Hope for the Heart: Advances in Treatment
Today two-thirds of people survive their heart attacks, thanks to medical advances. Learn how some of these medical marvels evolved.
By Martin Downs
Reviewed By Charlotte Grayson
In the late 1950s, when Douglas James, MD, was studying medicine at Harvard, it was still the Dark Ages of heart disease treatment. The rate of coronary deaths in the U.S. was steadily rising, and physicians had little practical wisdom for students like James as to how to save heart patients' lives.
"It was something that you knew about and you didn't do anything about," says James, an associate professor and former chief of cardiology at Dartmouth Medical School in Hanover, N.H.
"We used a lot of morphine and kept people comfortable," he says.
What a difference a half century makes. Doctors now have many marvelous tools on hand to keep an ailing heart pumping, and the death rate from coronary disease continues the steep slide it started after peaking in 1963.
Yet it would be hard to point to one breakthrough that deserves all the credit for the improved standard of care we have today. Every innovation has built on another before it, and often the innovators have been ridiculed for breaking with tradition. It has been a slow and difficult climb towards the relatively enlightened era of 21st-century advances in treating heart disease.
One early pioneer was a doctor named Werner Forssmann. In 1929, as a surgical resident at a small country hospital in Germany, Forssmann became interested in delivering medicine directly to the heart through a catheter. He performed the first experiment on himself, pushing a catheter through a vein in his arm and into his heart. He then walked down to the hospital's basement and took an X-ray picture to prove that the catheter was in there. In other experiments, he used a catheter to inject contrast dye into the heart so it could be more clearly seen on X-ray film.
Many in the medical community were outraged by Forssmann's work, presumably for its daring nature, and he shrank from doing any more research. Others seized upon his idea, however, and used catheters to measure pressures and oxygen levels within the heart, which filled big blanks in science's understanding of how the heart pumps blood, and how disease affects its function. In 1956, Forssmann shared a Nobel Prize with Dickinson Richards and Andre Cournand, doctors at New York Hospital who studied heart function using catheters.
Clot Busters to Prevent Heart Attacks
The full significance of what Forssmann did in 1929 was not realized until the mid-1970s, when Marcus DeWood, MD, of Spokane, Wash., began to use angiography, a procedure based on Forssmann's techniques, to look at blockages in the arteries of heart attack victims. At the time, conventional wisdom held that heart attacks were merely the last gasp of a dying heart, and that they couldn't be reversed once in progress. DeWood's research on coronary blockages was widely derided.
But challenging entrenched ideas by constant scientific inquiry is an essential driving force behind every medical marvel. "Once you actually start looking at stuff, it changes your understanding; your insights change, and what you can do changes," James says.
In 1980, DeWood published data showing that in virtually every heart attack observed by angiography, there was a clot blocking an artery.
"This was a revolutionary change in cardiology," says Jon Resar, MD, director of the Adult Cardiac Catheterization Laboratory at Johns Hopkins University School of Medicine in Baltimore, Md.
At that point, doctors realized that clot-busting medicines, which had been around in various forms since the 1930s, might save lives when given immediately after a heart attack. Now it was known that during a heart attack, a clot starves part of the heart of oxygenated blood, causing the muscle to die. The longer it lasts, the more damage is done. If the clot can be broken up quickly, less heart tissue dies, and you have better odds of survival.
Clinical trials on clot-busting drugs followed, which sought to find out if survival improved when they were used in treating heart attacks. "The improvement was quite pronounced," Resar says.
The best clot buster available in the early 1980s was streptokinase, a drug made from a bacterial culture. But drug companies soon got to work on making "designer" clot busters. In 1987, the FDA approved the first of the next-generation drugs, called tissue plasminogen activator (tPA), for dissolving coronary clots after heart attacks. In 1996, the FDA approved tPA for treating stroke.