Dr. Klaus Restcop provides acute myocardial infaction: part 4

Dr. Klaus Rentrop He describes how three scientific errors suspended the treatment of life -saving heart attacks from patients for 30 years.

In 1880, Dr. Karl Weigert, a German pathologist, described the cause of heart attacks: a blood clot (blood clot) is created in one of the arteries of the heart in a place that already narrowed by atherosclerosis. Total obstruction of the vessel suddenly stops blood flow to part of the heart muscle, which then dies. Dr. James Herrick familiarized American doctors with this insight 30 years later. Further studies have shown that the creation of clots is caused by a rupture of atherosclerosis, called “plaque crack”.

Doctors hoped that the damaged muscle of the heart would heal during a long -lasting bed up to six weeks, which is the cornerstone of treatment for half a century. However, about 30% of patients died in the hospital because of the deadly heartbeat abnormalities or because of extensive loss of heart muscles.

Streptococcus, bacterium, can dissolve blood clots in a process called thrombolysis. This discovery of Dr. William Tillett in 1933 led to the development of “Streptokinase”, the first thrombolytic drug. The Dr. Saul Sherry group believed that streptokinase could save the lives of patients with a heart attack through “a quick solution to the coronary thread”. Blood flow to the heart would be restored and limit muscle death, they put a hypothesis.

Their small pilot process, published in 1958, was promising. Blood flow has been restored as some of the blood chemicals. The hospital’s mortality was 15% among patients treated within 14 hours of symptoms, compared to 30% among patients later. However, Sherry, a hematologist, could not assess Tromboliza in a larger study, because, as he said, “cardiologists did not emphasize the coronary thrombosis as a cause of an acute heart attack.”

At the end of the 1950s, pathologists reported that blood clots were rare among the victims of heart attacks and suggested that these clots developed after a heart attack. However, they always found extensive coronary atherosclerosis. They proposed that reducing blood flow without complete obstruction could cause a heart attack. In this approach, the clots developed only when a large heart attack violated circulation, causing blood flow in a slow artery.

Some pathologists did not agree with this view, but cardiologists adopted it in the 1960s. They thought the dissolution of blood clots, which did not cause a heart attack, was in vain. This first error derailed the development of life -saving thrombolytic therapy.

However, there was important progress in the treatment of heart attacks, but in 1962 with the introduction of coronary care units. Immediate diagnosis of fatal heartbeat by trained staff and treatment with recently developed defibrillators or starters reduced the mortality of the heart attack by half. Still high mortality in the hospital of 15% resulted from the insufficient function of the pump seriously damaged hearts.

Animal studies published by Dr. Eugene Braunwald in 1969 suggested that the scope of death of heart muscles may be limited pharmacologically, without restoring blood flow. It was the second mistake. Research dominated in the seventies. It has been reported that about 50 “anti -Zawada drugs” limit the size of the infarction in experimental animals by reducing the demand for oxygen, preventing the accumulation of destructive substances or providing energy regardless of oxygen supply. Clinical pilot tests were promising. However, in the mid -1980s, better designed tests rejected the initial positive results.

Dr. Schper has proved that even after reducing the cell metabolism, they will inevitably exceed energy in the infarction zone and die, unless the blood flow is restored. No agent has never achieved approval as anti -reflection.

The young, inquisitive Dr. Francis Everhart was one of the few cardiologists who questioned the view that clots were not the cause of heart attacks. He became acquainted with discussions between pathologists during the annual pathology community in St. Paul, MN in 1967/68, after completing the cardiology scholarship. He continued to participate in autopsy when the surgical group dr. Berg and Kendall in Spokane, Washington employed him in August 1968, and when he opened his own practice in March 1969. He finally came to the conclusion that clots cause heart attacks and that only early restoration of blood flow may limit the size of the heart rate. Successful operations of bypassing Berg in patients before infunction convinced him that surgical revascularization could achieve this goal.

However, coronary angiogram would be required before the bypass surgery. Coronary angiography would also reveal the incidence of complete coronary obstruction at the beginning of heart attacks, resolving the issue of competition among pathologists. Everhart’s concept was radical at a time when the rest of the bed was still a cornerstone of treatment, acute invasive procedures were considered harmful, and anti -inferior drugs aroused cardiologists.

Everhart introduced Berg his vision at the meeting in mid -June 1970. The concept made sense to Berg, who drew parallels for legs of leg artery through a blood clot that required rapid surgical revascularization to avoid amputation. He agreed to consult the surgery of the emergency circumventing of patients with Infarct in one condition: they would scientifically document and publish their work. In March 1971, Dr. Kendall performed the first emergency transplant surgery for a sharp myocardial infarction in Spokane. When he opened the coronary artery to attach a vein transplant, a fresh clot “jumped”, spectacularly confirming that the blood clot pushed the artery of a heart attack at the beginning of a heart attack.

The patient was doing very well. The heart function returned to normal to repetitive angiography a few weeks later. During the next conference on the hospital, doctors were excited about hearing about regaining blood clot and immediate improvement of the patient’s condition. Within a few years, surgical treatment of heart attacks has become a standard of care in Spokane. But everywhere in the United States, revascularization found itself harmful. It is believed that bleeding in a dead heart muscle reported to experimental animals after restoring the flow has expanded the damage. The third mistake began to root.

Among the pathologists, a consensus as to the frequency of coronary clots in heart attacks, he remained elusive at workshops organized by the National Institute of Health in 1973. The workshops found that the importance of coronary clot ” Further examination.

The evidence gathering in Spokane provided answers. Coronary angiography during a developing heart attack revealed total obstruction of the artery associated with a heart attack in 81% of 118 patients. The surgeons encountered clots after opening the artery of a heart attack in a third of cases and regained them. In addition, the revascularization was not harmful; improved the heart function. The hospital’s mortality was 5.6% among 71 patients served compared to 21% among medically treated patients.

Everhart presented this data at the World Congress of Cardiology in Buenos Aires, Argentina, in September 1974 and at the American College of Angology meeting in San Juan, Puerto Rico in February 1975.

His abstract “surgery of revascularization of acute heart muscle damage” was printed in a 1974 supplement to circulation. However, the audience of doctors reacted negatively to new discoveries that should improve scientific errors dominating in research and hindering clinical treatment. Everhart was called a fool. He presented the annual summaries of the National American Kardiology Meetings. None of them have been accepted. Everhart left Spokane at the end of 1977.

Berg focused on his presentation at the annual American Association for Netracic Surgery meeting in April 1975 on reducing the mortality of a heart attack achieved during the circumventive operation. Dr. Eldred Mundth from Boston, concerned about the extension of Infarct, warned against the approach of the Spokane.

However, Berg’s presentation, published as an article, created international interest. The Dr. Phillips group in des Moines in Iowa repeated the results of the mortality of the group Spokane in 75 patients. Their circulatory article from 1979 confirmed the high dissemination of the total obstruction of the infarction of the infarction and reported intraoperative intake in almost all cases. Accompanying the editorial article of this article, however, neglected important angiographic findings and screech search.

This suggests that low mortality was caused by the selection of low risk patients, although 16 of them could not maintain normal blood pressure before surgery! The perseverance of the errors of blinding cardiologists to the installation of scientific evidence was unusual, Piotr back notes.