As I have written before, many, many times, our Patient Forum on Angioplasty.Org is filled with thousands of patients asking questions that were not sufficiently answered by their doctors, patients wanting to know more about their procedure, their disease, why they feel the way they do after the procedure, how much activity is “safe”, why they still have a pain in their leg, etc., etc., etc. Continue reading
Category Archives: Heart Attack
I’m working on at least six different articles about the many studies presented at the American College of Cardiology in New Orleans yesterday and today, from new stents to transradial vs. femoral access, etc. etc. etc. and suddenly all of this is swept aside by an email that arrived in my Inbox seconds ago, posting the following to the topic of Heart Attack and Stents or Angioplasty on our Patients Forum:
Okay. Now that I have your attention…. Sure, we all know that smoking significantly increases the risk of having a heart attack…but sex? Well a study, published in this week’s Journal of the American Medical Association (JAMA) looks at this topic, in an article titled, “Association of Episodic Physical and Sexual Activity With Triggering of Acute Cardiac Events“. And it’s a topic that a not insignificant number of readers writing into Angioplasty.Org’s Patient Forum are concerned about. Continue reading
A study from the Mayo Clinic presented at this week’s American Heart Association Scientific Sessions in Chicago caught my eye. Researchers looked at the medical records of 1,262 people who had no history of heart disease. Using the standard Framingham Risk Score (FRS) which factors in age, sex, cholesterol levels, blood pressure, diabetes and smoking status, they calculated the ten-year probability of heart attack.
They then performed genetic tests on these patients’ existing blood samples to find if any of 11 genetic variants were present. Called single-nucleotide polymorphisms (SNPs) these variants have been found to be potential risk factors for heart attack. Continue reading
It’s a holiday concurrence: Valentine’s Day and President’s Day and American Heart Month — and former President Bill Clinton who got his heart fixed six years ago and just got a “tune-up”, is already back home. He was having discomfort, so yesterday morning he saw his cardiologist, he was wheeled into the cath lab — an hour later he had two stents opening up one of his original coronary arteries (not one of the bypass grafts which had closed completely) and this morning, less than 24 hours later, he was at home in Chappaqua and no doubt already on the phone and back to work. His prognosis: excellent — this incident should not affect or hinder him in any way.
Whatever your take on comparative effectiveness research, whether too many stents are used, etc., you have to admit it’s pretty amazing. The advances made in diagnosis, bypass surgery and interventional catheter-based techniques have revolutionized the treatment of coronary artery disease. Especially when you look back at how this illness used to be treated (or not).
Dr. William W. O’Neill, Professor & Executive Dean for Clinical Affairs, University of Miami, Division of Cardiology has a favorite lecture that he gives on this topic. He goes back to 1955 and describes how then President Eisenhower’s chest pains were first diagnosed as gastric upset and finally almost a day later an EKG showed he was in the midst of a massive heart attack. But there was nothing any doctor could do then, except give Ike morphine for the pain. The heart attack had to play itself out, Ike’s heart muscle was damaged and he was in the hospital for 7 weeks. He didn’t return to work for 3 months. (for you young folk, our Vice President at the time was Richard Nixon!). Ike did continue as President and, in fact, was re-elected to a second term (after all, he was THE hero of WWII). But without question, his ability to lead a fully active life was significantly compromised and ultimately, in 1967, he succumbed to heart disease.
The take-away from Bill Clinton’s episode is that even though his quadruple bypass surgery was successful, the natural history of coronary artery disease is that it will progress. Surgery, angioplasty, stents, medicine — none of these are cures, but they are interventions in this progression. Along with the medications, exercise, diet and smoking cessation, the natural history can be slowed down. Clinton, having experienced this pain previously, knew it was significant and did precisely the right thing: he saw his cardiologist.
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Updated February 15, 2015: The above post from 2010 was written, of course, just after Bill Clinton received his stents. Since then, George W. Bush has also benefited from this technology, as well as Supreme Court Justices Kennedy and Ginsberg, Dick Cheney, and no doubt quite a few Senators and Representatives.
Updated June 12, 2018: Since this post, Dr. O’Neill has moved from Miami and is now the Director of the Center for Structural Heart Disease at Henry Ford Hospital in Detroit. He can be found on Twitter as @BillONeillMD.