Faculty Spotlight: Shalini Dixit, MD

Communication is the Key

“One of the most satisfying parts of my job is forming longitudinal relationships with patients,” said Shalini Dixit, MD. “My goal is to help them feel heard and understood and to know that someone is invested in their problems. Diagnosing what is causing their symptoms and helping patients feel better and improve their quality of life is really gratifying.”

As a general cardiologist with advanced training in echocardiography, or ultrasound of the heart, she cares for patients with a wide range of heart disease. She has a particular interest in conditions affecting the heart valves, which open and close with each heartbeat and help ensure efficient blood flow. Heart valve disease comes in different forms, such as a leaky valve which allows backflow of blood, or a stiff valve which impedes forward flow. “What I love about valve disease is that echocardiography really is the best way to assess hemodynamic changes across valves and provides a window into what may be causing a patient’s symptoms,” said Dr. Dixit, referring to the dynamics of blood flow.

As part of the UCSF Heart Valve Disease Clinic, she works with interventional cardiologists, cardiothoracic surgeons, radiologists, other echocardiographers, and nurses to provide multidisciplinary care to these patients. “It’s a rewarding experience to work with the complex patient population seen in the valve clinic,” said Dr. Dixit. “We try to understand the patient’s symptoms and their impact on the patient’s daily activities. Based on the imaging, we aim to identify the specific valvular abnormality causing the problem and determine whether it could be fixed by interventional techniques or surgery. Because every procedure has risks, we try to determine most importantly whether intervening will improve their quality of life.”

Dr. Dixit values the opportunity to work with a team of experts. “Making complex decisions about the risks and benefits of procedures is often daunting and requires collaboration,” she said. “In our multidisciplinary conferences each week, we discuss these cases with our surgery and interventional colleagues, and it is an open forum where people can feel comfortable raising questions and concerns in order to help arrive at the correct treatment plan.”

She also appreciates the clinic’s nursing and administrative team. “The staff in the valve clinic are highly efficient and dedicated to patient care,” said Dr. Dixit. “They do an excellent job of streamlining patient care – walking patients through the initial intakes, ensuring echocardiograms are done prior to the visit, obtaining outside records, and following up regularly with our patients. In an ideal world, all outpatient care would function so seamlessly, and I’ve had really nice feedback from patients about our staff."

Meeting Patients Where They Are

Once the team has agreed on a recommended treatment plan, Dr. Dixit works closely with patients to discuss their options.  “Communication is key,” she said. “A big part of being a clinician is understanding which patients are likely to benefit from which treatments and setting realistic expectations. Sometimes it’s explaining that a procedure may not fix all their symptoms but could help in certain ways. Patients often receive a lot of information in a clinic visit, and it can be overwhelming. It’s important to give them the time and space to really think about what’s being said, to ask questions, and to not push them to make a decision in that moment. These are big life decisions for the individual.”

Dr. Dixit often suggests that patients message or call her once they’ve had time to think about their options, or schedule a follow-up appointment to continue the discussion at a later time. Sometimes patients ask her to talk with a family member or friend to explain the situation, which can also support their decision making.

She is respectful of each patient’s process. “Our job is to inform them, make sure our recommendations are clear, and discuss risks and benefits of various options,” said Dr. Dixit. “But it’s very important to meet a patient where they are while still recommending what we think is best. If they aren’t willing to undergo the recommended procedure or take the recommended medications, it’s still important to advocate for doing smaller things like diet or lifestyle changes, or exploring what the patient is willing to do.”

Improving Health, Step by Step

In addition to caring for valve patients, Dr. Dixit also works with many general cardiology patients. She appreciates the privilege of earning people’s trust over time. “As a new faculty member just building my clinic panel, the first visit is usually about getting to know the patient, and their wishes and goals,” she said. “I do make recommendations, such as quitting smoking, starting a statin, or modifying their diet if needed. But if the patient isn't ready, that’s okay. I might say, ‘Why don’t we do this other thing in the interim, and you can think about it?’ Very often, once the patient has more information about other metrics of their health, or as their disease progresses, they warm up to the idea. Often they just need more time, information, and a level of comfort with me as their provider.”

Although she is a cardiologist, she considers other aspects of their health. “Even though I may be seeing a patient for atrial fibrillation or their recent heart attack, I also make a point to check their cholesterol levels, their risk for diabetes, and discuss their diet and exercise habits,” said Dr. Dixit. “I don’t see those as solely primary care issues. Many things we deal with as cardiologists are prevention-oriented.”

Part of what she enjoys about cardiology is the way she can use diagnostic tools to help patients. “Very often I can get a heart ultrasound, ECG [electrocardiogram], or heart rhythm monitor, and show the patient exactly what’s going with their heart [in a way] that explains their symptoms,” said Dr. Dixit. “It’s very satisfying to tell someone, ‘This is what your skipped beats look like on an ECG. It’s not something to worry about, but what you are feeling is real.’”

She also works with patients to take the next step in improving their diet or exercise habits. “A lot of patients tell me, ‘I’m really out of shape these days – I can’t go to the gym yet,’” said Dr. Dixit. “I like to tell them, ‘You don’t have to go to a gym. Just try to walk 10 minutes a day. Then maybe in a month, try to do 20 minutes a day.’ At the next visit I remind them what we talked about and check in on their progress, any challenges, and current goals.”

Planning for Success

In addition to caring for general cardiology and valve patients in clinic, Dr. Dixit is also an attending physician in the Echocardiography Lab. She reads echocardiograms and supervises and interprets stress tests – heart imaging tests administered while a patient is exercising.

Dr. Dixit also performs transesophageal echocardiograms (TEEs), which involve inserting a scope through the mouth and into the esophagus after a patient has been sedated. From this vantage point, the scope transmits high-quality images of the heart that can be very helpful for diagnosis. TEEs are also performed during some procedures such as transcatheter valve replacement, in which a collapsible valve is threaded up through a blood vessel and placed in the heart, without requiring open-heart surgery.

She appreciates the opportunity to work closely with core cardiology and advanced echocardiography fellows in the echo lab. “The fellows are incredibly bright, which pushes me to be more inquisitive and to spend extra time reviewing the studies with them,” said Dr. Dixit. “It encourages me to be a better physician.”

For diagnostic TEEs, Dr. Dixit teaches fellows how to prepare for and carry out a successful imaging procedure. “Before we start, we always have a plan in place,” she said. “The worst thing would be to put someone under sedation, do the whole procedure, then afterwards realize you forgot to do a certain measurement you needed. So each time, the fellow and I thoroughly review the patient’s chart, their comorbidities, discuss the indication for the TEE, and what we need to determine with our imaging prior to starting.”

Dr. Dixit helps fellows develop a plan as well as a backup plan. “If a patient is coughing a lot, we may need to increase sedation, or reposition the patient to improve image quality,” she said. “If there are any hemodynamic issues like low blood pressure or low oxygen levels, we may need to end the procedure prematurely. So I teach the fellows to be strategic about obtaining the most important information first. In these procedures, it is important that we communicate this plan with the nurses and anesthesia colleagues involved so that we as a team are on the same page.”

Another important part of the preparation is ensuring that the study is safe for the patient and will add value to the overall treatment plan. “Sometimes we get referrals for a TEE but there is actually a different study that would be better suited to provide the information that the referring physician needs,” said Dr. Dixit. For example, if a transthoracic echocardiogram – which is conducted by putting the ultrasound probe on the surface of the chest to image the heart – indicates that a patient’s aortic valve is significantly narrowed, a TEE is unlikely to add additional information in most cases. “Other times we might suggest that the referring clinician consider a cardiac CT or cardiac MRI, depending on the particular indication,” she said.

She also enjoys working collaboratively with other specialties. “A fun part of the job is that sometimes the cardiology, infectious disease, internal medicine, or CT surgery teams will come to the echo lab to review the images with us,” said Dr. Dixit. “Often what we put in the written report is a factual objective assessment, but we can offer guidance beyond that when we know the specific circumstances of the patient. Understanding what the referring clinician is worried about makes us better readers [of the images] and able to make a more informed assessment.”

Discovery and Medical Education

Dr. Dixit was born in the East Bay and earned a bachelor’s degree in molecular biology from Northwestern University. She then completed a Fulbright fellowship in Madrid teaching at a secondary school before returning to the Bay Area to complete her medical degree, internal medicine residency, and fellowships in general cardiology and advanced echocardiography, all at UCSF.

In addition, she completed the UCSF advanced training in clinical research program, working with cardiologist Gregory Marcus, MD, Endowed Professor of Atrial Fibrillation Research, to study how secondhand smoke, alcohol and sleep disruption contribute to atrial fibrillation. She also contributed to research that found there was no relationship between consumption of caffeinated products and ectopy, or extra heartbeats. In another study, she and her colleagues found that, based on telomere length as a marker of age and health, there was no demonstrated benefit of alcohol consumption, even in moderation.

During fellowship, she worked with echocardiographer Francesca Delling, MD, investigating risk factors for arrhythmic mitral valve prolapse. “This was a really rewarding project as it allowed me to do a lot of hands-on work interpreting echocardiograms as well as strain echocardiography, a new technique being used more frequently,” said Dr. Dixit. “I also had my first exposure to interpreting cardiac MRIs and gained expertise surrounding mitral valve prolapse. I remain interested in how we can use more advanced imaging techniques such as strain echocardiography and cardiac MRI for risk prediction. The ultimate goal is to identify cardiac pathology early and to prevent disease progression and negative outcomes before they occur. ”

During her medical training, Dr. Dixit developed an interest in working with the Latino population in San Francisco. She volunteered at Clínica Martín Baró in San Francisco, led a medical Spanish elective taken by medical and other health professions students, and co-facilitated a weekly support and education group for Spanish-speaking cancer patients at Zuckerberg San Francisco General Hospital. Her interest in medical education also led her to create a tobacco cessation curriculum that was integrated into the medical school syllabus, and to develop online medical content for the Khan Academy.

During her fellowships, she also taught small group sessions for medical students and led workshops for internal medicine residents. As chief imaging fellow, she planned a weekly echocardiography lecture series and taught first-year fellows in the echo lab. “I have always enjoyed the social aspect of teaching – getting to engage with other people, hearing their thoughts, and answering questions,” said Dr. Dixit. “It truly helps you solidify your own understanding of the material. Now as a faculty member, I especially enjoy working with core fellows and advanced fellows in the echo lab. I hope to help create a more formal echocardiography curriculum for the fellows.”

From Mentors to Colleagues

Dr. Dixit appreciates the diverse and supportive atmosphere of the Division of Cardiology. “A big goal of the Division is to increase the number of women and underrepresented minorities within cardiology,” said Dr. Dixit. “At UCSF, I’ve had a lot of exposure to female cardiologists and mentors, which has been a really positive experience. It’s important to have representation. When trainees can see that there are people who have similar backgrounds or are balancing similar challenges, that can foster a sense of belonging and help them envision themselves pursuing this career path.”

During her general cardiology fellowship, Dr. Dixit assisted in planning the UCSF Women in Cardiology career development event, an annual event which seeks to increase interest in the field among female trainees at UCSF. “As a fellow, I participated in breakout groups where we would talk with college students, medical students and internal medicine residents, answer their questions about the field of cardiology, and how to balance work with personal life goals,” she said.

Dr. Dixit is glad to join the UCSF faculty. “I’ve been very fortunate to have great mentors at UCSF,” she said. “I am excited to continue to work with these colleagues as I grow my clinical acumen, further develop my interests in echocardiography and valve disease, and help teach the core and advanced echo fellows.”

“We are very excited that Shalini decided to stay at UCSF,” said echocardiographer Kirsten Tolstrup, MD, Associate Chief of Cardiology for Ambulatory Operations. “She brings diversity and strong clinical skills in general cardiology care and echocardiography. She is a very valuable member of our new heart valve team, performing comprehensive transesophageal echocardiograms and seeing complex valve patients in our valve clinic.”

“Dr. Dixit has been highly regarded throughout all of her training here at UCSF, first as a medical student, then a resident, and more recently a cardiology fellow and advanced echo fellow,” said Atif Qasim, MD, director of the Cardiology Fellowship Program and Echo Core Lab and Associate Chief for Education for the UCSF Division of Cardiology. “During her training she stood out as a fabulous clinician and educator of junior trainees. Currently as one of our experts in structural echocardiography, Dr. Dixit has helped us expand the scope of our rapidly growing valvular heart disease program.”

Outside the clinic and echo lab, Dr. Dixit enjoys spending time in the great outdoors with her husband, Kevin Kane, MD, a gastroenterologist. Together they love running, hiking, and sampling baked goods and artisan coffees across San Francisco.

-  Elizabeth Chur