As part of our “Meet Yale Internal Medicine” series, today’s feature is on Inderjit Singh, MBChB, BMedSci, MRCP, assistant professor of medicine (pulmonary, critical care, and sleep medicine) and director, Pulmonary Vascular Disease Program.
While growing up in Malaysia, Inderjit Singh, MBChB, BMedSci, MRCP, was exposed to the hospital through his father’s work. Singh’s dad was a pediatrician, and Singh would go to the hospital with him while school was not in session. Looking back, he admits that seeing his father make patients better and family members happier probably influenced his decision to go into medicine, although Singh’s path would differ than that of his father.
At age 17, Singh was awarded a scholarship from the Malaysian government to go to medical school in Ireland. Different than the American system, Singh could start medical school directly out of high school, so he relocated to Dublin to continue his studies.
During his residency, he was able to rotate within various specialties, where his interest in pulmonary was peaked. Upon relocating to the U.S. for a second residency, while Singh knew he was interested in pulmonary, he didn’t know what area of pulmonary he wanted to pursue. While completing his residency in Philadelphia, Singh took an elective in pulmonary hypertension. He was hooked.
Pulmonary hypertension occurs when the blood pressure in the pulmonary artery going from the right side of heart to the lungs is high. This condition is classified into five groups, each with a distinct cause and different treatments. It is diagnosed using a right heart catherization study.
“The interaction between the lungs and the heart fascinates me,” explained Singh. “My training in Ireland was very comprehensive. With this disease, you have to have a very good grasp on general medical knowledge overall, because I don’t just see lung patients. I can see patients with liver or rheumatological diseases. It encompasses a large breadth of medicine.”
Singh completed fellowships in New York and Boston before joining the Section of Pulmonary, Critical Care & Sleep Medicine (Yale-PCCSM) at Yale School of Medicine (YSM). After completing his Boston fellowship, his mentor and YSM alumni Aaron Waxman, MD, PhD, gave him the ‘inside scoop’ into working at Yale. Waxman completed his residency and fellowship at YSM.
At Yale, he would be able to lead a pulmonary hypertension program at a “world class institution and a very dynamic and exciting academic environment,” so Singh relocated to New Haven in May 2018.
“Yale New Haven Hospital (YNHH) is very large, similar to the hospital I worked at in New York,” said Singh. “My service has been very busy, I am booked out a few months, but a second pulmonary hypertension physician, Philip Joseph, MD, started in July 2019 so this will help in all dimensions of the Pulmonary Vascular Disease Program, clinical, research, and education.”
Joining Yale-PCCSM and working with YNHH and YSM allowed Singh to pursue another interest, cardio-pulmonary exercise physiology. Together with Brian Clark, MD, supervisor of the cardio-pulmonary exercise physiology laboratory at Yale-PCCSM, Joseph and Singh aim to use cutting edge exercise physiology approaches to diagnose patients with pulmonary hypertension earlier, leading to better outcomes.
“We plan to begin operation of a comprehensive invasive cardio-pulmonary exercise testing program (iCPET) here at Yale by the end of this year.”
The program in conjunction with the Yale New Haven Hospital Heart and Vascular Center involves the placement of pulmonary and radial catheters to allow for continuous and comprehensive assessment of cardio-pulmonary physiology while patients undergo exercise on a cycle ergometer. This testing would help diagnose patients who are referred for unexplained shortness of breath after having gone conventional testing including resting CT, echocardiogram, or lung function testing. The iCPET is able to diagnose conditions such as exercise pulmonary hypertension, exercise heart failure with preserved ejection fraction, mitochondrial myopathies, and pre-load insufficiency or dysautonomia.
He is also planning to augment the translational and clinical research at the Pulmonary Vascular Disease Program by establishing collaborations locally and nationally. He is partnering with Naftali Kaminski, MD, Boehringer-Ingelheim Endowed Professor of Internal Medicine and chief of Yale-PCCSM, to establish a translational physiology program, for diagnosis and research purposes. He hopes to study biomarkers that will help to identify patients at risk for developing the disease. Singh is teaming with Hyung Chun, MD, MAHA, in the Section of Cardiovascular Medicine to earn grants to support their pulmonary hypertension research. Additionally, Singh works as part of the multidisciplinary Scleroderma Program team at YSM and co-directs the pulmonary embolism response team (PERT), a multidisciplinary group encompassing the division of interventional radiology, vascular surgery, and cardiology dedicated to caring for patients who develop acute blood clots in the lung.
Singh recently published three papers relating to his physiology interest. In the upcoming CHEST issue, the group investigated the correlation between right ventricular (RV) dysfunction and heart failure with preserved ejection fraction in patients with and without pulmonary vascular disease during periods of exercise and rest. They found that right ventricular-pulmonary artery (RV-PA) coupling was worse during exercise in patients with concomitant heart failure with preserved ejection fraction and pulmonary vascular disease. Singh and team also published results from a 44 patient study looking at decreased pulmonary vascular (PV) distensibility in CHEST. They concluded that “PV distensibility is an early and sensitive hemodynamic marker of PV disease that is associated with RV-PA uncoupling and decreased aerobic exercise capacity.” In June’s Pulmonary Circulation Journal, Singh and team looked at RV function and found that even in early pulmonary hypertension, an individual’s RV function is compromised.
Singh admits his workload is heavy, but is happy that he took Waxman’s advice. “The transition has been a bit overwhelming,” he admitted. “But the staff have all been very supportive. The transition from a trainee to faculty can be difficult, and then compound that with a heavy program load and clinical service. Things have been a lot easier because of the collegial work environment at Yale-PCCSM.”
To learn more about the Section of Pulmonary, Critical Care, and Sleep Medicine, visit Pulmonary, Critical Care, and Sleep Medicine.