An Expanding UVA Heart & Vascular Team Includes New, Highly Skilled Subspecialists

The UVA cardiology team is made up of skilled providers from a broad range of subspecialties. When these experts come together, the result is quality care tailored to meet the needs of every individual. Two new team members, bringing their unique expertise to this collaborative environment are profiled below. 

C. Michael Valentine, MD, MACC

Title: Professor
Fellowship: Emory University
Residency: Emory University

You are a past president of the American College of Cardiology. How did you step into that role?

I became active in the Virginia chapter of the ACC in the early 1990s. My first appointment in the national ACC was by [former Chief of the Cardiovascular Division at UVA] George Beller when he was president of the ACC, from 2000-2002. I worked in many different volunteer positions within the college; [Dr. Beller] first put me on the Advocacy Committee. I later became governor of the Virginia chapter and worked closely with UVA colleagues like Dr. Beller, Dr. John Dent and Dr. Bobby Battle. I later became chair of the Board of Governors, and then served as Finance Chair and  Treasurer. I was fortunate to become President in 2018. 

The president of the College is the chair of the Board of Trustees, which is the decision-making body of the college. This also allowed me to be an ambassador for cardiology members in ACC, and led to much national and international travel, working with cardiologists here and across the globe.

What did you take away from that experience?

Having a more worldly view is important for all of us. Realizing the incredible inequities of healthcare not only here in Virginia, but around the world, gives us all a much better perspective in which to practice. Learning from international cardiologists also helps us expand our horizons, to be open to learning new techniques or new methods. Taking those opportunities to share my experiences has been very important for me.

Why did you decide to join the faculty at UVA?

I was part of an excellent practice in Lynchburg — with Centra — for 30 years, and had the opportunity to teach young residents in training early in my career. Chris Kramer, MD, the cardiology section chief here, asked if I was interested in working with residents and fellows at UVA. This was a great opportunity for me to learn more and teach in a university setting, and an ideal way to enjoy my last years of practice and to be able to give back in some way.

UVA is in a unique position in Virginia as a tertiary and quaternary referring hospital. But it also sets the standard for culture and how we treat our patients, our students and our fellow clinicians. I am grateful for the opportunity to learn from these young doctors and also to be able to share experiences with them. This is a wonderful institution and I am fortunate and proud to be a small part of it.

What will be your focus at UVA?

My focus will be on clinical care and education. I will be in the hospital on acute cardiac services 8 to 10 weeks per year, which I really enjoy. This gives me the opportunity to work with cardiology fellows, residents and students on the wards and critical care units. In the outpatient setting, I will be seeing patients in the general cardiology clinic, electrophysiology access clinic and doing some cardiac prevention work as well.

Is cardiac prevention a new subspecialty?

Cardiac prevention has been around forever, but it has gained newfound importance over the past few years because of the growing number of patients with increasing risk factors. The problems of obesity and diabetes are creating more cardiac problems than we could have anticipated 20 years ago. We have learned that prevention can be more valuable and less costly than acute and emergent treatment. There’s been newfound attention to prevention in every segment of our specialty. 

As a professor, what are some of the key non-clinical competencies you feel are most important to teach to aspiring doctors?

When we go through our training processes, we get excellent teaching in the science of cardiovascular care, but rarely do we get enough training in the art of practicing medicine. The skills we need often take years to develop, but there is a wonderful opportunity to begin learning them here as an integral part of our education. 

We need to teach conflict management with patients and colleagues, how to console grieving patients, shared decision-making around difficult choices, developing transparency and trust, learning how to document our care properly and learning how to navigate and optimize our electronic records so that we spend appropriate face time with patients. Quality and value in healthcare systems is also important. Other key topics include teaching physicians how to negotiate, to understand what they need to do to find their best career opportunities, achieving long-term satisfaction in their careers and finding ideal work-life balance. Those are just some of the skills we have worked on at the ACC. It’s a wonderful opportunity to try to work on those skills, to learn them better and teach them to younger physicians.  

What are you most excited about in terms of the future of cardiac care?

We have made such incredible advances in cardiac care in the last 30 years. We have dramatically lowered mortality and morbidity rates across subspecialties in cardiology. We have enhanced the lives of our patients so well that I believe chronic, long-term care is going to present major new challenges for us. Patients’ quality of life is going to be important. Also, I think we have exciting new ways to treat heart failure that, hopefully, will be very helpful to us in our aging population. We have been in a golden age of cardiac care, but I’m still excited for the horizon, what is available in new research and how prevention will positively impact society.

What goals do you and your team have for working with referring providers?

We are always working at UVA to improve patient satisfaction and referring clinician satisfaction, so access to care is critically important for us all. We will search daily to try and enhance the opportunities for our referring clinicians, not only through electronic consults, but also by offering timely subspecialty and preventive care in our clinics. 

Michael Ayers, MD

Title: Assistant Professor
Fellowship: University of Pennsylvania
Residency: University of Pennsylvania

What is your clinical focus?

My focus primarily is sports medicine and hypertrophic cardiomyopathy. I will be treating hypertrophic cardiomyopathy in competitive athletes, as well as other cardiac symptoms or concerns, inherited cardiac conditions or incidental cardiac findings, in a broad spectrum of athletes, ranging from recreational runners and cyclists to professional athletes.

I’m also trained in advanced lipidology with a clinical focus on preventive cardiology, and I’ll be managing patients with a strong family history of premature heart attacks, cholesterol or lipid disorders, or a high individual risk for cardiac events. 

Multimodality imaging is another interest of mine and I look forward to working with Dr. [Christopher] Kramer. He has done a lot of work in this area, so I feel like I have a tremendous opportunity to learn from the best. Multimodality imaging at UVA is nationally recognized — that was one of the draws of coming here. I’m qualified for advanced reading in cardiac CT, but at UVA, I’ll be focusing mostly on echo and nuclear cardiology; MRI and CT are also outstanding here. Exposure to multimodality imaging improves your ability to lead in a single modality, so I’m optimistic my skill set will come in handy at UVA.

What is unique or challenging about caring for athletes?

One of the challenges of caring for these patients is that often we will get very healthy patients who are having heart issues. We have to juggle our initial assessment – where everything looks great on the surface – with family history, symptoms and restraints they’re experiencing during exercise. It can be very tricky. 

There is also a lot of misinformation about what these patients can and cannot do. For a lot of people who carry these diagnoses or who come to us with sports-related cardiac issues, exercise is a very big part of their life, so it can be mentally taxing to have physical limitations. However, recent data shows that things like regular exercise is not only safe, but is good for this population. 

Over the past five to 10 years, the guidelines have been very conservative compared to more recent studies being published and we anticipate, with the next set of guidelines over the next year or so, there will be some changes in what people are being told is safe. This will provide a lot of relief and happiness for those patients. 

Will you be involved in research at UVA?

In the past, I’ve been dealing with retrospective looks at databases to help deliver more accurate prognostic and risk assessment information for this patient population. I’m hopeful that work will continue at UVA.

You majored in theater studies and traveled around the country to perform. How did that experience impact your approach to patient care and teaching?

Yes, at Duke University, I majored in theater studies in addition to completing my pre-med requirements. After graduating with honors, I took three years off to do musical theater. I did some big shows in Chicago, Sacramento and New York. But in 2006, I was doing a pre-Broadway run with Jeff Daniels when the market collapsed. I was already leaning toward medical school, so I applied to Columbia College of Physicians and Surgeons in New York, which is where I met my wife, Emily, who is an oncologist at UVA. 

In terms of how this impacts my practice, I think I probably view conflict within the hospital slightly differently than some of my colleagues with different backgrounds might. In acting, you think a lot about the intentions behind people’s actions — not necessarily what they do or say, but why they’re doing or saying it. So when it comes to conflict, people can, for better or worse, get caught up in what was said or done and not take the time or put in the effort to figure out why they’re doing what they’re doing or saying. Whether you’re dealing with different providers or different specialties or even patients, thinking about their intentions allows you to get a lot done in terms of resolving conflict. For example, those patients who are not adhering to their medication plan. When you can consider their motivation rather than just the action, then you can tailor a plan of care that is much more specified for that individual patient and they’re more likely to be successful in the long run.

In terms of teaching, generally I think I’m drawn toward roles with more teaching responsibilities because of my theater background. When you start studying theater, you focus a lot on distilling narratives into clear narrative themes. That practice lends itself to teaching quite well because often what students want is a digestible linear sequence of events where they’re not just memorizing facts, but understanding a pattern of cause and effect. I think those abilities come from theater. Not to mention the fact that when you have students in front of you, there’s a bit of a show aspect in the way you’re engaged with them and you make sure there’s a give-and-take just like live theater has. 

What are some of the key indications that a patient may need to be referred to a sports cardiologist?

There are two general reasons that athletes seek out sports cardiologists. The first reason is that they have some condition (oftentimes incidentally found) or a family history of some condition, and they want to know if and how they can continue to participate in their athletic endeavors. This includes conditions like atrial fibrillation, coronary artery disease, high cholesterol, abnormal aortas, or even rarer entities like inherited cardiomyopathies or inherited rhythm disorders. The answer is rarely that an athlete cannot participate at all—in most cases it is beneficial to continue sports. But after we screen the athletes to help understand and quantify their risk, there is usually still more work to be done. Working with dieticians and sports physiologists, we can provide tailored advice about what types of activities are safer, how to perform those activities and what warning signs to look out for.  

The second reason athletes may benefit from seeing a sports cardiologist is that they sense something is wrong, but they don’t know what it is. Oftentimes athletes come to a sports cardiologist after being told over and over “not to worry, that they are in great shape.” But athletes tend to be very in-tune with their bodies, and if an athlete tells you something has changed … they are often right. Utilizing advanced testing like cardiopulmonary exercise testing, cardiac MRI and long-term rhythm monitoring, we can help determine what the issue may be. Sometimes the issue is as common as coronary artery disease or atrial fibrillation. But sometimes, the problems are more complex. Then, we again tailor advice about how to move forward safely and hopefully get the athlete back on the bike, on the field or in the water.    

To refer a patient to UVA Health, call UVA Physician Direct at 800.552.3723.