Shortly before my sister was to be married this summer, my Dad had a heart attack. It was his third…I think. It wasn’t major, but the doctors were saying how it was only time till ‘the big one’ came. I think he was wanting a stent, which I believe he had received after his first heart attack, which was very major. But the doctors were saying it wouldn’t do anything, and instead were suggesting he get triple-bypass surgery. Which…I mean, in terms of medical vernacular, we’ve all heard of before. It’s like, the big word for surgery, or whatnot. Anyways, I was shocked to find out my Dad declined the surgery, and instead decided to completely revamp his lifestyle. My Mom at the time was saying that the doctors were saying that, that’s nice, but too late. And I agreed, although through blind faith and pure ignorance. My Dad said that the statistics was not in the favour of the surgery, which I just couldn’t believe. I thought, really? Wouldn’t doctors know this, and thus stop performing the surgery?
Well, turns out he’s right. Here are two quick reads: first a bit from wikipedia under the ‘controversy’ segment, and then an article from New York Times which was cited in the wiki article.
The value of coronary artery bypass surgery in rescuing someone having a heart attack (by immediately alleviating an obstruction) is clearly defined in multiple studies, but studies have failed to find benefit for bypass surgery vs. medical therapy in stable angina patients. The artery bypass can temporarily alleviate chest pain, but does not increase longevity. The “vast majority of heart attacks do not originate with obstructions that narrow arteries”.
Loss of mental function is a common complication of bypass surgery, and should influence procedure cost benefit considerations. One published study using MRI imaging just after coronary bypass surgery found significant brain damage in 51% of patients.
Several factors may contribute to immediate cognitive decline. The heart-lung blood circulation system and the surgery itself release a variety of debris, including bits of blood cells, tubing, and plaques. For example, when surgeons clamp and connect the aorta to tubing, resulting emboli block blood flow and cause mini strokes. Other heart surgery factors related to mental damage may be events of hypoxia, high or low body temperature, abnormal blood pressure, irregular heart rhythms, and fever after surgery.
A safer and more permanent and successful way to prevent heart attacks in patients at high risk is to exercise, give up smoking, take “drugs to get blood pressure under control and drive cholesterol levels down to prevent blood clotting”. Longer term, behavioral and medication treatment may be the only way to avoid vascular related loss of mental function.
And the New York Times article can be read here. Below are some highlights:
But, researchers say, most heart attacks do not occur because an artery is narrowed by plaque. Instead, they say, heart attacks occur when an area of plaque bursts, a clot forms over the area and blood flow is abruptly blocked. In 75 to 80 percent of cases, the plaque that erupts was not obstructing an artery and would not be stented or bypassed. The dangerous plaque is soft and fragile, produces no symptoms and would not be seen as an obstruction to blood flow.
That is why, heart experts say, so many heart attacks are unexpected — a person will be out jogging one day, feeling fine, and struck with a heart attack the next. If a narrowed artery were the culprit, exercise would have caused severe chest pain.
Heart patients may have hundreds of vulnerable plaques, so preventing heart attacks means going after all their arteries, not one narrowed section, by attacking the disease itself. That is what happens when patients take drugs to aggressively lower their cholesterol levels, to get their blood pressure under control and to prevent blood clots.
Dr. David Hillis, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas, explained: ”If you’re an invasive cardiologist and Joe Smith, the local internist, is sending you patients, and if you tell them they don’t need the procedure, pretty soon Joe Smith doesn’t send patients anymore. Sometimes you can talk yourself into doing it even though in your heart of hearts you don’t think it’s right.”
Researchers are also finding that plaque, and heart attack risk, can change very quickly — within a month, according to a recent study — by something as simple as intense cholesterol lowering.
My Dad has since given up smoking (YAY!!), become a vegan (…something I wish I could accomplish for myself), and…I think has done some other life altering things…maybe exercise? One would hope. I guess the really neat thing is how, according to my Mother, he seems to be a whole new person. He’s the one doing all the cooking now, he continues to read voraciously (which he started a couple years ago when he became obsessed with global warming and the energy crisis) but now he reads about the benefits of a vegan diet and such, and seems to have a passion in life. Awesome. Go Dad 😉
This whole thing does remind me of that doctor I wrote about, Dr. Agus, who wrote The End of Illness. Now I have another reason to want to read that book…