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Health

Five Decades
Of Heart Treatments

MARSHALL FRANKLIN
Special to The Jewish News

erman was 56 years old
when he awakened one
night with the feeling of an
elephant sitting on his chest.
With the help of morphine and
complete bed rest, Herman's chest pain
went away, and he felt more comfort-
able. When he tried to get out of bed, a
nurse rushed to his bedside to remind
him that he must stay in bed and not
make any unnecessary movement.
Herman stayed in bed for one full
month. He used a bedpan and was not
even allowed to sit up. Nurses fed him
to spare him the effort of having to
move his arms.
For the first two weeks his diet was
liquid or soft to avoid the stress chew-
ing might place on his circulation.
These simple activities, it was felt at the
time, might further injure his recently
damaged heart.
As you read this, you are probably
thinking, "That must have been one
horrific heart attack." If I told you
Herman had his heart attack in the late
1940s, you might still think the same
thing. However, in the '40s, that's how
all heart attacks were treated. A heart-
attack victim was considered damaged
goods and emotionally labeled "Fragile:
Handle with extreme caution."
Those were the days before we knew
very much about heart attacks and how
to treat them, but because so many vic-
tims of heart attack died, protective
inactivity and minimal stress were the
prescription for care. Many patients
never returned to work, even after a
minor heart attack, for fear they would
suffer additional injury to the heart.
In the '50s, a bold research study was
done. It compared how heart-attack vic-
tims fared if they were kept at strict bed
rest vs. being allowed to get up in a
chair for a few minutes every day, start-
ing a few days after the actual heart
attack occurred.
To the surprise of many experts,
there was no detrimental effect. This
study led to additional evaluations that
confirmed that no adverse effects
attended early mobilization to a chair.
Then some doctors, even more bold,
started allowing patients to walk short
distances, beginning a week or so after a
heart attack, as long as they were clini-
cally stable. It took about 15 years to
get to the point of realizing that the
heart-attack patient was better off with

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Dr. Marshall Franklin writes for
Copley News Service.

'60
early mobilization than with prolonged
complete bed rest.
'
If Herman had his heart attack in
the '70s, he would have fed himself
from the outset, been walking around
his hospital room in less than a week
and be out of the hospital in less than
two weeks.
A cardiac rehabilitation program,
11'4
including physical exercise, would have
been started in the hospital and contin-
ued as an outpatient. Herman would
have probably returned to work within
a month or two after his attack, unless
his job was highly stressful.
Although heart catheterization was
available in the '50s, coronary angiogra-
phy was not until the '60s, and coro-
nary angioplasty did not make its
appearance until the late '70s.
Coronary bypss surgery started in
the late '60s but was not used very
much until the '70s. Even then, because
of the feared instability_ of the heart-
attack victim, these new and vital proce-
dures were not applied to their care
until the late '80s and early '90s.
If Herman were to arrive at a hospi-
tal in the throes of a heart attack today,
11.4
he would be given a clot-dissolving
medication to abort the heart attack
within hours of its onset. At many hos-
pitals he would be taken for coronary
angiography within hours to a few days
after the attack, and coronary angioplas-
ty would be performed if the proper
coronary artery lesions were defined.
He would be up and walking within
a few days and discharged in less than a
week. In the absence of severe perma-
nent heart damage, his future outlook
would be excellent.
During these same 50 years, new and
effective medicines for the heart-attack
patient were developed.
Medications and implantable defib-
rillators protect patients from ventricu-
lar fibrillation, the cardiac irregularity
that kills many patients after heart
attack. Even common aspirin has been
proven to reduce the incidence of repeat
heart attack.
Now, research is telling us that using
angioplasty to open a coronary artery
that has already caused a heart attack
can prolong life.
The next exciting developments are
,)
cooking in research laboratories
worldwide and have to do with genetic
engineering. Someday doctors may be
able to tell their patients that they will
be spared the heart attack genetically
imprinted from their parents because
they can be "reborn," if you will, by
replacing the defective gene with one
that will protect them. ❑

