Caitlin Giesler, M.D., is a cardiologist at Ascension Medical Group in Austin, Texas. A Houston native, she went to medical school at McGovern Medical School at the University of Texas Health Science Center at Houston. Giesler then completed her residency and fellowship at the University of Cincinnati.
Giesler started her practice as a general cardiologist in 2008 at Austin. After about four years, she became curious about the differences in heart disease between men and women. She transitioned her practice to treating only women, primarily because most of the research on heart disease is conducted on men.
Giesler's goal is to help fill the gaps in the knowledge base for the treatment of women with heart disease.
Editor's note: This interview has been edited for length and clarity.
Giesler: I did four years of undergrad, four years of med school, three years of internal medicine residency and three years of cardiology. If you specialize further in cardiology, like for interventional cardiologists who put stents in or the electrical guys who do pacemakers, it's one more year past that.
The heart is amazing; the physiology of the heart is just incredible. You have the heart muscle. You have the blood vessels that feed it. It has its own electrical system. That was extremely interesting to me in medical school.
I also have a very strong family history of heart disease. My dad died of a heart attack in my last year of med school, which changed my perspective a little bit in that I just realized the importance of being aggressive, prevention and being aware of the overall risks.
With heart disease, primarily it's treatable. As long as we know it's there and you're at high risk for it and we treat it, we can greatly reduce the risk of complications. It's super-interesting and also really exciting.
You would see a cardiologist if you have a risk for heart disease. If you have high blood pressure, high cholesterol or a family history of heart disease, come in and we address all of those issues. We fix them but then also assess your overall risk in the short term and then the long term.
If you're a 40-year-old with those issues, your risk of a heart attack in the short term is pretty low. But if you're 70 and you have high blood pressure and high cholesterol, we need to be pretty aggressive in investigating any symptoms you're having. I will do a lot of maintenance stuff. But if you're having symptoms, chest pain or shortness of breath, then I treat patients by doing testing, like stress testing, echocardiograms and ultrasounds of the heart.
And if we've made a diagnosis of heart disease in somebody, then maybe they need open-heart surgery and I'll send them to a surgeon. But the long-term maintenance of that is on the cardiologist. We check their numbers and maintain their overall health in the long term. We do the prevention, the investigating and then the maintenance.
Most conditions fit into one of three categories. It can be a pump problem where the heart muscle is not working, which is typically called heart failure. Or the valves inside the heart are not working properly, which also can cause heart failure. You can also have electrical problems where the electrical system isn't conducting properly; [for] things like atrial fibrillation where people feel their heart racing, we check on electrical problems. If their heart's electrical system isn't feeding enough, then they get a pacemaker.
There are also plumbing problems, where the blood vessels that feed your heart can get blocked up. That's where, typically, somebody would have a heart attack. We can go in and open up blockages in those blood vessels and get the blood flowing again.
The main thing is knowing the objective. What's the problem you're trying to solve? Do you want to know what your risk is? Are you curious about symptoms? Make sure you know what your question is so we answer the questions on your mind.
Also, knowing your history and knowing your family history, mainly parents and siblings who have had any heart problems. It's helpful to know what those are because there are a lot of genetic issues. And then knowing your numbers. Do you know what your normal blood pressure is? Do you know what your cholesterol is?
I always ask patients how they feel when they're active because that's a good heart test. How do you feel if you go up a flight of stairs? Because that's when your heart really works. So if there's a problem, we can often figure it out based on how you feel when you're active.
We take into consideration the likelihood of certain things, again, pending age and other risk factors. We look at all the objective data. We look at the heart exam. We'll look at your EKG [electrocardiogram]. We can often do other tests, like a stress test. That's how we look to see if your symptoms are heart-related or not. We do the echocardiogram ultrasound; that's where I can look at the heart muscles and the valves. That objective testing, we use and then put it all together and figure it out.
You want to ask about your risks for heart disease in the short term and the long term. Ask what you can do lifestyle-wise that reduces your risk and can help you feel better.
There are quite a number of problems to solve, but I think the biggest breakthrough would be an artificial heart that can be implanted permanently. The problems of battery life and damage to blood cells from stress, among other things, have prevented success historically. If we had artificial hearts available, we could save many lives and improve the lives of people disabled by heart failure and chronic chest pain.
