Ike's Convalescence

Every year hundreds of thousands of Americans suffer first attacks of coronary thrombosis, 170,000 of them men between 40 and 60. Of the total, 80% survive to enter the anxious period of convalescence through which President Eisenhower is low passing. The high survival rate is more a testimony to the toughness of the heart and better recent understanding of how it functions than to any radical advances in medication. Neither new surgical techniques nor wonder drugs have proved useful in treating coronary thrombosis.

Moreover, heart specialists differ widely in their theories of what causes coronary disease. It is variously attributed to the strains of modern life, overwork, excessive smoking, too rich a diet, exercise, lack of exercise, heredity, hormones, and emotional factors.

The Critical Hours. The most critical is the period for first the few victim hours of a after the coronary blood attack clot (thrombus) has formed in a coronary artery, cutting off the blood supply to one section of the heart muscle. If the patient is moved too soon after such an attack he may die of any one of a variety of immediate causes: a state of shock, ventricular fibrillation (a disorder of the heart rhythm in which the heart ceases to act as a pump) or, less often, the choking of the heart's action from the leakage of blood through the ruptured wall into the sac around the heart.

Most effective early treatment for coronary thrombosis is therefore to administer pain-killing drugs and to keep the patient on his back and preferably asleep until the pain of the original seizure has passed, There was some criticism of Presidential Physician Major General Howard Snyder ast week for not taking a cardiogram un til eleven hours after the attack and for giving no drugs except morphine at first.

But Boston's Dr. Paul Dudley White (see NATIONAL AFFAIRS) called Snyder's treatment "just right."

The First Days. After the first few hours, the general location of the infarct (the damaged area resulting from loss of circulation) can be determined by use of the electrocardiograph (see chart). Although the electrocardiograph frequently fails to detect the atherosclerosis (narrowing of the coronary arteries) that precedes a thrombosis, it can accurately trace the healing process as a scar forms in the damaged area of the heart.

For several days coronary patients may be kept in an oxygen tent in an effort to reduce strain on the heart and avoid possible complications in the lungs. They also get Dicumarol or a similar anticoagulant which reduces the danger of extension of the thrombus and formation of circulation-blocking clots.

In the first stage, the dead muscle tissue is carried away in the blood stream by polymorphonuclear leukocytes ("scavenger" cells), and at the end of about a week scar tissue starts to form in its place. This process usually causes fever and an increase in white blood cell count. But as the scar tissue--in Ike's case forming in the front wall of the heart--becomes stronger and more dead cells disappear, temperature and blood count return to normal. At the same time, the heart is developing collateral circulation. Immediately after a clot forms, the pressure drops in the area beyond it, and blood enters the area by alternate routes, such as already-existing interconnecting channels (see chart). Later, new arteries may grow into the area, and after that a new channel may even grow through the clot.

Although a scar has generally formed by the end of the second week, a third week of almost total rest is necessary to avoid such possible complications as permanent heart dilatation or rupture of the temporarily weakened heart wall.

Recovery. Toward the end of convalescence, the major problem is frequently psychological rather than physical. Most coronary patients feel fine a day or two after the initial attack, and then tend to become depressed by enforced inactivity and the fear of being permanently invalided. To avoid this, the President's doctors have thoroughly informed him about the nature of the injury to his heart and the healing process through which it is passing.

How complete can recovery be? It depends in part on the size of the infarct (it can vary from small marble size to the size of half a tennis ball); the larger the infarct, the more strain is put on the heart. It also depends on how efficiently the heart develops collateral circulation to feed and repair the damaged area. Even if convalescence is rapid and without complications, no doctor can commit himself on what "complete" recovery would be in terms of the responsibilities and pressures of the presidency. Said Dr. White: "I haven't seen any Presidents with coronary thrombosis."

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