The female patient had complained of shortness of breath, but no other symptoms that screamed cardiovascular disease, so doctors decided to look at the blood flowing to her heart.
She was brought on Tuesday morning to one of the newly renovated cardiac catheterization labs at Mary Washington Hospital, which recently spent $12 million to enlarge the rooms and refit them with state-of-the-art equipment.
During a test called an angiogram, a thin tube was threaded into the patient’s artery, followed by a contrast dye. It made the size and shape of her various vessels obvious on an X-ray, shown on what looked like a big-screen TV. Some looked like the main branches of a river, while others streamed off in squiggly directions.
The test showed the 67-year-old woman did indeed have a serious blockage at the top of the main artery feeding blood to the whole heart—even though she didn’t have typical symptoms, such as chest pain or palpitations.
Her case illustrated that women with heart disease present different symptoms than men, but it wasn’t the only unusual aspect of the procedure. The physician calling the shots was Dr. Micaela Iantorno, the Fredericksburg region’s only female interventional cardiologist.
While women recently outnumbered men in medical school, the sphere of interventional cardiologists—who perform diagnostic tests on the heart and place devices such as stents to keep vessels open—remains a man’s world. Only 5 percent of the field in the United States are women.
Iantorno isn’t sure why that is, but she definitely was questioned about her choice, even at prestigious facilities such as Johns Hopkins University, where she did her general cardiology fellowship.
“The comment was, ‘Are you sure you don’t want to talk to other women that have done this because it’s going to be very labor intensive,’ and to me that was surprising because any job in medicine is labor intensive,” Iantorno said. “So I could not understand why that would be so different.”
She didn’t let the attitudes stop her. While the route she took to get from her homeland of Italy to a private practice in central Virginia twisted and turned almost as much as the blood vessels projected on the screen in front of her, Iantorno stayed the course.
And, it was a long one.
Her advanced education started at 18, when she attended medical school at the Catholic University in Rome. At one point, she considered being a researcher, so she did a visiting fellowship at the National Institute of Health in Bethesda, Md.
She liked the American health care system so much, she decided to become a doctor in the United States and became trained not only in interventional cardiology, but also in internal medicine, critical care medicine and cardiovascular diseases.
She did a busy fellowship, doing the same kind of procedures at Medstar Washington Hospital Center in Georgetown that she’ll perform as part of the Oracle Heart & Vascular team in Fredericksburg.
“This is my first job,” she said, smiling. “I finished my fellowship in June at the young age of 42.”
‘TOP LEVEL OF CARE’
Iantorno is one of almost 10 new specialists dealing with some aspect of heart-related care who have joined the medical staff of Mary Washington Hospital in the last year, said Jessie Mountjoy, director of cardiac services. Many are probably like Iantorno, who was drawn to the facility for its reputation as one of the 50 top cardiovascular hospitals in the country.
“That’s part of the reason I came here,” she said.
For two consecutive years, Mary Washington has received the 50 top cardiovascular designation by IBM Watson Health, which ranks hospitals that perform open-heart surgery and other heart-related procedures on their rates of survival, complications and readmissions.
Community members and officials with the Fredericksburg Regional Chamber of Commerce gathered in the newly outfitted labs for cardiac catheterization and electrophysiology on Feb. 12 for a ribbon cutting. Mary Washington Healthcare CEO Mike McDermott told the crowd that when a team of clinicians provides the quality outcomes demonstrated in the labs, the hospital’s board does what’s needed to keep that momentum going.
“You reinvest in them and you give those teams all the tools they need to provide those outstanding outcomes to our community,” he said.
That includes the $12 million overhaul of labs and surrounding spaces to make each of the four rooms bigger—for the growing number of procedures that require clinicians from different specialties to work together. The newly renovated suite has design features that Mountjoy borrowed from similar labs she visited across the country.
The whole process took about four years to design and another year to construct, but “it’s changing the landscape for cardiac care in this region,” said Dr. Zeshan Rana, director of cardiac catheterization. “No longer are we having to send patients to Richmond and D.C. and other areas like that to get the top level of care.”
Fredericksburg Council member Kerry Devine said she’s grateful that patients, and their families, don’t have to leave town for complicated procedures and can “feel a little more comfortable at very tense moments of their lives.”
She thanked the MWH team for their innovations, adding: “I hope this is the only time I have to be here.”
When Oracle Heart & Vascular started looking for a new interventional cardiologist, the staff didn’t set out to hire a woman, said Dr. Ashok Prasad, one of three partners at the practice. He was more intrigued by the caliber of Iantorno’s character—and her extensive training—than her gender.
Prasad said he’s watched Iantorno put her skills to use, dealing with “patients who require a higher level of care, which certainly does bring its own level of stress,” he said.
“But she handles it very easily and maintains poise and composure, and that’s a very unique thing,” Prasad said, “especially when dealing with sick and acute patients.”
While Mountjoy said there’s a “strong bond” between physicians and staff in the cardiac catheterization and electrophysiology labs, she’s enjoyed watching Iantorno interact with other women.
“I feel like she gives some of the women that empowerment, just being another woman here, especially in a male-driven field,” Mountjoy said. “I heard her teasing one of the pregnant girls the other day about what carbs she was eating, silly things like that, where a man wouldn’t have that relationship.”
Iantorno suspects the extensive training required of interventional cardiologists and the impact on family life are among the reasons women may avoid the field. She has two children, 10 and 13, from a previous marriage, and a 2-year-old with her husband.
They live in Prince William County, and when she’s required to be on call—for four to five days every three to four weeks—she stays in a hotel near the hospital. The on-call duty can make scheduling difficult with her older children’s activities, but she and her ex-husband manage it with a Google calendar.
A couple of times, her husband and baby joined her at the Fredericksburg hotel when she was on call.
Even though Iantorno is about the same age as some of the more experienced cardiologists at the practice, she brings a just-out-of-fellowship perspective and has advocated for newer techniques and more complicated procedures.
Her team recently considered a high-risk case that calls for two interventional cardiologists, working together, to drill inside the coronary artery to break up a blockage that’s become hardened. Iantorno had been exposed to the procedure during her training, so she encouraged her colleagues to take on the case, which they recently performed for the first time.
Now, the practice is planning to set aside one day a week for such procedures.
Prasad appreciates that level of passion and enthusiasm.
“She has demonstrated excellent clinical acumen and judgment,” he said. “I’d put her up [against] anyone, male or female.”