Fellow Feature: Dr. Sibi Krishnamurthy

Fellow Feature

Dr. Sibi Krishnamurthy is a Third Year Cardiology Fellow at UMH. He volunteers regularly at the SJB Clinic cardiology nights and DOCS Health Fairs. He has made a significant impact on the lives of many patients in the South Florida Community. This story exemplifies how Dr. Krishnamurthy helped provide life-saving treatment and access to longitudinal care to a patient in need.

“I first met our patient in the cardiology subspecialty night. The medical students I worked with had taken a great, thorough history and told me that she had been dealing with chest pain limiting her ability to do work over the past few weeks with symptoms that sounded like angina: substernal, worse with exertion, and relieved with rest. Our patient had all the classic risk factors for coronary artery disease: poorly controlled diabetes with an A1c of about 13%, severe hyperlipidemia with an LDL of 212, hypertension, obesity with a BMI of 31, and approaching her late 40s in age.

Unfortunately, the pain was also becoming more intense and more frequent, even occurring at rest. At this point, she was experiencing what we call crescendo angina, which was progressing to unstable angina, a type of acute coronary syndrome where a blood vessel in the heart likely has a significant but not complete blockage. She had gone to another hospital the week prior but only had lab tests done (negative troponins to assess for an active heart attack). There was no echocardiogram, stress test, or cardiac catheterization performed, which are very important in a workup for a patient with these symptoms and risk factors. I’ve been to the SJB clinic many times through medical school, residency, and fellowship, but this was the first time I was really concerned that something needs to be done urgently.

Dr. Sibi Krishnamurthy

The patient population that we see at SJB clinic has very limited access to medical care and testing provided at most major hospitals. A majority of these patients can’t even qualify for a Jackson Card, which has been a great resource for underserved populations in our county. As such, our best option was to stress to the patient that she needed to go the Jackson ER and that we would expedite a cardiac catheterization for her to assess her blood vessels and fix the potential blockage. We discussed the possible financial difficulties this may cause, especially with her work, but also relayed that the high risk of mortality and morbidity if she has an unstable plaque. I coordinated with the on-call cardiology fellow that night as well as the daytime consult fellow to be on the lookout for her arrival in the ER so that she would not slip through the cracks of the busy hospital. Unfortunately, she was hesitant to go, and despite phone calls from the daytime SJB staff as well, she never came to the ER.

Fortunately, I saw her at the next Cardiology night. Her symptoms had gotten even worse since the last visit, and we once again spent a thorough amount of time explaining the importance of seeking immediate medical attention at the hospital. She finally agreed to go the following night. I contacted my colleagues in the cath lab and ER at Jackson to expedite her admission so that we would minimize her length of stay and costs at the hospital.

After being admitted to the hospital, she underwent the cardiac cath in the morning and was found to have a severe 80% blockage in the proximal portion of the biggest vessel of her heart, the Left Anterior Descending (LAD) artery. Heart attacks in this vessel have colloquially been referred to as the “widow maker” due to high rates of mortality. She had a stent placed at that site with significant improvement in the size and flow of the blood vessel. She was monitored overnight, started on the appropriate medical therapy for her stent as well as for her hyperlipidemia and diabetes, and went home the following day without any complications. Since then, she has followed up at both the post-stent clinic at Jackson and at SJB where she reports no further chest pain. She has been able to go back to work without any limitations. Going forward, our main goal at the clinic will be to prevent any new plaques from forming by optimizing her risk factors: cholesterol, diabetes, blood pressure, and weight.”