Lebanese Cardiology… A beating heart of its own

The global medical community pauses to observe World Heart Day, a campaign born in 1999 when Dr. Antoni Bayés de Luna, then president of the World Heart Federation, introduced the idea with backing from the World Health Organization, holding its first official observance in 2000 under the slogan "Let It Beat." The Federation itself traces back to 1978, when the International Society of Cardiology merged with the International Cardiology Federation, forming a body recognized by the World Health Organization as its leading partner in cardiovascular disease prevention. The stakes behind the ceremony are stark, for cardiovascular disease still kills nearly 18 million people annually, making it the single leading cause of death on the planet.

Nowhere is that burden felt more acutely, relative to population, than in Lebanon. The World Health Organization attributes 47 percent of all-cause mortality in the country to cardiovascular disease, a figure driven by rapid urbanization, shifting diets, and a notably high rate of consanguinity that has surfaced a cluster of hereditary conditions, from familial hypercholesterolemia to inherited cardiomyopathies. A landmark cohort study following Beirut residents over the age of fifty found that circulatory disease alone accounted for sixty percent of deaths in the sample.

Against that backdrop, Lebanese cardiology has built a peculiar reputation, a specialty forged under scarcity that nonetheless exports some of its most gifted practitioners abroad, while cultivating, at home, a style of medicine markedly more intimate than the subspecialized systems of Europe and North America. Two physicians, one who stayed, one who left, illustrate both halves of that story.

Dr. Ronald Challita: Carrying Lebanon into a changing field

Dr. Ronald Challita's route ran from medical school at the Lebanese University of Beirut to research at UCLA, then internal medicine residency and cardiology fellowship in New Jersey. "My journey in cardiology has been challenging, but very rewarding," he said. "There were a lot of challenges along the way, but each experience taught me something and helped me grow, both personally and professionally."

What the path taught him, he said, is that "being a good cardiologist goes beyond knowing the medicine. You have to be able to connect with patients, work well with your team, and stay humble enough to keep learning." He describes a field transforming in real time, explaining, “ in general cardiology, we have seen major advances in heart failure treatment, lipid management, and imaging, and we are able to diagnose and treat patients much earlier. “I’ve also been impressed by the progress in electrophysiology, especially with catheter ablation for arrhythmias and the continued evolution of cardiac devices. In structural heart disease, procedures like TAVR and newer trans catheter mitral and tricuspid therapies have completely changed the way we think about treating some patients.”

He credits Lebanese physicians broadly with a particular resilience. "Many of us end up training or working in different countries and healthcare systems, and we learn pretty quickly how to adapt, work hard, and keep moving forward," he said, calling it "the combination of hard work, adaptability, and staying connected to where we come from." Looking ahead, he expects interventional cardiology to grow "less invasive, more precise, and more tailored to each patient"  and hopes to see more of his countrymen shaping that future. "I would be very proud to be part of that journey."

Dr. Zeina Kadri: The doctor who answers her phone

For twenty years, Dr. Zeina Kadri has run the Cardiac Intensive Care Unit at Saint-Jean Hospital in Beiteddine, a post she inherited. Patients arriving in search of her father, also a physician, found her instead. "You are stuck with me now," she used to joke, and, she said, "honestly, I feel very lucky. Once a patient comes to me, they do not go anywhere else."

Trained in echocardiography and intensive care in Paris, Dr. Kadri is candid about what she believes distinguishes her care, citing a *New England Journal of Medicine* study linking female physicians to lower patient mortality. "I believe women work from the heart," she said. "They go home and continue thinking about their patients. Their minds do not switch off." Her own phone, she said, "is open 24 hours a day, wherever I am, even when I am travelling."

That reachability, she argued, is a hallmark of Lebanese cardiology broadly. "Outside Lebanon, a cardiologist often has a very specific subspecialty," she explained, one doctor for rhythm disorders, another for imaging alone. While cardiology in many countries has become increasingly divided into highly specific subspecialties, from electrophysiology and rhythm disorders to echocardiography and catheter-based interventions, Kadri says Lebanese cardiologists often continue to maintain a wider clinical perspective.

"In Lebanon, cardiologists also have their specialties, but they tend to maintain a broader medical practice... we still have that older tradition where a doctor may be a cardiologist but still understand and treat other medical problems." Her own work reflects that model. Alongside her specialization in intensive care and echocardiography, she sees patients in her clinic, manages conditions such as hypertension and high cholesterol, and deals with broader cardiac problems.

Patients living in Lebanon, she added, compare local doctors to the old médecins de campagne, country doctors who treated everything. "Being able to reach your doctor," she said, "can prolong your life." Her abiding concern is sudden cardiac death among the young. "If you are young and you have chest pain, please get it checked," she urged. "It costs you nothing to have it evaluated. Sudden cardiac death does not only happen to older people."

One doctor stayed; one left. Yet both describe the same inheritance, a resourcefulness born of necessity, a refusal to let subspecialization erase the whole patient, and a conviction that medicine, at its best, remains personal.