The Heart Healers by James Forrester M.D

Author:James Forrester, M.D.
Language: eng
Format: epub
ISBN: 9781466862555
Publisher: St. Martin's Press

16

THE CLOT BUSTERS

I don’t want to play 10 years and then die of a heart attack when I’m 40.

—PETE MARAVICH, ALL-AMERICAN BASKETBALL PLAYER WHO DIED SUDDENLY AT AGE FORTY IN A PICKUP GAME

THROUGHOUT THE 1970S I (and many others) focused on that era’s central topic: managing the devastation caused by myocardial infarction (heart attack). At that time we all believed that myocardial infarction was a final exclamation point, the culmination of a relentless progressive stenosis (narrowing) of a coronary artery plaque. A moderate narrowing caused angina, which was Mother Nature’s way of saying it’s time for bypass surgery. Left unattended, the narrowing ultimately became so severe that the need for oxygen in a segment of the heart muscle exceeded the supply. That segment could no longer survive. Without a way to open the narrowing during a heart attack, we focused on reducing its need for oxygen, using drugs that slowed the heart rate and diminished its vigor of contraction.

We imagined that a solution might lie with emergency bypass surgery, but creating such a program posed a logistic nightmare. If a heart attack occurred during the day, the surgeons, operating rooms, and heart-lung machines were typically busy with other elective procedures, so waits of three to four hours were often unavoidable. If the heart attack occurred at night, rapid mobilization of the entire team of surgeons, nurses, and technicians was at least as frustrating, and then wreaked havoc with the next day’s operating schedule.

In 1979 one of my former cardiology trainees, Dr. Marcus DeWood, came back to visit me. Marcus had recently settled into practice in Spokane, Washington, and sought me out for advice about the results of a small research project he had organized. He and his local cardiac surgery group had been able to establish a new program offering around-the-clock emergency bypass surgery for patients with acute myocardial infarction. At that time, no other hospital in the United States had yet succeeded in establishing a program like it. I was eager to see Marc’s results, believing that emergency coronary bypass might well reverse the imbalance between oxygen supply and demand precipitated by a heart attack.

I had attended the autopsies of patients who died of acute myocardial infarction, so I knew that a blood clot, called a thrombus, was sometimes found in the coronary artery. We considered it an uncommon incidental finding of no great importance, agreeing with my friend Dr. William C. Roberts, chief of the cardiac pathology at the National Institutes of Health, who said, “Although it may play a major role in causing atherosclerosis, coronary thrombosis may well play a minor role, or none at all, in precipitating a fatal coronary event.” Roberts, like the rest of us, believed that diminished blood flow led to death of the heart muscle, and blood clots then formed in the damaged arteries. As an international lecturer, I had pontificated innumerable times with professorial grandiosity on the imbalance between oxygen supply and demand, not blood clot, as the cause of myocardial infarction.

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