He was an executive in a major American company. He was over 50 and he had a history of high blood pressure. He came into my office urgently with chest pain. I didn’t like the sound of it. The pain lasted 10 minutes and it occurred at rest. It was like a pressure in his mid-chest and he had never had anything like it. I called a cardiologist who saw him right away and did a nuclear stress test which was completely normal. He sent him home.
The very next day he was in an executive meeting and suddenly fell over dead in his seat. Fortunately, his company had installed a defibrillator on the wall. His coworkers restarted his heart with the defibrillator and called 911. First responders immediately transported him to a large hospital that was nearby. He had a heart catheterization that proved a clot was totally blocking a large heart artery. His cardiologist opened the artery with a stent which minimized the heart muscle damage and probably saved his life. This is a case which shows the value of urgent stent placement to relieve an acute blockage. This gentleman started optimal medical therapy and made a full recovery. He never had another chest pain.
How can we explain what happened to this man with unstable angina that worsened to cause a heart attack? Two thirds of heart attacks occur in arteries that were less than 50% blocked prior to the heart attack. These blockages cause no symptoms prior to the blockage with clot. It is only when the cholesterol deposits rupture and cause a clot that symptoms develop because of increased blockage. These clots are unstable. The clot in unstable angina is frequently ‘dynamic,’ causing intermittent flow obstruction and more or less pain and even no pain. The symptoms and the outcome depend on the location of the obstruction and the severity and duration of arterial blockage with clot. The clot in unstable angina most often does not totally block the artery or temporarily blocks the artery. That is probably what happened in this man. He had a partial blockage which resolved on its own. The next day he had a complete blockage.
When the clot has resolved and there is no or minor underlying chronic blockage, there is no test that reliably identifies these patients. Dr. Shen’s multifunction cardiogram is probably the best to identify the disease in this setting when there are no symptoms. Remember, his stress test was completely normal just hours after his pain. My main lesson from this patient is to start aspirin plus another blood thinner to reduce clot formation until his ruptured cholesterol deposit heals over a matter of weeks. That also provides time for optimal medical therapy to stabilize plaques so that they don’t rupture and cause clot.
All Americans over 50 are at risk of dying suddenly. Every leader in a non-medical industry should make sure that optimal medical therapy is available for herself and her employees. She should also install defibrillators so that patients who “die” suddenly can be rescued. Let’s get started.
I have witnessed this too many times! This was one of my main motivations to embark on the journey to create MCG Technology!