The Heart Healers (54 page)

Revival after prolonged CPR
. The Internet has a story that closely parallels Greta’s experience. The video can be found at
www.youtube.com/watch?v=yapZZTGRp94
.

Organized medicine’s perspective on the Schiavo case.
The history of her illness, and the ethical issues from a physician perspective are found, with an audio interview at: Quill TE. Terri Schiavo—A tragedy compounded.
N Engl J Med.
2005;352:1630–1633. Dr. Quill is a professor of medicine, psychiatry, and medical humanities and the director of the Center for Palliative Care and Clinical Ethics at the University of Rochester Medical Center, Rochester, New York.

Terri Schiavo’s right to live.
The case evoked passion, sometimes from unexpected sources. Judicial and medical authority is condemned in: Hentoff N. Terri Schiavo: Judicial murder.
Village Voice.
March 22, 2005.
Amazon.com
lists ten books dedicated to the Schiavo debate.

Greta’s recovery and return to good health
. As mentioned in my introductory author’s note, Greta is two patients’ stories combined. The two young women had very similar histories, and both had good outcomes. The first Greta was my patient. I use her story to introduce one of the primary themes that reappears throughout my book: a central conundrum in the practice of medicine is the uncertainty inherent in diagnosis, in treatment, and in research. I merged her story with our second Greta, because her story, which runs from her entry into the cath lab to Yosemite, represents the single most dramatic outcome that I have ever encountered in my forty-some years in cardiology. And of course, her dramatic recovery encapsulates so many of our breakthroughs in the life of a single person. I interviewed both Jon Jackson and our second Greta and her husband with my friend Jon in March 2013.

The public verdict on removal of Schiavo’s feeding tube.
In March 2005, the Gallup poll asked, “As you may know, on Friday the feeding tube keeping Terri Schiavo alive was removed. Based on what you have heard or read about the case, do you think that the feeding tube should or should not have been removed?” The results: 56% of Americans agreed that it was the right thing to do, while 31% disagreed.

25. Conquering CAD in Our Lifetime

Analysis of national health data trends for high blood pressure and LDL cholesterol over the past twenty-five years.
Egan BM, Li J, Qanungo S, Wolfman TE. Blood pressure and cholesterol control in hypertensive hypercholesterolemic patients.
Circulation.
2013; DOI: 10.1161/circulationaha.112.000500. Available at
circ.ahajournals.org
.

The impact of healthy diet upon patients already on drug therapy.
Dehghan M, Mente A, Teo KK, Gao P, Sleight P, Dagenais G, et al. Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET)/Telmisartan Randomized Assessment Study in ACEI Intolerant Subjects With Cardiovascular Disease (TRANSCEND) Trial Investigators. Relationship between healthy diet and risk of CVD among patients on drug therapies for secondary prevention. A prospective cohort study of 31,536 high-risk individuals from 40 countries.
Circulation.
2012; 112.103234.

The importance of diet in the clinical practice of cardiology.
See
www.theheart.org/article/1481799
.

The impact of exercise on disease prevention.
Lee IM. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy.
Lancet
. 2012;12:61031–61039.

The NCAA compiles a comprehensive database on sudden death in athletes.
Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in national collegiate athletic association athletes.
Circulation.
2011;123:1594–1600.

The number of athletes in the United States is huge and increasing.
According to the American College of Cardiology’s Section of Sports and Exercise Cardiology, among athletes younger than thirty-five years of age, 44 million now participate in organized sports. We have 7.7 million high school athletes and 463,000 college athletes. Athletes older than thirty-five years of age are particularly engaged in endurance sports. Marathoners have increased from 353,000 in 2000 to over 500,000 in 2011. U.S. triathlon memberships increased from 21,300 to more than 146,000 in the same time frame.

The most recent published survey of sudden death in NCAA athletes identified an event rate of four to six deaths per year
. Suicide and drug deaths in this group greatly exceed cardiovascular death, and by comparison annual automobile fatalities in the same age group are about 2,500-fold more common. Nonetheless the cardiovascular SD rate in college athletes is higher than that reported in high school athletes, possibly due to the longer exposure to rigorous training over longer periods of time. Sudden death was more common in Division I athletes, and African American college athletes were at substantially greater risk for cardiac sudden death than white athletes, as were male compared to female athletes. Maron BJ, Haas TS, Murphy CJ, Ahluwalia A, Rutten-Ramos S. Incidence and causes of sudden death in U.S. college athletes.
J Am Coll Cardiol.
2014;63(16):1636–1643.

Is your athletic kid at risk?
Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults?
J Am Coll Cardiol.
2003;42:1959–1963; and Meyer L et al. A 30-year review incidence, causes, and survival trends from cardiovascular-related sudden cardiac arrest in children and young adults 0 to 35 years of age.
Circulation.
2012;126:1363–1372.

Risk during athletic competition in France.
Marijon E, Tafflet M, Celermajer DS, Dumas F, Perier MC, Mustafic H, et al. Sports-related sudden death in the general population.
Circulation.
2011;124:672–681.

Modern statistics on sudden death in marathons.
Kim JH, Malhotra R, Chiampas G et al. Cardiac arrest during long-distance running races.
N Engl J Med.
2012;366:130–140.

The cost and effectiveness of screening athletes
. Halkin A, Steinvil A, Rosso R, et al. Preventing sudden death of athletes with electrographic screening.
J Am Coll Cardiol.
2012;60:2271–2276.

The 2012 London Olympics.
Preventing sudden cardiac death on the world’s biggest athletic stage. July 23, 2012. Lisa Nainggolan and Michael O’Riordan.
cardiacscreeningcenter.com/wp-content/uploads/2012/07/CARDIAC_ARREST_IN_OLYMPIC_ATHLETES.pdf
.

The issue of childhood obesity and diabetes.
Hamman RF, Pettitt DJ, Dabelea D, et al. Estimates of the burden of diabetes in United States Youth in 2009. American Diabetes Association 2012 Scientific Sessions. June 9, 2012; Philadelphia, PA. Abstract 1369-P.

The obesity epidemic.
The Global Health Estimates, which provides a comprehensive and comparable assessment of mortality and loss of health due to diseases and injuries for all regions of the world, is arguably our most reliable and comprehensive source for such information. It is compiled by the World Health Organization.

The new American College of Cardiology/American Heart Association guidelines for the treatment of cholesterol would increase the number of individuals eligible for statin therapy by 12.8 million people, 81% of whom are individuals without known cardiovascular disease.
According to investigators from the Duke Clinical Research Institute published in
The New England Journal of Medicine,
among the 115 million U.S. adults now aged forty to seventy-five years old, 49% would be eligible to receive a statin, and among those aged sixty to seventy-five years old, 87% of men would now be eligible, based on their ten-year risk of cardiovascular disease. My view, and that of many cardiology thought leaders, is the guidelines swing too far toward initiating statin treatment late in life.

The 2014 American Heart Association Statistical Update provides eight bullet points:

•   21% of men, 16% of women, and 18% of students in grades 9 to 12 use cigarettes.

•   Secondhand smoke exposure declined from 53% to 40% between 2000 and 2008.

•   In grades 9 through 12, 18% of girls and 10% of boys do not engage in ≥60 minutes of exercise at least once a week despite recommendations that children do so 7 days per week.

•   30% of adults engage in no aerobic leisure-time physical activity.

•   Less than 1% of Americans meet at least 4 of 5 healthy dietary goals. Among adults, the percentage reaching goals were: fruits and vegetables 12%; fish, 18%; sugary drinks, 52%; and whole grains, 7%. Only 29% of children aged 12 to 19 met goals for low sugary drinks.

•   154.7 million U.S. adults (68%) are overweight or obese, and 35% are obese.

•   24 million children (32%) aged 2 to 19 years are overweight or obese. From 1974 to 2010, the prevalence of obesity in children 6 to 11 years of age increased from 4% to 19%.

•   Obesity is associated with marked excess mortality, diabetes mellitus, CAD, stroke, and heart failure, and other health conditions, including asthma, cancer, end-stage, renal disease, and degenerative joint disease.

The falling prevalence of CAD in U.S. soldiers.
Webber BJ, Seguin PG, Burnett DG, Clark LL, Otto JL. Prevalence of and risk factors for autopsy-determined atherosclerosis among US service members, 2001–2011.
JAMA.
2012;308(24):2577–2583.

Projected CAD mortality rate in 2020
. Huffman MD, Lloyd-Jones DM, Ning H, Labarthe DR, Guzman Castillo M, O’Flaherty M, et al. Quantifying options for reducing coronary heart disease mortality by 2020.
Circulation.
June 25, 2013;127(25):2477–2484.

26. The Present Creates the Future

A critical assessment of the benefits and limitations of cardiac stem cell therapy.
Forrester JS, Makkar RR, Marbán E. Long-term outcome of stem cell therapy for acute myocardial infarction: Right results, wrong reasons.
J Am Coll Cardiol.
June 16, 2009;53(24):2270–2272.

Our experience with cardiac stem cell infusion in patients
. Makkar RR, Smith RR, Cheng K, Malliaras K, Thomson LE, Berman D, Czer LS, Marbán L, Mendizabal A, Johnston PV, Russell SD, Schuleri KH, Lardo AC, Gerstenblith G, Marbán E. Intracoronary cardiosphere-derived cells for heart regeneration after myocardial infarction (CADUCEUS): A prospective, randomised phase 1 trial.
Lancet.
March 10, 2012;379(9819):895–904.

Edward Sukyas.
He tells his experiences in Kowacky K. Walking to his own beat.
Discoveries
,
www.cedars-sinai.edu/Patients/Programs-and-Services/Heart-Institute/Walking-to-His-Own-Beat.aspx
All the names in this story are real.

Reducing the cost of hospitalization for heart failure.
Several devices hold promise. One, invented by my mentee Dr. Neal Eigler, measures the pressure that causes congestion in the lungs. Comparing the year before and after its use in thirty-five patients, the number of hospitalizations fell from fifty-one to twelve, and days of hospitalization fell threefold.

The most recent perspective on the wireless defibrillator.
The wireless pacemaker and defibrillator era begins. The complexity and politics of FDA decisions for approval of new technology has led most device manufacturers to initiate clinical trials in Europe. Introduction of effective new devices is often several years longer in the United States than in Europe. The situation represents the conflict inherent in innovation vs. regulation. See Tiny, wireless pacemaker due to be launched in Europe at
www.bbc.com/news/technology-24535624
, and Aziz S, Leon AR, El-Chami MF. The subcutaneous defibrillator: A review of the literature.
J Am Coll Cardiol.
April 22, 2014;63(15):1473–1479. doi: 10.1016/j.jacc.2014.01.018. Epub 2014 Feb 12.

Our experience with aortic valve replacement without surgery.
Chakravarty T, Jilaihawi H, Doctor N, Fontana G, Forrester JS, Cheng W, Makkar R. Complications after transfemoral transcatheter aortic valve replacement with a balloon-expandable prosthesis: The importance of preventative measures and contingency planning.
Catheter Cardiovasc Interv.
February 21, 2013. doi: 10.1002/ccd.24888.