Top Doctors 2021: Med School Crisis Sparks Career in Cardiology

Name: Keiko Aikawa, M.D., Fellow of the American College of Cardiology

Practice and hospital affiliation: PacMed cardiologist at First Hill and Canyon Park clinics; medical director of PacMed Cardiovascular Lab (Vascular Studies)

Why did you pick your specialty? I fell in love with cardiology when I was a medical student. I was on my cardiology rotation and followed my attending to see a man who presented with a sudden onset of excruciating chest pain. I watched as she swiftly gathered information in her history and physical examination and promptly decided to perform a transesophageal echocardiogram [in which an ultrasound imaging probe is passed into the esophagus to directly visualize the heart and large vessels]. She skillfully performed the study and diagnosed the patient with a life-threatening aortic dissection, and the patient went immediately to surgery to have it repaired. It was one of the most amazing things I had ever seen, and I knew at that moment that I wanted to go into cardiology. 

Cardiology has provided me with the opportunity to make a real difference in people’s lives. After over 20 years of practicing cardiology, I have gone through challenging and, occasionally, scary situations alongside my patients, and I am grateful for the relationships I have developed with them. Every day is unique, and I enjoy the variety of ways that I can help people. I may see an 18-year-old man with palpitations, and then turn around and treat a 70-year-old woman suffering from symptoms due to severe narrowing of her aortic valve. 

On one end of the spectrum, I talk to patients about cardiovascular disease prevention and discuss the evidence behind eating well, exercise, blood pressure control and lipid management. As each patient has their own obstacles to implementing this in their lives, I enjoy the challenge of finding individualized ways to help each person reach their goals. On the other end of the spectrum, I may see acute issues such as congestive heart failure or a patient in the throes of a heart attack that requires hospitalization. 

I also really enjoy the intellectual aspect of cardiology. It’s a field that requires you to be an epidemiologist, cellular biologist, detective, patient advocate and a sympathetic ear. From new treatments to cutting-edge technology, cardiology is always evolving and allows me to continue to learn and develop new skills. 

We have many effective treatments available to improve longevity and quality of life. I see patients in the office and also perform diagnostic procedures in the hospital, including coronary angiograms. 

What do you wish people knew about your specialty? It’s easy to make a difference in your heart health, often in simple or surprising ways. While there are many excellent medications in our armamentarium, diet and exercise can play a major role in treating hypertension, hyperlipidemia and coronary artery disease. I have my patients focus on a whole-food, mostly plant-based diet and avoid commercially processed foods as much as possible. Nutrients from food are better than taking a vitamin supplement.

I also care about the quality of your sleep. Undiagnosed obstructive sleep apnea is strongly linked to heart disease, and I frequently refer patients to Sleep Medicine for evaluation.

Your blood pressure measurements at home are more important than the one I get in the office. I see a lot of “white-coat” hypertension, where blood pressure in the office is high, but normal at home. I encourage my patients to get an automated blood pressure cuff for home measurement.

How will the pandemic change your practice? Telemedicine has emerged as an important tool to connect me to my patients this year. Our practice transformed to virtual visits quickly, and we have been pleasantly surprised at the way it has improved patient care. While there are still situations where an in-person visit is essential, virtual doctor visits are likely here to stay. They have been incredibly helpful for my elderly patients who are concerned about leaving their homes and convenient for other patients who have difficulty with transportation or scheduling.

This feature is a part of our 21st annual list of the region’s best physicians. View the list here.