Thrombosis

Last week at the New York Academy of Medicine four able investigators explained how coronary thrombosis, a common cause of heart failure, can be overcome and the victim's life prolonged indefinitely. What Boston's Dr. Edward Franklin Bland and Manhattan's Drs. Arthur Morris Master, Harry Lawrence Jaffe and Simon Dack had to say was good news for every overworked man in his fifties.

Feeding the ever-active muscles of the heart as any other tissue in the body is fed are two arteries about the diameter of a soda straw. If anything happens to these coronary arteries, the heart muscles are quickly poisoned and cease to function. Result: Death. The most serious thing that can happen to these arteries is sudden clogging of the blood flow. This may occur when: 1) a blood clot floating through the circulatory system (i.e., embolus) jams in a coronary artery; or 2) disease so roughens the smooth wall of a coronary artery that blood cells accumulate like silt on a river bar (i. e., thrombus). In either case the victim of coronary thrombosis, who may think he is suffering from acute indigestion, often drops dead without warning. Such, for example, was the end of Calvin Coolidge.

The symptoms of coronary thrombosis were set forth last week by Drs. Master, Jaffe & Dack as follows: "Severe pain in the chest, signs of shock, a drop in blood pressure, increase in the number of white blood cells, fever, diminution in intensity of heart sounds, a pericardial rub and typical electrocardiographic changes (q, t and rs-t deviations) serve as evidence of an attack of thrombosis. When in doubt the patient should be treated as if he had suffered a coronary artery occlusion. He should be put to bed and a search patiently made for the signs just described."

Said Boston's Dr. Bland: "The disease is far more prevalent among males than among females. The former, however, appear to survive more frequently the acute attack and also to live longer thereafter. In our experience prolonged nervous tension directly related to professional or business responsibility appears to be the most important single contributing factor. ' Added Manhattan's Drs. Master, Jaffe & Dack: "The ages of the patients studied ranged between 27 and 87 years. The average was 54 years, both for men and women. The average age of those who died was 57 years."

The Manhattan doctors were unusually optimistic about circumventing this disease. Said they: "Clinical and pathological evidence points to the fact that following occlusion of the coronary arteries new blood vessels take up the nourishment of the heart. There are not infrequent instances cf good health for many years following coronary thrombosis. . . . The majority of patients survive their first coronary occlusion." Added Dr. Bland: "In general the younger the patient at the time of onset the longer they live."

Survival depends upon complete rest in bed for six or more weeks in undisturbing; surroundings, all four agreed. During that time the coronary circulation may repair itself.

The Manhattan men urged that in addition to rest, thrombosed patients be practically starved following such a heart attack. Said they: "Very little food is given in the first 24 to 72 hours, particularly if the patient is in shock. The fluids are limited to [one quart] unless the patient is perspiring excessively. When nausea or vomiting is present, food is avoided; if it persists, bits of cracked ice and sips of charged water are given. The diet is slowly increased so that in five to seven days the patient is receiving a 750-850 calorie diet. An endeavor is made to accord each patient individual attention and to satisfy his tastes whenever possible. ... In the great majority of cases pain disappears after the first two days on this diet."

They added: "A first attack of coronary thrombosis rarely is fatal and the mortality of subsequent attacks is only moderate, if a regime of prolonged bed rest and limited diet is employed and the injudicious use of drugs, such as digitalis and nitroglycerine, avoided. Consequently the pessimism with which coronary artery thrombosis has been regarded seems to us no longer justified."

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