WHAT DR. D.S. DasGupta was looking at he has seen, in a variety of packages, many times recently: an American male in his 40s, not in horrible shape but certainly a shape altered from that he inhabited a decade earlier, a creature become sedentary, an unwise eater, a juggler of stresses, a man beginning to notice that a few contemporaries were having coronary
”episodes” and noticing, too, a vague tugging at the sleeve of his sense of mortality. Specifically, DasGupta was looking at me.
”No personal history of smoking, no family history of heart disease,”
he said. ”That`s good. You`re how tall? About 6 foot 2, 182 pounds, that`s not fat though I see that you and I both are fighting the battle.” He patted his belly and glanced to mine. ”Your job is a physically inactive one, and you don`t exercise regularly. That`s not so good. We`ll have to see about your cholesterol level and do a brief psychological profile.”
I was being examined at the University of Chicago Medical Center. DasGupta is director of the coronary care unit in Bernard Mitchell Hospital there. I had taken off my shirt for the first of what I was told would be about a dozen times over the next few days and was wondering how to write that –”I took off my shirt more times than a . . .”–because I was there not only as a patient but as a reporter as well.
Though most patients come to DasGupta with symptoms–chest pain upon exertion maybe or shortness of breath–more and more are coming out of concern rather than distress. They have heard about the risk factors of heart disease –high cholesterol levels in the blood, cigarette smoking, high blood pressure, obesity, sedentary lifestyle, stress (more on these later)–and they know that risk factors can add up to trouble. They may be considering changes in lifestyle–beginning an exercise program, for instance–and, as the recent heart attack death of fitness guru Jim Fixx showed, running 80 miles a week doesn`t necessarily leave the grim reaper eating dust.
WHAT YOU DON`T know about your heart can kill you. Sure, you say, but what you do know can kill you, too; why look for trouble? I`ll deal with that question at length later, but I can tell you now that, as patient after patient is diagnosed and treated, as more and more research is done into slowing the advance or even reversing the damage of heart disease, the case for discomforting knowledge against rosy ignorance looks better and better.
Never before has knowledge about the heart been available in such great detail with so little risk or discomfort. Non-invasive (no cutting one open)
diagnostic technology improves almost daily, and what follows here is a menu of sorts of that technology. I had come to the medical center to undergo all the cardiac tests possible then describe and explain them in the newspaper. The only tests I put off limits (unless indications of a major cardiovascular problem should appear and warrant them) were exploratory surgery, tests in which I`d be exposed to radiation (with two minor exceptions) and the angiogram–a type of surgery in which a catheter is inserted in a major vessel and manipulated up into the heart (with a one in 1,000 fatality rate).
Although any of a number of writers could have done this story, my age and sex–men are three times more at risk of heart disease than women–and some other factors previously mentioned put me uncomfortably close to the heart disease bullseye. It`s far from lonely there. The American Heart Association claims that more than 43 million Americans, a fifth of the population, already have one or more forms of heart disease. Millions more are at risk of joining that group. To ride an exercycle for a stress test would be a way for me also to ride a rising national tide of concern.
The concern is well-founded.
HEART DISEASE is a blanket term covering problems the majority of which are found not in the heart itself but in the network of blood vessels thoughout the body that distribute nutrients and oxygen and collect wastes. The main delivery routes, called arteries, branch into smaller arterioles and then into still smaller capillaries, vessels less than a tenth the thickness of a human hair. The ”garbage” routes by which oxygen- and nutrient-depleted blood returns to the lungs are called veins.
A block or a break in those vessels that supply blood directly to the heart muscle (vessels called coronary or crown arteries because they circle the heart) may result in a heart attack. If this year is not radically different from the one just ended, 1985 will see 1,500,000 Americans suffer heart attacks. About 550,000 of these people will die with some 350,000 of those deaths being what doctors call in the field (before the victims can be gotten to a hospital). Heart attack survivors face a five times greater chance of death in the five years after their attack than does the population as a whole.
As a block or a break in the coronary vessels may cause heart attack, blockage or breakage of the vessels that supply blood to the brain may result in a stroke. Some 170,000 people likely will die of stroke this year. Deaths due to other cardiovascular (the heart and blood circulation system) disorders including high blood pressure, rheumatic fever and rheumatic heart disease bring the annual cardiovascular death toll close to 1 million persons, more than the combined total of deaths attributable to cancer, accidents and infections. In this country, in this year, 54 percent of all graves dug will hold the victims of heart disease.
Failures of the heart cause suffering and sorrow to the victims and their families, of course, but they also constitute an attack on the economic health of the nation. In 1985, the costs of heart related hospitalizations, doctors` bills, nursing home services, medication and losses of job output are estimated to be $72.1 billion.
Even that staggering figure doesn`t take into full consideration that heart disease in effect targets the economy for damage in that it seeks out people in the prime of their productive lives. Not only are typical victims producers, they often are superachievers. Think of the stereotype of the corporate success–a hard-driving, steak and two-martini lunch kind of 40- to 60-year-old guy who exercises nothing but his stock options–and you are thinking of a prime candidate for the ravages of heart disease.
DASGUPTA POKED a needle into a vein in my arm and drew four vials of blood. This would be as invasive as my tests would get, little enough discomfort and bloodshed–the latter mostly on the carpet and a chair; the doctor had struck a particularly juicy vein. Some of the captured blood would be sent to a lab to be inspected for certain enzymes whose presence in the bloodstream would indicate heart muscle damage (a test commonly done during suspected acute heart attack). The red blood cells would be counted. A lower than normal number of these oxygen-carrying cells might be a reason for the heart to race to carry, in effect, the same amount of coal to the furnace in a reduced number of wagons. One vial was to be sent to Dr. Angelo Scanu in the medical center`s Plasma Lipoprotein (fats in the blood) lab where cholesterol levels and types are charted.
The eyes sometimes are called poetically ”windows on the soul,” but DasGupta, through an illuminated viewer, looked deep into mine as windows on the vascular system. The cluster of nerves and blood vessels in the center part of the retina at the back of the eye is the only site on the body where the vessels are not covered by a relatively opaque layer of skin. Swollen or broken vessels (indicating high pressure or blockage) can be seen there. In my eyes, however, no such problems were visible.
My heart rate while I was sitting still was 74 beats a minute and regular. The normal range is about 60 to 75. A conditioned athlete`s heart, however, may beat much more slowly. When he was 20, Bjorn Borg`s resting heart rate was 35 beats a minute.
DASGUPTA LISTENED with a stethoscope to the distinctive ”lub, dub”
of a beating heart. The sound comes from the closing of heart valves, valves that keep the blood flow from reversing. My lubs and dubs sounded okay, no murmurs or other signs of malfunction. He felt with his hands to sense whether the heart was beating out of rythmn and whether it was at all out of place or enlarged, possibly indicating a heart forced to work harder than it should. No. (A chest X-ray later would confirm the lack of enlargement.)
He did a quick visual check. Were my mucous membranes bluish, a condition called cyanosis, an indication of improper supply of oxygen due to something like a hole in the heart? No. Nor did I have the yellowish cast of jaundice, sometimes a hint of heart failure causing a backlog of blood to build up in the liver. He looked at my neck to see if there was visible engorgement of the jugular vein, again an indication of heart failure. There wasn`t.
DasGupta got out the familiar hand pump and cuff mechanism for taking blood pressure. It is called a sphygmomanometer (a manometer is a pressure gauge, and sphygmo is Greek for ”throb”). To use it, the doctor wraps the cuff around your upper arm, inflates the cuff to cut off the blood flow in the brachial (arm) artery, then deflates the cuff while listening through a stethoscope–originally just a wooden tube, the modern version was devised in 1852–for the sound of blood begining to flow again. The pressure (expressed in the height in millimeters of a column of mercury such pressure would support) at which the first rush of blood is heard is the systolic pressure, the pumping pressure of the heart. The pressure recorded when the thumping sound of pumping blood ceases is the diastolic pressure, the pressure when the heart is between beats.
These pressures are normally stated as the systolic over the diastolic:
120 over 80 is in the normal adult range; 140 over 90 is borderline high pressure; 160 over 95 would be cause for concern. Pressures vary from day to day, even moment to moment, driven up by things like exertion or nervousness, lowered by things like a cold or internal bleeding.
”Yours reads 145 over 85,” DasGupta said. ”That`s borderline hypertensive (high blood pressure), but I`d expect you to be a little nervous in new surroundings with a doctor who`s new to you. It may be nothing to worry about.”
MAYBE NOT worrying about the high pressure reading, I went down the hall to the ECG room. ECG (or sometimes, after the German spelling, EKG)
stands for electrocardiogram, a chart of the heart`s electrical activity. That borderline hypertension indication is the sort of thing that would call for a further test such as this. The ECG is not new technology. Its techniques were developed nearly a century ago.
”Take off your shirt (that`s twice) and roll up your pants cuffs,” the technician said. ”Then lie down on this table.”
She applied a jellylike substance to places on my ankles, arms and chest. That was to improve electrical conductivity. Electrodes were positioned by means of little suction cups on the six designated places. A recording device was started up, and the electrical activity of my heart was recorded by a stylus that traced on moving graph paper.
About once each second electrical discharges from ”pacemaker” cells do to the heart just what an electric shock does to the body as a whole. When you get a shock, your muscles contract. You jump. When tiny voltages course through the heart, it contracts. It beats. First, blood is squeezed from the two entry chambers of the heart, the atria, into the lower chambers, the ventricles. Spent blood from the body in the right atrium enters the right ventricle through the tricuspid valve, and oxygenated blood from the lungs in the left atrium enters the left ventricle through the mitral valve. Blood filling these lower chambers closes those valves (”lub, dub”) to prevent blood from going back into the atria. The moving contraction then causes the left ventricle to squeeze blood out to the body through the aortic valve and the right ventricle to squeeze blood to the lungs through the pulmonary valve. Doctors who have performed open heart surgery say that the vigorous, rythmnic action of that fist-sized, 11-ounce pump is one of the loveliest and most stirring sights in medicine.
THE ECG MACHINE`S electrodes on the surface of my body sensed electrical activity going on within and recorded the impulses` strength and directon. The ECG thus can show malfunctions of the heart`s electrical system, a misfiring spark plug, in effect, that can throw off the coordination of pumping action in the chambers. An abnormal wave chart also may indicate blocked arteries and even previous, undiagnosed heart attacks (electrical waves are obstructed by dead tissue).
My ECG chart turned out a bit more spiky than normal, an indication of thickened heart muscle which, in turn, indicates hypertension. Strike two on hypertension.
This was the first of five ECGs I would experience. It showed the electrical activity of my heart at rest for a few minutes. Other tests would monitor electrical activity while I was exercising and one would show the activity over a full day. For this latter test, my chest (shirtless as usual) was shaved in spots and five electrodes taped on. The electrodes were connected to a tape recorder slung over my shoulder. The recorder had a digital clock on top. I was to write down the time of day any symptoms occurred so they could be checked against the 24-hour graph of my heart`s electrical activity.
”Good way of finding out if a guy`s having an affair,” I thought I joked to the woman technician who shaved me and hooked me up. She, however, had created the bigger giggle. With several patches shaved out of it, my chest now looks like a mangy dog.
Monday: A heart test that`s like a submarine hunt.
