Heart disease is still the leading cause of death in the U.S. Yet for many, it doesn’t feel urgent until it’s unavoidable.
David Theodoro, MD, sees that moment every day.
As a cardiothoracic surgeon at FMOL Health | St. Dominic in Jackson, Mississippi, Dr. Theodoro spends his time where prevention has already failed, inside the operating room, looking directly at hearts that have been pushed too far for too long.
On this episode of Straight from the Source, Dr. Theodoro shares a message he wishes more people hear earlier: timing matters, awareness matters, and small choices made over decades add up in very real ways.
From the Midwest to Mississippi: Seeing the Difference
Before coming to Mississippi, Dr. Theodoro spent nearly 25 years in St. Louis, where he led the largest minimally invasive valve program in Missouri. The move south wasn’t far geographically, but medically, the difference was striking.
“It literally is 450 or so miles due north,” he says. “But the distance is more than you would perhaps think when it comes to the pervasiveness of cardiac or heart problems here in the deep South.”
After five years practicing in Mississippi, the comparison is clear.
“It’s worse. There is no doubt.”
Dr. Theodoro points to health care disparities, access issues and differences in health literacy, especially outside major population centers.
“When you move into the Mississippi Delta we really do see tremendous variation in the progression of cardiovascular problems.”
Those differences often show up at the worst possible time: when patients need surgery.
What Surgeons See That Patients Never Do
Most people understand heart disease in abstract terms: blockages, bad valves, heart failure. Surgeons see the physical realities.
Dr. Theodoro describes calcium buildup as “rock-like.” Valves that should be thin and flexible become something else entirely.
“An aortic valve that used to have the pliability of one or two layers of Saran Wrap,” he says. “Heart disease literally turns it into thick leather with rocks implanted in it.”
That change doesn’t just affect the valve. It reshapes the entire heart.
“The heart that should have a conical shape, like half of a football, turns into a sphere or a soccer ball,” he explains. “And every single heart that goes through that transformation weakens.”
The Hard Truth: Heart Disease Has a Clock
If there’s one theme Dr. Theodoro returns to again and again, it’s this: heart disease is a time-dependent process.
“When valves go bad, it’s very important to get to that problem as early as possible,” he says.
Delay changes outcomes. Delay changes heart structure. Delay limits what surgery can fix. That’s why he places so much emphasis on awareness, not just for patients but also for care teams.
“It’s a disease process that has a very significant time component to it,” Dr. Theodoro says. “Awareness, early detection, vigilance and lack of complacency are all tied together.”
Mississippi Heart & Vascular Institute: Excellence at Scale
At the Mississippi Heart & Vascular Institute at St. Dominic, Dr. Theodoro sees firsthand how the highest quality heart care is delivered every day. He emphasizes that, despite the challenges of disparities in the region, the care at MHVI is consistent and world-class.
“Everyone is treated completely equally,” he says.
He underscores the advanced technology and collaborative approach of the team. “I see excellence at scale, delivered towards these problems, however bad they may be.”
From cardiac surgery to interventional cardiology and electrophysiology, MHVI brings together specialists and cutting-edge tools to provide the highest quality heart care in Mississippi. As Dr. Theodoro notes, this level of care is possible because of the dedicated teams and the resources in place to support patients at every stage of heart disease.
Often-Missed Symptoms, Especially in Women
Chest pain gets the most attention, but Dr. Theodoro is quick to clarify that heart symptoms are often subtler.
For many patients, it’s not sharp pain at all.
“It’s a tightness, a squeezing, a heaviness, a pressure,” he says. “That’s much more common.”
And symptoms don’t always follow the textbook, especially for women.
“Fatigue, shortness of breath, nonspecific muscle aches, indigestion is not uncommon,” he explains. “Those subtle one-off symptoms can sometimes be missed, and they’re more likely to be missed in our female patients.”
His advice is simple and firm: don’t normalize what’s new or unexplained.
“The mindset is there’s a problem until proven otherwise.”
The Fast-Food Reality We Don’t Like to Hear
One of the most candid moments in the conversation comes when Dr. Theodoro reflects on what his career has changed about his own habits.
“At a relatively young age, sometimes shockingly young, plaque can begin to build in coronary arteries,” he says. “In the 20s. Certainly in the 30s.”
That makes long-term dietary habits impossible to ignore.
“It isn’t a free lunch to do the fast-food thing all through childhood, teenage years, and college years and think there’s no ramification.”
What he sees now, significant coronary disease in younger and younger patients, has changed how seriously he takes it.
“It has made all of us more aware of the seriousness of this widespread problem.”
Why Team-Based Care Matters
Despite the gravity of his work, Dr. Theodoro is quick to point out that heart surgery is never a solo act.
“Cardiac surgery really is the ultimate team sport,” he says.
From anesthesiologists and perfusionists to ICU nurses and cardiologists, outcomes depend on coordination, trust and experience, something he says is deeply embedded at St. Dominic’s.
That team approach, especially in critical care, is one of the things that brings him joy.
“To come together around these super sick patients and watch the great work our teams do, that’s really very special.”
In the end, Dr. Theodoro says heart disease prevention and treatment starts in the community through awareness, education and timely diagnosis.
Because by the time someone meets a heart surgeon, the window for prevention has already narrowed.
And if there’s one thing he wishes people understood sooner, it’s this:
Heart disease doesn’t wait, and neither should we.
