Shivanshu Madan, MD

Shivanshu Madan, MD, is completing his last year as a general cardiology fellow at University of North Carolina Hospitals (Chapel Hill, NC) and will be starting a 1-year program in interventional cardiology in July. He was educated at Michigan State University (East Lansing, MI) and completed his training in internal medicine at Case Western Reserve University/University Hospitals Case Medical Center (Cleveland, OH). In addition to interventional cardiology, Madan is passionate about cardiac imaging and has spent his free time honing his skills so that he can be a more well-rounded cardiologist. He is also active in research and most recently contributed to anobservational study looking at genotype-guided antiplatelet decisions after PCI. Madan hopes to eventually go on to complete a fellowship in structural interventions and then work in academic medicine where he can also continue his passion for teaching.

Why did you decide to train in interventional cardiology?

It's incredible. From the point of view of a scientist and a learner, interventional cardiology is cognitively challenging, requires tough decision-making, and is conducive to lifelong learning. You always have to be reading. From more of a personal standpoint, we have the privilege of taking care of health issues that are really sacred to our patients. When you talk to someone about their heart failing or having a blocked artery, there's a sort of unique anxiety that I think they and their families encounter. When I was younger, I always envisioned myself as a physician working in some kind of critical care setting. Throughout my medical career, I have encountered very sick patients and I have observed my mentors in interventional cardiology be very intelligent caregivers, whether it came to their medical decision-making or their technical and procedural skills. The thing I really fell in love with was the amount of love and care that went into educating and counseling patients and family members—what the procedure is going to be like for them, what they are going to experience, and then what to do to avoid long-term problems. It's a very special thing that I'm sure is part of other fields of medicine, but I had a connection in this way with cardiology when I started out.

When you talk to someone about their heart failing or having a blocked artery, there's a sort of unique anxiety that I think they and their families encounter.

What kind of career are you hoping to pursue?

That’s something I spend a lot of time thinking about. I've had a lot of great mentors, and the best part of cardiology is the more you work with some of these talented people, the more you want to be just like them and practice the way they're practicing. I have a really strong interest in cardiac imaging and structural heart disease. My hope is to find an opportunity to do a structural fellowship after I finish my interventional year, so that I can evolve my skills from that standpoint. Then I’d like to work in a place where there's a need for those skills. With the advent of TAVR, that need is being met pretty explosively, which is great, but I think that there's still quite a bit more needed for mitral valve disease patients around the world. My institution has this great program where they send a number of physicians down to Nicaragua. It's not a US population, but it's certainly a population that has significant valve disease. The folks here who do structural heart disease do such an excellent job down there, and they are such good examples for the kind of work that I might want to do in the future.

What would you like your first job to be like?

My heart is in academics. I've always been the kind of person who loves to teach, and I've always had really, really great teachers. My mother is a teacher, so that probably has a lot to do with where that comes from. During my residency in Cleveland, I had a number of incredible mentors—not just from a cardiac standpoint with Dr. Sahil Parikh, but throughout internal medicine within all the specialties. Here in Chapel Hill I’ve been fortunate to have a number of wonderful teachers as well in Dr. Larry Klein for cardiac imaging and Dr. Rick Stouffer in the cath lab. Whenever I have a chance, I work with the medical students here at UNC whether it be teaching small groups, running codes, or on rounds on the inpatient service. Probably I'd like to spend most of my time working in the cath lab and seeing patients—I'm a clinician first and patient care is always paramount—but my desire for conducting research and advancing knowledge is not far off.

What has been your most meaningful clinical experience so far?

I would say probably the most challenging and the most meaningful experience has been working in the cardiac intensive care unit at night when I was a resident. In Cleveland, our CICU was very busy. We had 20 beds and very sick, sick patients. Our CICU attendings had very high expectations, which they should have, and I'm so glad because they were great educators. I remember spending entire nights examining patients, reviewing literature, and devising a sort of argumentative cases akin to what you might imagine in a courtroom or a debate. I would see a patient and want to come up with a strategy, and point by point I would develop my plans. I found myself becoming so much more confident and passionate about my clinical decision-making.

What has been the most unexpected thing that you've learned?

Probably the most unexpected thing was that as I've kind of continued in my cardiology fellowship, I’ve gotten exposed to these different facets of cardiology—structural, for example, peripheral, complex coronary, and CHIP training. There's almost a sense that from the get-go, you've got to maybe pick one and that's got to be your niche. I guess I didn't expect how challenging it would be to make that decision. It's hard to keep this idea in mind that you just have to learn the basics, hone your skills, and at the same time have the sort of wisdom early on that will help you make the decision of what to go into later.

Something else, one of the hardest things, is when there are complications with patients. As a first-year fellow, I remember very clearly that I had a complication with a patient that I did a procedure on. I know the best thing to do when you have a complication is to not run away and instead spend time with the patients and their families. But I remember at the end of this one specific complication, I really felt so connected to the person I was taking care of that when something bad happened to her, the extent to which I was affected was unexpected. I saw that patient every day, multiple times a day, and spent hours with her and her family. You can get close to people even when they are very sick due to a complication that you caused, but what I learned is you have to really be strong and courageous with how that situation plays out.

You can get close to people even when they are very sick due to a complication that you caused, but what I learned is you have to really be strong and courageous with how that situation plays out.

What is the best piece of advice you've received from a mentor?

When I was a medical student, my mentor was an interventional cardiologist named Dr. Tim Fritz. I remember him telling me just before residency began that no matter what happens, if I get a call or a page from someone, it doesn't matter if it's in the middle of the night or during the day, just remember that someone on the other side of the phone has a question or that they don't understand something and need help. And so, always do everything to help in any way. Probably my best mentor is my father, and he used to tell me something similar but in simpler words. He always says: “Help ever, hurt never.” It's helped me throughout most of my life.

Is your father a physician as well?

No, actually no one else in my family went into medicine. My father is a civil engineer in Detroit. He always wanted to be a physician. That's probably what drove me to medicine to begin with. He grew up in a small town and was part of an agricultural family in India. When I was young, I remember him telling me that he had always wanted to become a physician one day but his family didn't really have a lot of money and he had eight other siblings, and so it was a miracle for him to get the education he did and move to this country. I remember just thinking, "Don't worry dad, I'll take care of it."

What do you like to do in your free time that helps to balance out your work life?

I love playing tennis and weightlifting quite a bit. I'm a huge Harry Potter fan. I was a little disappointed not to make it to Harry Potter World when I was in Orlando for the CRF Fellows Course, but I'll go back. As much as possible, I like to read whatever other novels I can. And I love dogs, and am planning on getting one. As for what kind? It doesn't matter. I fall in love with all of them.

What his nominator, Craig Lee, PharmD, PhD (University of North Carolina at Chapel Hill), says:

Dr. Shiv Madan has made significant contributions to a research project investigating the feasibility, sustainability, and clinical impact of using CYP2C19 genotype to guide selection of antiplatelet therapy in high-risk PCI patients at our institution. In addition to playing a significant role in data collection and analysis, Dr. Madan served as a mentor to multiple medical students who assisted with the project. Since cardiology fellows play a critical role in the application of CYP2C19 genotype-guided antiplatelet therapy to patient care at our institution, Dr. Madan has gained real-world experience with the daily application of pharmacogenetic testing in cardiology clinical practice.

*To nominate a stellar cardiology fellow for the Featured Fellow section of TCTMD’s Fellows Forum, click here.