#351 Mock Cardiac Genetic Counseling Session
This is our fourth installment in our new Mock Genetic Counseling Session Series! In this episode, cardiac and pediatric genetic counselor Monisha Sebastin and student Avital Habshush perform a mock genetic counseling session. The session indication is a family history of sudden death.
This session was recorded in-person, providing a more dynamic and engaging learning experience therefore, we highly recommend watching it on YouTube to fully immerse yourself in the interaction.
We hope this series is helpful for prospective and current genetic counseling students, as well as the general public, by demystifying the genetic counseling process. Understanding how these sessions work can empower individuals and provide valuable educational insights into this critical healthcare service.
Please note that the information provided in this mock genetic counseling session is intended strictly for educational purposes and should not be used for personal medical decision-making. If you have questions or concerns about your health, we encourage you to consult directly with a certified genetic counselor who can provide tailored medical recommendations. If you are in the United States, you can find a genetic counselor near you by visiting FindAGeneticCounselor.com. Stay tuned for an international genetic provider directory.
The Actors:
Monisha Sebastin, MS, CGC, (she/her) is Senior Genetic Counselor, Pediatrics at the Children's Hospital at Montefiore Einstein. In addition to providing genetic counseling services in genetics clinics, Sebastin specializes in rare diseases, cardiovascular genetics and immunogenetics. In 2018, she earned her Master of Science from Sarah Lawrence College. Sebastian has won multiple prestigious awards including the National Society of Genetic Counselors’ (NSGC) 2024 Audrey Heimler Special Projects Award and the 2022 Heart of Genetic Counseling Award in 2022. We caught up with her right after her win on Episode #212 of DNA Today. Sebastin has been principal investigator and contributor to several research projects, and her work has been published in numerous peer-reviewed journals. Her leadership roles include serving as the 2024 President of the New York State (NYS) Genetics Task Force, co-chairing the International Special Interest Group (ISIG) at the NSGC, among many other roles.
Avital Habshush (she/her) is currently in her second and final year in the Human Genetics Program at Sarah Lawrence College training to be a genetic counselor. Habshuch is a graduate of Yeshiva University with a B.S. in Biology. She previously served as a genetic testing coordinate at Dana-Farber cancer Institute. The premise of this mock case was Habshush’s work as part of her internship with DNA Today.
Mock Cardiac Genetic Counseling Session Outline
Indication: 30y AFAB referred to genetics by cardiologist for suspected hereditary LQT syndrome. The patient recently fainted during an exercise class and has a family history of fainting and sudden cardiac death. See cardiology evaluation summary attached.
Patient’s Name: Lev Loveheart
Cardiac Evaluation: Resting ECG obtained today shows sinus bradycardia (59 bpm) with prolonged QTc of 495 ms (Bazett). T-wave morphology is broad-based without ischemic changes. Electrolytes and TSH are within normal limits. A 14-day ambulatory ECG monitor (Zio patch) is pending. Given the syncopal event, prolonged QTc, and strong family history—including emotion-triggered syncope—the presentation raises concern for congenital Long QT Syndrome, likely type 2 (LQT2).
Contracting
Introduction
Understanding the referral: personal history of fainting and family history of fainting and sudden cardiac death
Overview of the session
Setting expectations and goals
Questions
Medical History
Fainted “only a handful of times” estimates about 4 times in her lifetime
First time fainting was in second grade due to startling
Family History
Brother: died at age 25 while running
Maternal: family history not significant
Paternal
Aunt 55 who faints a lot, very emotional
Grandfather died at 45 due to heart attack
Grandmother died of old age 90
Ancestry: Ashkenazi Jewish and Yemen
Patient education
Overview of genetics
Explaining Long QT Syndrome and how this might explain family history
Risk assessment
Explain how family history factors in to your calculation
Which genes/syndrome would you test for?
Who is the best person to be tested?
Shared Decision Making
Explain the type of testing
Explain the 3 types of results
Asking the patient if they are interested in testing?
GINA
Recommendations and Next Steps
Summarize session
Offer resources
Relevant Cardiac Genetic DNA Today Episodes:
Episode #315 Preventing Sudden Cardiac Death via Genetics with Drs. Liebman & McNally
Episode #287 Familial Hypercholesterolemia with Jess and Julie
Episode #283 Cardiogenetics with Blueprint Genetics
Episode #76 Amy Sturm on Cardiac Genetic Counseling
Cardiac Genetic Resources:
National Society of Genetic Counselors’ Cardiovascular Genetics Special Interest Group
New York City’s Office of the Chief Medical Examiner Molecular Genetics Laboratory
Long QT Syndrome GeneReview’s Overview
Sudden Arrhythmia Death Syndromes: Long QT Syndrome
Previous installments of our mock genetic counseling session series:
Episode #311: Cancer Session for Breast and Prostate Cancer Family History
Episode #317: Prenatal Session for Advanced Maternal Age
Episode #331: Pediatric Session for Autism
The next new episode of DNA Today will drop next Friday! New episodes are released every Friday. In the meantime, you can binge over 350 other episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “DNA Today”. Episodes since 2021 are also recorded with video which you can watch on our YouTube channel, this includes some episodes recorded at NBC Stamford Studios.
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