Heart: An American Medical Odyssey by Dick Cheney, Jonathan Reiner Read Free Book Online

was a heart injury.
    This would have been an impressive diagnostic achievement for a physician not trained in cardiology and not having ready access to an EKG. Nonetheless, Snyder asserted that the president was immediately treated with amyl nitrate, an inhaled vasodilator; papaverine, also a vasodilator, this one administered in an injection; morphine for pain; and heparin, an anticoagulant injected intramuscularly. Because the patient was sweaty, cold, and restless, Snyder asked Mrs. Eisenhower to get into bed with the president in the hope that this would calm and warm him (a curious strategy not currently recommended for a patient witha suspected heart attack). Snyder later administered a second dose of morphine, which eased the president’s pain and lowered his blood pressure to a closer-to-normal 140/80. The morphine allowed the president to fall asleep around 5:00 a.m., but when he awoke at 11:00 a.m., his chest pain was still present. At 12:30 p.m. (ten hours after the president’s chest pain began and about twenty-four hours after his initial discomfort), Dr. Snyder requested an EKG machine; forty-five minutes later he documented an anterolateral myocardial infarction (a heart attack involving the front wall of the heart). The president was then walked downstairs and transported by car to the hospital.
    In his exhaustive book Eisenhower’s Heart Attack , from which this chronology is obtained, Clarence Lasby casts doubt about whether Snyder’s note was indeed a contemporaneous depiction of the events that night and instead suggests that Snyder wrote the memorandum much later to cover up for misdiagnosing the president’s symptoms and for erroneously treating him many hours for a presumed gastroenteritis.
    After arrival at Fitzsimons Army Hospital, President Eisenhower was placed in an oxygen tent, not permitted to see his cabinet for two and a half weeks, ordered to remain at bed rest for a month, and kept out of Washington for seven weeks. Two hundred thousand people lined the streets to view the motorcade when he returned to the nation’s capital. After only a weekend in the White House, Eisenhower left Washington to continue his recovery at his farm in Gettysburg, Pennsylvania, and didn’t return to work at the White House until after the New Year.
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    Regardless of whose version of events one accepts, Eisenhower’s case illuminates the standard of care for a heart attack at midcentury. For the first eight decades of the twentieth century, the standard therapy for a heart attack mostly involved bed rest and pain control, usually with morphine, palliative treatments intended to keep the patient quiet and comfortable in the hope that no further catastrophe would befall the damaged heart. In the 1950s, oxygen was introduced as a standard therapy and papaverine and nitroglycerin, blood vessel dilators, wereoften given to prevent coronary spasm. Sometimes warfarin (an oral anticoagulant) or heparin (an injectable anticoagulant) was prescribed to prevent another heart attack or pulmonary embolism (a real hazard because of the prolonged bed rest); however, no strategy was employed to reopen the culprit vessel and limit the damage to the muscle. Patients spent on average four to six weeks in the hospital, and 30 percent died during the hospitalization, a toll reflecting the dismal progress achieved in the management of this disease through much of the twentieth century.
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    The term infarction , derived from the Latin infarcire , “to stuff,” refers to the death of tissue resulting from interruption of nutrient-rich blood.In 1880, Karl Weigert, a German pathologist, first made the association between an occluded coronary artery and a myocardial infarction, but most physicians of the time, includingthe legendary Sir William Osler, considered a heart attack a nonsurvivable event. In his classic 1892 textbook, The Principles and Practice of Medicine , Osler incorrectly noted,