Premature Heart Attack

Until last week, no case of an adult-type heart attack, with destruction of part of the heart-wall muscle, had been reported in anybody under the age of twelve. Now two Montreal doctors de scribe the case of a baby boy whose electrocardiogram, at the age of only five hours, gave evidence of severe heart-muscle destruction (technically, "myocardial infarction"). The boy died when 18 hours old, and the autopsy showed two areas of infarction, one of which was so massive as to involve half the heart's lower left chamber.

The baby was born at Montreal's Royal Victoria Hospital. In the New England Journal of Medicine, Drs. Mathew H. Gault and Robert Usher report that, despite a difficult breech delivery, he seemed normal and healthy and began breathing spontaneously. But by the time he was taken to the nursery, he was pale and limp. The electrocardiogram was taken by happenstance: the hospital was making a study of heart action in prematures, and this baby seemed to have been about a month premature. The startling ECG finding alerted the doctors to the possibility of serious illness. When the baby turned blue, they gave oxygen. But the heart was too badly damaged to survive.

Obviously this heart attack was not the result of a long process of abusing the body with too much tobacco and fatty food, too little exercise, and the other factors seen in the stereotyped coronary attack of an executive. So what caused it? The doctors can only speculate. But the baby had been predisposed to a heart attack by thickening of the lining in some of the coronary arteries, roughly similar to atherosclerosis in the adult. Circulation, the doctors believe, had been interrupted by the difficult delivery that followed premature descent, and probably squeezing of the umbilical cord. Blood clots formed, as in the adult's coronary thrombosis. As far as they can judge, the baby had his fatal heart attack when only one hour old.

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