The Future of Your Heart Attack
By Jim Atkinson
ABOUT TWENTY-FIVE YEARS AGO, I listened raptly to a group of young
surgeons who were prophesying a time when hearts would be virtually bloodless.
The most barbaric and common procedure at the time--open-heart, coronary-artery
bypass grafting (CABG)--would become, they said, only slightly more serious
than day surgery for an ingrown toenail through the wonders of fiber-optic
imaging, microsurgical instrumentation, and lasers that could simply vaporize
arterial blockages without a scalpel ever having to touch flesh. Given the
pervasiveness of heart disease (our number-one killer, then and now) and the
brutal trauma of open-heart surgery, this was big news. A quarter of century
later, we're still waiting.
SO IF I BEGIN TO FEEL CHEST PAINS, I STILL HAVE TO GO IN AND BE "OPENED UP' LIKE MY DAD WAS?
Not necessarily. If the bad news about modern heart surgery is that we
haven't been able to make it bloodless, the good news is that when the Big One
visits, there are a lot more options to run through before being filleted like
your dad was. To begin with, while he probably didn't know about his
coronary-artery disease until he began to have angina (the chest pains that are
an early symptom of it) or the real item, a heart attack, improved screening
techniques--high-speed CT scans, MRIs, PET scans, stress echocardiograms--will
allow many of us to elope out our problem long before a heart attack arrives.
Individually, none of these technologies are anywhere near foolproof, but in
aggregate they can fairly accurately separate those of us with an incipient
heart-disease problem from those of us who, by virtue of good genes or clean
living, don't seem to have a Big One in our future. This gives us a leg up on
the problem that our dads didn't have. And though lifestyle
adjustments--low-cholesterol and low-sodium diets, exercise, et cetera--haven't
proved to be any magic bullet (half of all heart-attack mortalities are among
people with normal cholesterol), deaths from heart disease have actually
declined 60 percent since 1950, and the reason isn't simply open-heart surgery
but cleaner living, particularly a 50 percent reduction in smoking.
BUT SUPPOSE CLEANER LIVING DOESN'T DO IT AND THE MRI'S KEEP SHOWING A PROBLEM. IS THERE ANYTHING MORE WE CAN DO ABOUT IT, SHORT OF OPEN-HEART SURGERY?
Yes. Let's say your latest scan shows a couple of arteries blocked by 70
percent and you've been suffering intermittent angina--a level of
atherosclerosis that tends to call for serious intervention. In the old days,
you'd be on the block and opened up, no question about it. But these days, you
may have the option of one or more considerably less invasive and traumatic
angioplasties--the minor surgery in which a balloon catheter is threaded up
through an artery in your groin and then into one or more of your coronary
arteries and expanded to compact the plaque and open the vessel.