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Puzzle Master

B.K. Srivastava, MD, went to medical school in northern India before moving to the U.S., where he did his residency and fellowship.

CYNTHIANA, KY The heart is a highly complex organ. When something goes wrong, the diagnosis is seldom simple. Tests and scans provide valuable clues, but there’s a trick to seeing the full picture.

“You have a piece of paper like an electrocardiogram,” says B.K. Srivastava, MD, cardiologist at Harrison Memorial Hospital in Cynthiana, Kentucky. “You have to look behind the paper to see what’s going on. It’s like solving puzzles.”

Solving those puzzles has become Srivastava’s specialty. The first piece to his career puzzle was put in place when he graduated from MBBS GSVM Medical College in India in 1990. From there, he moved to the United States, performing his residency in internal medicine at Bridgeport (Connecticut) Hospital in affiliation with the Yale University School of Medicine. He then completed a fellowship in cardiology at the University of Cincinnati College of Medicine. He practiced in Dayton, Ohio, for over 20 years at Miami Valley Cardiology, affiliated with Miami Valley Hospital.

In 2017, he received a call from an old friend, Matthew Shotwell, MD, who was in the cardiology program at the University of Cincinnati along with Srivastava. Shotwell had recently started a pilot cardiology program in Cynthiana, and the department was growing quickly. Srivastava was both intrigued by the program and excited for the opportunity to work with his friend.

Shotwell, a board-certified interventional cardiologist, had launched the cardiology department at Harrison Memorial Hospital in 2015 as part of a primary angioplasty program designed to treat heart attack patients at rural hospitals rather than having to transport them to larger cities. The service area for the cardiology department includes 45,000 in the primary market area and reaches up to 75,000 to 100,000 patients in the secondary market area in a 10 to 12 county area. Currently, the cardiology department serves approximately 300 patients, and the volume has nearly doubled every year since its inception. That growth prompted Shotwell’s call to Srivastava.

While Shotwell prefers performing procedures, Srivastava’s expertise at diagnosis and figuring out the puzzles has made them a great team.

“I practice general cardiology,” Srivastava says. “I take care of the people with chronic illnesses, their follow-ups and making sure they don’t get in trouble medically. I used to do a lot of procedures, but here, Dr. Shotwell and I have divided our work. He is doing more of the interventional work and I’m taking care of the non-invasive part of the practice – imaging and making diagnoses. I’m a finder, he’s a fixer.”

Patient Population at Risk

What Srivastava has found is a patient population desperately in need of the care they can provide. A lack of health education and awareness of the implications of poor lifestyle choices contribute to a high level of heart disease and other chronic illnesses among the members of the community.

“It’s a wonderful patient population here,” Srivastava says. “They are innocent, honest, hard-working people. They are very straightforward and they trust their physicians. They have real problems, and I enjoy helping them out. The difference between the population here and the urban area where I worked for 20 years is, this is a far less serviced area so the disease process is often quite advanced when we catch it.”

Srivastava notes that heavy tobacco use remains a problem in Kentucky and was surprised to see so many children exposed to tobacco at a young age.

“They get exposed to tobacco by age 5 or 7,” he says. “By the time they are 22 or 23, they have 15 or 16 years of exposure to tobacco. Early exposure to tobacco and eating habits are the factors leading to premature disease in this younger patient population. Often times, no one has taught them the harmful effects of these things.”

The rural culture is one piece of the puzzle. Another is the access to care. Greater access to care, including screenings and diagnostics, is demonstrating encouraging results. Harrison Memorial Hospital has committed fully to providing the best equipment available to the cardiology department.

Cutting Edge Diagnostics in a Rural Hospital

“We have every tool to make a diagnosis,” Srivastava says. “Because of technology, diagnosis is not a guessing game anymore. By non-invasive testing, you can get a black-and-white diagnosis on what’s wrong with a patient. The big jump has been made in the imaging of the heart. The paradigm has shifted from when most of the diagnostic procedures were done in the catheterization lab. Now the patient goes to the catheterization lab for fixing.”

Srivastava says a major breakthrough came with the echocardiogram, which enables him to see the moving parts of the heart and how they function. He also points to the impact of the CT Coronary Calcium Score, which detects hardening of the artery. Plaque inside the arteries is coated with calcium.

“When we do the CT scan, we can detect the hardening in the artery by looking at the calcium inside the artery,” Srivastava says. “We can predict the likelihood of a patient having a clogged artery. That alerts the physician to be aggressive with the risk modifications, which reduces hospitalizations.”

The capabilities of the cardiology department at Harrison Memorial is also reducing the need for local patients to travel to larger cities for care. Srivastava says the idea that patients need to go to larger facilities for serious conditions such as heart ailments has become a misconception.

“It doesn’t matter which car garage you take your car to, it depends what mechanic is working on your car,” he says. “If you have a good mechanic and he’s 20 miles away from a major city, he can still fix your car. We are changing perception here at Harrison Memorial.”

Srivastava credits the hospital administration for committing to excellent care by fully supporting the medical staff with top equipment and the resources needed to succeed.

“They bend backwards to get the right physicians and to provide us the means we need to succeed,” he says. “There is a lot that needs to be done in the state of Kentucky. There are a lot of underserved areas. These people have real problems. It’s not about the money or the quality of life. We are here to serve people. That’s what we are trained for. If we can do that for underserved people, that’s the best thing we can do as physicians.”

Another puzzle solved.