Heart Disease Treatments: ICDs, stents, tPA clot busters

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In the late 1950s, when Douglas James, MD, was studying medicine at Harvard, it was still the Dark Ages 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 arteries of heart attack victims. At the time, conventional wisdom held that abdomen with wires running up to the heart.

Langer says two prototypes were made, just in case someone dropped one on the floor. “The first one really did get dropped,” he says.

After the device was in, the researchers had to test it, which meant purposely inducing ventricular fibrillation in the patient. Having done so, they waited for the device to switch on and shock the heart back into a normal rhythm. “That seemed like an eternity,” Langer says, as the seconds ticked by. But it worked.

“The first indications for use were fairly strict,” Langer says. To qualify for an ICD, you had to have experienced sudden cardiac death and been resuscitated. Today, the devices are used much more broadly, and they’re a lot smaller. People with heart failure routinely get them. Vice president Dick Cheney has one.

Langer moved on from ICDs to found Cardiac Telecom Corporation, where he developed a telemetry system that keeps track of a heart patient’s vitals at home, and alerts doctors or calls an ambulance if something goes wrong.

An Ounce of Prevention Still Best for Heart

Although medicine has come a long way from what James calls “the bad old days” of the late 50s and early 60s, he says it’s still a fact that, “the vast majority of the heart disease that we’re treating is unnecessary.”

For those with access to top-notch cardiac care, it’s too easy to think that when we have our inevitable heart attacks, the docs will be able to fix us up and send us home. But prevention — by diet, exercise, quitting smoking, and taking cholesterol-lowering drugs if needed — is still most important.

James recalls hospital wards full of people stricken by heart disease is like “working on the technology so you could walk around with your ventilator instead of developing the vaccine.”