“I just wouldn't know what else to do,” Rahimtoola says, fortunate to work at the University of Southern California, where there is no set retirement age for clinicians. “What greater thing could you do in life than take care of people who aren't well. The theme of everything I do has been to improve patient care.”
After growing up in Bombay and graduating from the University of Karachi in Pakistan, Rahimtoola spent ten years in training posts in the UK before trying his luck in the US, working first at the Mayo Clinic and then at the University of Illinois. “Initially I'd only intended to stay for a year, but America gave me the opportunity to fulfil my potential,” he says.
That potential has included discovery of “hibernating myocardium”, in which some segments of the myocardium exhibit abnormal contractile function. “After about four or five years of treating patients with ventricular dysfunction I had a eureka moment, realising that, if the heart recovers, it can't be dead. It's a living muscle that just isn't working so well,” he recalls.
His hypothesis that the phenomenon was associated with reduced myocardial blood flow was entirely vindicated in 2005 when Joseph Selvanayagam and colleagues in Oxford showed using MRI that myocardial blood flow is indeed reduced in hibernating myocardium.
Today the phenomenon is recognised as a “transformative moment” in the management of coronary disease, since it shows that chronic left ventricular dysfunction at rest, far from being inoperable, can be reversed by PCI or bypass surgery.
For Rahimtoola other career highlights include description of the phenomenon of valve prosthesis-patient mismatch. He also documented the natural history of peripartum cardiomyopathy and alcoholic cardiomyopathy.
“All my research has a common theme,” he says. “It starts out by making observations in patients and I've always found it important to challenge medical dogma.”
The ESC Gold Medal, he adds, came completely out of the blue: “It’s especially pleasing to me because coming from Asia and being trained in the UK I've always considered myself to be a person of the world. This is European recognition of my contribution to cardiology.”