Better Hearts?

Heart specialists in Atlantic City reported progress against heart disease, the No. 1 killer:

A Smooth Flow. Most dreaded and suddenly fatal of all heart ailments are those due to bloodclotting, e.g., coronary thrombosis. For reasons not yet perfectly understood (too little exercise, poor metabolism, infection), blood cells sometimes begin to stick together to form a thrombus (a stationary clot). But the thrombus grows, may eventually let loose daughter clots (emboli) which swim on to lodge at vital bottlenecks in the blood stream. A thrombus which lodges in a coronary (heart) artery, blocking off the blood supply to the heart muscle, can kill within a few minutes; a clot in the brain causes a stroke.

Against coronary thrombosis and embolism attacks, doctors used to be fairly helpless; standard treatment was to dope the patient, give him oxygen to relieve the strain on the heart and a drug to relax the blood vessels. In most cases, patients survived one attack, succumbed to a second.

Thrombosis, the specialists reported last week, is no longer so dreaded. In the past two years investigators have had notable results with two anti-clotting drugs: heparin and dicumarol. Heparin is a substance in the liver and lungs first isolated in 1916; dicumarol is found in spoiled sweet clover (its anti-clotting property was first discovered when it was found that cattle feeding on it sometimes bled to death). Both drugs prevent clots from forming.

Heparin acts within a few minutes, but it is expensive and has to be injected every few hours. Dicumarol is cheap and easy to take (in pills), but it takes 24 hours to work. Doctors combine them: heparin for the emergency, dicumarol for longer-range effects.

Dr. Irving S. Wright of New York's Post-Graduate Hospital reported that he had successfully treated more than 300 patients. Dr. Edgar V. Allen of the Mayo Clinic had used the two drugs in nearly 700 attacks of pulmonary embolism and venous thrombosis. Under previous treatments, by normal expectancy, 80 patients would have died. Dr. Allen's score: one death.

A Pleasant Smoke. A sacred creed of most doctors--that smoking is bad for diseased hearts--was disputed by Dr. Robert L. Levy and a group of colleagues at Columbia's College of Physicians and Surgeons. Dr. Levy's group found that patients with various heart diseases who smoked two cigarets in succession showed no harmful effects. Smoking raised their blood pressure and heart rate, but no more than their usual daily emotional experiences.

Dr. Levy's conclusion: moderate smoking is all right for many heart patients and helps promote "emotional stability" in smokers. But patients with such diseases as congestive heart failure, active rheumatic heart disease and acute heart damage, should let tobacco alone.

Too Much Sodium. The A.M.A.'s gold medal for the most original exhibit went to a pair of young Tulane doctors who had broken out a new track of investigation. Drs. George E. Burch (see below) and Paul Reasor wanted to find out why people with congestive heart failure have so much trouble getting rid of water, and thus show such symptoms as massively swollen legs. They suspected that sodium, an extremely "thirsty" element, had something to do with it. So they fed patients salt containing radioactive sodium, and followed the sodium's course. Sure enough, they discovered that the patients retained nearly all the sodium that was fed to them. Result: sodium kept seeping into the tissues from the blood stream, and extra water followed the sodium. The water caused swelling.

Specialists have realized for some time that such heart patients do poorly on a normal diet, and need as little salt as possible. A diuretic, to help the patients get rid of water, is also a standard treatment. But Drs. Burch and Reasor showed that the big problem is to get rid of sodium rather than water. For that purpose, a mercurial diuretic is best; it carries off excess sodium in urine.

What interested heart doctors most: the Tulane researchers' new tool--radioactive tracers--suggested a method by which other mysteries of heart disease might be studied.

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