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"I don't feel tired anymore," he
said. He recognized the improve-
ment himself.
Within a month Jerry was
back on his exercise program
again.
"You know," he told me, "I have
taken such good care of myself.
How could this happen to me?"
I told him, "Jerry, it was just
one spot; everything else was
clean. If you hadn't taken such
good care of yourself, the chances
are your condition would have
been more widespread and more
difficult to treat." ❑
A Pacemaker
Can Cause Angina
MARSHALL FRANKLIN SPECIAL TO THE JEWISH NEWS
OPEN 7 DAYS
West Bloomfield • 851 7323
Oak Park
Orchard Lake Road In The West
• 547 9669
Bloomfield Plaza
24695 Coolidge At 10 Mile Road
CELLEX-C SERUM
TOPICAL ANTI-OXIDANTS
nificantly improve the chance of
long-term patency.
Jerry's angioplasty, with stent,
was completed within two hours
after his coronary angiograms
were done. We kept him in the
hospital for three days after the
procedure and discharged him on
medications that would help keep
the dilated artery open.
Jerry did a treadmill stress test
a few weeks after the PTCA. He
had no chest discomfort or elec-
trocardiogram changes this time,
and he exercised for a long time
on the treadmill.
SUN BLOCK SPF-50
OSMETIC VIT-C PATCHES
PYCNOGENOL SERUM
RETIN-A
The
Comparison
Shopper
buys at
HARPER
Furniture
916 N. Main
Royal Oak
(N. of 11 Mile Rd.)
545-3600
M
orris was 82 years old
and needed a pacemak-
er. For the past six
months he had been feel-
ing "puny," as he put it.
"Some days I feel like I can do
anything I want to do," he told me.
"Other days I feel weak, and any
little thing I do exhausts me."
He thought he was just grow-
ing old.
"I'm 82 years old, you know," he
said, pointing to himself. "Parts
rust and wear out. This tractor
is all plowed out."
Fortunately, his doctor didn't
share Morris' assessment, and he
investigated his complaint fully.
The doctor ordered a tape recorder
electrocardiogram that Morris
wore for a day and then returned
for analysis.
The device he used is called a
Holter monitor. The monitor
showed that Morris' heart rate
was a little slow, in the mid-50s,
but nothing else of any import.
This was not a danger to him.
Some doctors may not have
pursued ECG monitoring any fur-
ther when nothing serious showed
up on the recording, but the in-
termittence of Morris' complaint
left his doctor feeling that a single
day of ECG recording might miss
a problem that did not occur every
single day.
The doctor ordered a special
kind of monitor that the patient
could quickly and easily apply
himself whenever symptoms ap-
peared. The recording was then
transmitted by telephone to a cen-
tral processing office, printed out
and sent to the doctor's office, clin-
ic or hospital that supplied the
monitor to the patient.
Morris can-led the monitor with
him for a month. During that pe-
riod he experienced four bouts of
weakness and one near-fainting
episode. During those times the
monitor revealed a very slow heart
rate — in the 30s — a dangerous
circumstance, especially for an 82-
year-old man.
Morris needed a permanent
pacemaker, and he was referred
to us for that purpose.
After delivering appropriate in-
formed consent, we took Morris to
the operating room and surgical-
ly implanted the permanent pace-
maker. We set the pacemaker rate
at 72 per minute. He tolerated the
procedure well; however, when I
checked him the following morn-
ing in his hospital room, he com-
plained of an indigestion sensation
in the central portion of the front
of his chest.
I found nothing on his physical
examination, and the pacemaker
was keeping his heart rate at 72.
The pacemaker activity interfered
with the usual ECG pattern, mak-
ing it unreliable for the evaluation
of coronary insufficiency or heart
attack.
I canceled Morris' hospital dis-
charge and checked him several
times during the day. The chest
discomfort persisted despite
antacids and a bland diet. He re-
ported that nitroglycerin dissolved
under his tongue helped a little
temporarily.
This suggested that coronary
insufficiency might be the prob-
lem. I called the cardiac pace-
maker lab and had them
reprogram the pacemaker to a
rate of 55 per minute with an elec-
tromagnetic device. Within five
minutes Morris reported that the
chest pain had resolved com-
pletely, indicating his chest pain
represented angina pectoris due
to coronary insufficiency.
The sequence of events indi-
cated that Morris had underlying
coronary heart disease that had
remained symptomatically silent
because his heart rate was always
so slow. The amount of blood flow
needed to adequately supply the
need of heart muscle is a supply
and demand process. When de-
mand is high, coronary blood flow
must increase to supply heart
muscle with enough blood to keep
it functioning adequately. ❑