Using genetic testing to detect and treat heart disease early

Until recently, we’ve had to rely on clinical findings, EKGs and imaging to diagnose and treat some dangerous heart problems known to have strong genetic components. Unfortunately, this often occurred after symptoms and heart damage had begun. Cardiogenetics is a new tool that can help us improve screening and detection of certain inherited heart conditions and intervene early to prevent future health problems.

As an early adopter of this evolving practice, our team is making great strides on two fronts: offering genetic testing for people with hereditary cardiac conditions and their family members, and advancing research into the genetic factors of diseases, such as coronary artery disease. Our experts are working to identify the genetic risks that may predispose some people to such conditions. We are determined to enhance diversity in genomic research in order to understand how diseases manifest differently in people.

Genetic testing for heart conditions is both art and science, with no single genetic test. In long QT syndrome, for example, there are 15 causative genes known to date. Even when the right test is ordered, interpretation of test results is not always straightforward. Just because a change is identified, it doesn’t always mean it is the answer for that person and family. Variants of uncertain significance (VUS) must be researched and classified as disease-causing or benign.

Because of the field’s newness and complexity, guidelines advise that cardiogenetics testing only be carried out by dedicated centers like ours that offer genetic counseling before and after testing. A genetic counselor certified in cardiology will work with the individual and family to help them understand the various implications of results and options so they can make fully informed decisions. If tests identify a genetic mutation, we may recommend regular monitoring and avoiding certain things, such as some medications or strenuous exercise.

Heart conditions that might be suitable for genetic testing

Cardiogenetic testing is simple for the patient—we collect only blood or saliva samples. However, it’s only used for a subset of structural heart conditions and arrhythmias (abnormal heart rhythms) known to have a monogenetic cause, meaning the disorder is caused by a single mutation in one of a number of known genes.

These conditions can include:

Cardiogenetic testing may be recommended when certain signs point to a possible underlying genetic component, such as:

  • Diagnosis of heart failure at age 40 or younger

  • Fainting or palpitations during exercise

  • Multiple family members with the same heart condition

  • Sudden, unexpected death in the family due to heart disease

  • Suspicious findings during some heart tests

For more information about cardiogenetic testing, please call (202) 877-4363.

Monisha Kisling – Genetics Counselor

Monisha Kisling’s practice focuses on patients whose cardiovascular conditions may have an underlying genetic cause. This subset includes patients with heart failure, inherited forms of cardiomyopathy, arrhythmias, aortopathies, lipid disorders, and cardiac amyloidosis, as well as patients with family history of cardiac disease, cardiac arrest or sudden death. When a genetic change is found to play a role, she then helps manage medical care and guides screenings for family members.

Kisling works with patients and their physicians to understand the nuances of results and what they might mean for each unique case. She provides pre-test counseling for patients to help them understand the implications of genetic testing, even if it’s just risk education. She also works with referring physicians to determine which tests should be ordered for their patients. These services are available to patients across the region. Samples can usually be collected at home and counseling is completed in person or via telemedicine.

Philosophy of care: “As we gather data and learn more about the genetic variants that cause heart disease, I can provide useful information to patients and their families. Identifying at-risk relatives allows us to provide cardiac surveillance, and potentially prevent future complications. Genetic information is often not straightforward, and I strive to break down complex results in a way that patients can understand.”

Education:

  • Master of Science, Human Genetics
    Sarah Lawrence College

  • Bachelor of Arts, Biology & Society
    Cornell University

Practice location:

MedStar Washington Hospital Center
110 Irving St, NW
Washington, DC 20010
Phone: 202-877-GENE (4363) Fax: 202-877-3455

Our providers

Cardiologist taking EKG test of senior patient

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