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  • Heart and mind: hormones
  • Coronary procedures
  • Cardio-vascular diagnostic workshop: what complaints and symptoms may indicate
  • Systolic and diastolic pressure
  • How to recognize angina and heart attack: the precipitating factors & anginal pain
  • Echocardiography: what information can the doctor get from an echo?
  • Heart and mind: medication
  • Angina
  • Can heart attacks and re-infarctions be prevented?
  • Echocardiography: what is a dobutamine stress echo?


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    CAN HEART ATTACKS AND RE-INFARCTIONS BE PREVENTED?

    This question is crucial for the cardiologist, who must quote and rely on specialists, for example in life-table analysis. The head of the renowned Framingham Study, Dr. Kannel, replies to the question in this way: "We must advance to the point where we consider every heart attack to be a failure of preventive medicine." While this statement may be regarded as a mere dream for the future, it also provokes us to improve our preventive methods. Such questions are often raised at our congresses and force us to think about our responsibility to the patients. But often, Dr. Kannel's observation is misinterpreted as signifying that each and every heart attack could have been prevented. There are, of course, limits on the physician's influence: not only the personality of individual patients is to be considered, but even more importantly, their potential for changing their life-style. That is why our colleagues and the public often react with apathy.

    Our experience in observing the process of coronary disease in thousands of patients over the years permits us to formulate the following answer to the lead question. Elimination or control of each of the previously discussed risk factors lowers the probability of a heart attack or its recurrence. Since modification of the life-style is almost always required, the saying that "man does not die as a result of his disease, but of his character," is true in many cases. A skeptical reader may suspect that the authors are embellishing the truth or are overly optimistic. Such a person has probably developed an attitude of resignation because of reading some statistics according to which the normal life-expectancy after a heart attack is limited to five years. But this particular statistic resembles the claim that a "normal" life-expectancy is seventy years of age (which is calculated by including infant morality and by placing greater emphasis on suicides and accidents of young persons, than on persons of one hundred years of age). Statistical interpretation must be weighed very carefully in the individual case.

    The incidence of heart attacks or sudden death is higher in patients who have already sustained a myocardial infarction than in the general population. Dr. Ernest Wyndecof the American Health Foundation once made a very appropriate statement: "We hope to die young, but as late as possible." Even a patient who suffers from coronary disease or has already sustained a heart attack can live a normal life both in terms of quality and normal life expectancy.

    A colleague and friend of ours who is still active in sports had a heart attack when he was fifty-two years old. Despite this heart attack and subsequent irregular heart rhythm (atrial fibrillation) we found it difficult to follow him on a skiing tour high in the Alps when he was seventy-two years of age.

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    Cardio & Blood


     

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