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November 29, 2012

Heart attack treatment: A cardiologist's retrospective

Editor’s note: The Gazette publishes occasional columns from local medical experts. This is one of those columns.

I was 10 years old when Mike G. died, and it was the first time I was old enough to understand the impact of a death.

My family lived on a small suburban street and we all knew each other. Mike, the head of a large family, was strong, energetic and only 49 years old. He had a heart attack while mowing his lawn. At that time, they called it a coronary thrombosis, but I didn’t know that meant a blood clot in the heart until years later.

When I was 31 and starting my medical internship at a large hospital in the midwest, my first rotation was in the Cardiac Care Unit (CCU). One night, I was taking care of a patient who came in with chest pain due to a clear-cut heart attack. At the time we called it a transmural myocardial infarction, which meant it affected the full thickness of the heart muscle. The nursing staff and I felt helpless because there was very little in the CCU “medical toolbox” to help him.

Then in 1988, a very important study was published in the New England Journal of Medicine showing that most of the time when a heart attack occurs, there is a blood clot in one of the vital arteries feeding the heart muscle. This is what my neighbor Mike G. died from. The clot occurs when a plaque lining the wall of an artery ruptures. The body’s natural response is to try to repair the plaque rupture by triggering clot formation.

This landmark study led to revolutionary changes in treatment of those types of heart attacks, which are no longer called transmural myocardial infarctions. Today, they are called ST segment elevation MI or STEMI — a term that reflects what we see on the EKG when a blood clot and plaque block one of the coronaries feeding the heart muscle.

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