving their first heart attack.

Complicating the problem for physicians is that medically, men and women are different, and those differences can be deadly. It’s a theme Dr. Sharma returns to repeatedly.

Women may not be aware they’re suffering from heart disease. Their clinicians may not be tuned in to some of the symptoms patients are experiencing, like fatigue and shortness of breath, that can also be attributed to many less-serious conditions.

Sorting this out requires the detective work that begins with screening. It also involves a lot of missionary work.

“I am constantly meeting with groups of women at churches, sororities and women’s luncheons,” Dr. Sharma says. “Over and over in these sessions, I see how women are very good in their caretaker role, looking out for family members’ eating and lifestyle habits. But they are just not as diligent in looking out for themselves. The more women we can alert to the risks, the more we can save.”

Dr. Sharma worries about women who don’t realize that the pregnancy they had in their 20s could affect their hearts in their 40s or 50s. Menopause can be another contributor to heart problems, only in most cases the later it starts, the lower the cardiovascular risk. Depression can be another factor, because depressed people tend to exercise less, eat more and not be as diligent in taking their medications.

“It’s complicated,” Dr. Sharma says, “But it can all relate to heart health.”

That’s why she glows with enthusiasm when talking about Piedmont Hospital’s initiatives to become a primary destination center for cardiovascular treatment and research.

As co-director of Piedmont’s Women’s Heart Program, Dr. Sharma vigorously advocates cardiovascular screening at every opportunity. “Thanks to the screening, we’ve been fortunate to catch heart disease early on in scores of women, increasing their chances of long-term survival. We’ve also managed to identify women at increased risk for heart disease and help them adopt healthier lifestyle practices to ward off heart disease before it is diagnosed.”

Dr. Sharma is both inspired and instructed by patients to whom she’s given a second chance. She tells the story of one woman in her 50s who had many of the common and dangerous risk factors: diabetes, high blood pressure, overweight. She was always fatigued. Even walking around the supermarket would exhaust her.

But it was the symptoms she didn’t have that puzzled Dr. Sharma. She hadn’t fainted or passed out. She wasn’t dizzy or sweaty. In other words, her symptoms were uncomfortably vague or contradictory.

An echocardiogram was ordered. It was normal. A chemical stress test followed. Nothing. Despite the absence of the usual suspects as symptoms, the patient kept insisting she felt poorly. Finally, a CT scan uncovered the cause of the discomfort: massive blockage of coronary arteries.

Dr. Sharma smiles when she recalls the lessons of that case: “First, be wary of test results, especially negative ones. They can be dangerously misleading. Second, listen carefully to your patients. They might not know how to describe everything with precision, but their bodies are always telling you something.”

She pauses at the end of the story and admits that if she hadn’t believed the patient’s symptoms were important and pursued the tests to the point of discovery, its likely the women’s heart would have failed. That’s saving lives, one woman at a time.

It is not without some professional envy that Dr. Sharma praises the decades-long work being done for breast-cancer prevention and treatment. The Susan B. Komen organization has generated great awareness of breast cancer. These days, when a woman gets breast cancer, she is quickly surrounded by a community of supporters.

“We need to offer the same environment to heart patients,” Dr. Sharma says. “Beyond the treatments, beyond the stents and medications, we need to stay determined to keep our patients healthy. We need to be concerned about their diets, exercise and rehab regimens. We need to stay involved in their well-being.”

Her energy rises as she describes a recent Piedmont survey asking women patients and their families what the hospital could do better.

“It was not a surprise to me that they wanted someone to talk to. Who wouldn’t?” Dr. Sharma says. “We know people draw strength from support groups.” They also want to know more about heart-healthy diets. Diet is a hot topic with Dr. Sharma, the 36-year-old pregnant mother of a toddler.

She smiles when she talks about making rehab sessions more appealing to women: “Can you blame them? Most sessions are filled with older men. Nice fellows, I’m sure, but can’t we make the session more women-friendly?” It’s an example of how to Dr. Sharma, no detail is too small if it leads to improving a woman’s heart health.

Dr. Sharma has a great admirer in Takiyyah Hamilton, the patient who overcame cancer complicated by heart disease.

“God never failed me,” Takiyyah says. “Throughout the difficult days of treatment, my mom encouraged me to imagine myself healthy and remain positive. Dr. Sharma and her team gave me more than medications. They gave me hope and the will to stay healthy. I trusted God and my doctors. I feel blessed.”

One woman at a time.