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

“Complete obliteration of one coronary artery, if produced suddenly, is usually fatal.” Twenty years later, at the 1912 meeting of the Association of American Physicians, Dr. James Herrick, a master clinician who two years earlier was the first to describe sickle cell anemia, proposed the revolutionary idea that a patient could survive an MI:
    Obstruction of a coronary artery or any of its large branches has long been regarded as a serious accident. . . . But there are reasons for believing that even large branches of the coronary arteries may be occluded—at times acutely occluded—without resulting death, at least without death in the immediate future.
    Not only did Herrick understand that a myocardial infarction need not be fatal but he also suggested that it was caused by a thrombus (blood clot) and was among the first to suggest strategies that might ameliorate the damage:
    The hope for the damaged myocardium lies in the direction of securing a supply of blood through friendly neighboring vessels so as to restore so far as possible its functional integrity.
    Although the concept that a heart attack results from obstructed coronary blood flow was accepted as fact by the early 1900s, Herrick’s notion that a newly forming blood clot was the cause of that obstruction was the subject of continuing debate for most of the century. As recently as 1974, only four years before Dick Cheney’s first heart attack, Dr. William Roberts, head of cardiac pathology at the National Heart, Lung and Blood Institute at the National Institutes of Health, wrote an editorial in Circulation , the journal of the American Heart Association, in which he rhetorically asked,“Which comes first, coronary thrombosis or myocardial necrosis?” (Which comes first, a blocked coronary artery or the heart attack?) His answer, like that of many physicians before him, that coronary thrombosis was the consequence rather than the precipitating cause of acute myocardial infarction, would soon be proven incorrect.
    Without a clear consensus in the cardiology community that the usual culprit during a heart attack was a thrombus, a dynamic and potentially reversible problem, treatment was mostly limited to prodigious amounts of rest. In his brief remarks to the five thousand well-wishers who greeted him at the airport upon his return to Washington after his heart attack, President Eisenhower acknowledged the caution of his doctors and the torpid pace of his recovery:
    I am happy the doctors have given me at least a parole if not a pardon. I expect to be back at my accustomed duties, although they say I must ease my way into them and not bulldoze my way into them.
    The treatment administered for Dick Cheney’s myocardial infarction was remarkably similar to that received by Eisenhower twenty-three years earlier, both focusing mostly on rest. After an uneventful eleven daysin the hospital, Cheney was advised by Dr. Davis to remain “homebound with in-house activity” for an extended period of time.
    Dick Cheney’s care did differ in one important aspect from that delivered to President Eisenhower: Mr. Cheney was monitored in a coronary care unit, an innovation introduced just a few years after Eisenhower’s hospitalization and the first advance in the treatment of heart attacks that actually lowered mortality.
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    In the 1920s, as electrical power was being disseminated throughout homes and businesses in the United States, it was becoming common for utility linemen to die after accidental electrical shocks. It had been known since the mid–nineteenth century that electricity could cause a chaotic and fatal arrhythmia called ventricular fibrillation, but the prompt restoration of a normal heart rhythm remained an elusive problem. Ventricular fibrillation, also a dreaded complication of acute myocardial infarction, causes cardiac output to cease and blood pressure to drop to zero, halting the delivery of oxygen to the tissues, a