Renowned intervention cardiologist Dr Fayaz Shawl, who did the first angioplasty in the US’s Military Health System (MHS), and later devised the ‘Shawl Technique’ visited home after almost a decade. A Clinical Professor at George Washington University and Director of Interventional Cardiology at Adventist Health Care, he discusses the revolutions that have brought cardiac care to a new level, read the excerpts from his interview
KASHMIR LIFE: When we speak of the human body, we emphasise the heart more than the brain even though we know the brain undergoes the body’s most prominent operations. Why is that?
DR FAYAZ SHAWL (DFS): First, to have a functional brain and body, we need blood pumped at almost five litres a minute to supply the entire body. Unless the heart is pumping, no other organ will function. But the brain’s stress affects the connection between the two. Someone under stress is mainly affected by the brain, and because of that, the heart can worsen. This is why we tell heart patients to avoid stress, especially external and internal because it will affect heart function, circulation, and most importantly the arteries that nourish the heart called coronary arteries. When clamped down, these can cause heart problems.
KL: Tell us about your life struggles and learning curves when migrating from Srinagar to the United States.
DFS: I was born in Srinagar and went to middle school and later SP College. In college, I developed an interest in medicine. We struggled financially because my father died when I was 13, and my uncle gave us Rs 100 a month for food for 10-12 years before I could earn money. I went to medical school in Srinagar in 1967. Once I graduated, I was posted in Shahdara Shareef in Rajouri. I would take a horse from Jammu to reach Rajouri because there were no roads.
At 22 years of age, I was the only physician for 6000 people. As a medical officer, I always wanted to advance.
I thought America was best, so to go there I had to take an ECFMG examination. I applied to take it in London, the nearest centre, which India has now too. I arrived in London in 1974 and took the examination but wasn’t sure if I passed. A friend introduced me to Dr Fischer who asked what I was doing. He offered an internship at his hospital, so I stayed in England for two and a half years completing training. Like today, I struggled as a foreigner.
Later, I went to America and was selected for Walter Reed Army Medical Centre, a famous army hospital. There I heard of Andreas Grüntzig, a German who invented a balloon to open arteries. That marked the birth of Interventional Cardiology. This diagnoses and does procedures without surgery or cutting the heart. I was fascinated and wanted to learn his technique.
I went to Germany and returned to Walter Reed as and became the first to do an angioplasty in the USA military health system (MHS) in 1981. It was an achievement, and I was lucky to have the opportunity and timing.
This revolutionised cardiology as it helped open blocked arteries, and carotids to prevent stroke. It has advanced a lot and now valve replacements called TAVR are done without chest surgery. Thanks to Grüntzig, who taught me in 1977, intervention cardiology has transformed since 1980.
My biggest challenge was if a patient died during the intervention. I developed the ‘Shawl Technique’ where if the heart stops and we fear the patient could die during a procedure, we use CPR within five minutes to insert a catheter with my technique and connect them to a heart-lung machine. Even with no pumping, this machine takes over for six hours, giving me time to fix the problem. Of the 23000 patients I managed, 38 died during procedures.
KL: How popular is the Shawl Technique globally now?
DFS: We do not use this technique often because intervention cardiology has become safer with stents. We first used balloons that collapsed. Now stents open the artery. My technique is for cardiac arrest in the laboratory when things fail, maybe one in a thousand cases. It’s rarely used but it is a lifesaver.
KL: After starting at the US Army Hospital, how did your career progress?
DFS: I needed a fellowship to become a cardiologist, so I did a one-year fellowship at Prince George’s Hospital, becoming eligible in 1980. I stayed for two more years at the army hospital and then I moved out.
I wanted to start from scratch, despite offers from Harvard and many other places. In 1982, I went to Washington Adventist Hospital. People criticised me for choosing a small hospital without facilities, but I told the administration my vision for an intervention cardiology programme, which I started in 1982 and still direct 40 years later.
George Washington University wanted to associate with me, so I became a clinical professor there while at Washington Adventist, I continued training countless professionals globally through live broadcast courses.
In 1990 in Singapore, I met Qasim, who suggested I teach in India. I came and explored Delhi, Mumbai, Karachi, Lahore, and Madras, teaching balloon angioplasty. He suggested sending Indian doctors to train with me, which was my aim – to disseminate knowledge. It was easier to teach others. I wanted to give back to Kashmir, which is why I taught doctors.
KL: How will industrial revolution advancements like Artificial Intelligence (AI) and virtual reality improve heart treatments?
DFS: AI will have a tremendous impact, but it would not end up in losing the human touch in cardiology. AI will write research papers and analyse patient data. It’s still early days. We can scan a heart and have the computer identify problems in size and arteries, but for intervention cardiology, nothing replaces human hands. I don’t think that will change with AI.
KL: Devices like watches enable early diagnosis. What is your view?
DFS: Yews. These tools are helpful. The Apple Watch can pick up atrial fibrillation, an irregular heartbeat that can cause strokes. We also have under-skin loop recorders to monitor problems during activity, and pacemakers we can assess remotely for issues like fast heart rates. Ten years ago, we could not do this, but now patients get valve replacements without chest surgery.
KL: How close are we to using mechanical hearts?
DFS: You refer to severe heart failure with weak pumping muscles, a 10-15 per cent ejection fraction. We use artificial heart pumps with a catheter and back pocket controller so they can live normally until the transplant. Some in their 70s with diabetes and kidney issues can’t get transplants but use the pumps. It is revolutionary what we can do in medicine now.
KL: Can you tell us about the state of cardiology in Kashmir?
DFS: I have seen SKIMS has great facilities and expertise for interventions. I was very impressed with Paras Healthcare’s infrastructure – modern equipment like CT scans, MRI, Cardiac Catheterization Lab, etc. I have not seen other private institutes’, labs and scans, but I am sure if they have similar equipment, that’s excellent. I interacted with many skilled physicians in Kashmir during my brief stay in Srinagar.
I wanted to open a hospital to “bill the rich and feed the poor”. I run the Dr Fayaz Shawl Philanthropic Foundation. Every three months I spend five days in Dubai – anyone from Kashmir or elsewhere with heart problems gets free care from my foundation. God has given me enough, so I want to help people back home.
KL: Could you visit Srinagar for a week, partnering with a private hospital?
DFS: I have been here for five days. Mr Tramboo invited me to his hospital. He offered to come and see patients, so I am considering it. I aim to build infrastructure, and technology, and train doctors so that Kashmiris can get quality care here, especially heart patients going outside the valley. Profits would help the poor – that is my hope.
KL: We have more cardiac issues and sudden heart attacks here. Is our rate above average?
DFS: Heart disease and blocked arteries are the top killers globally, but in Asia including Kashmir, they strike younger people. In the US and Europe, people in their 60s-70s face these problems. Here we see people in their 30s having heart attacks. The reasons are we do not take care of ourselves – stress, diabetes, cholesterol from extreme eating habits, smoking, family history, and daily stress are so common. But there are solutions: walk 30-45 minutes, three times a week; control diabetes through diet and HbA1c levels below 7 per cent; check cholesterol and LDL levels, taking medication to lower LDL; go for lifestyle changes like quitting smoking; early check-ups, especially 35+ or premenopausal women and have stress tests for high-risk men and women. This will somehow improve the situation.
With lifestyle changes and controlling blood sugar and blood pressure, we can prevent hospitalisation and even leave Kashmir for treatment. Media awareness can tell people we can prevent problems by being active and not sedentary.
KL: You have taught people globally, but is anyone in your family inheriting your knowledge?
DFS: My oldest son is a Hollywood cinematographer and my second son is a paramedic. My daughter likes animals and wants to be a veterinarian. I tell parents not to force kids into medicine – they need passion, no matter the career. I know doctors who became physicians because of parental pressure. It has to come from within to be successful. My passion was always to be a doctor.
(Syed Shadab Ali Gillani processed the interview)