Three takeaways about heart disease
This is the story of my brother’s coronary bypass surgery. It contains three critically important messages:
1. Don’t assume that your coronary arteries are in great shape because your “numbers” are good, you’re taking the prescribed medications to keep them that way, you’re trim and athletic, and you live a mostly heart-healthy life.
2. Don’t ignore or dismiss potential symptoms of coronary distress by assuming that muscle soreness, unusual stress or heartburn is the cause.
3. Should it turn out that you need open-heart surgery to fix the hidden damage, be sure to pick a top-notch surgeon who uses the most effective, up-todate techniques and operates at a hospital with an excellent coronary care unit.
My brother, Jeffrey Brody, is a 73-year-old trial lawyer. We share a family history of midlife heart disease: Our father, paternal grandfather and grandfather’s brother all had heart attacks in their 50s and had succumbed to coronary disease by 71.
Jeff did pay attention, up to a point. He’s lean, physically active and takes medication to help keep his blood pressure and cholesterol levels normal.
What he didn’t do as soon as he might have was determine the cause of his monthslong episodes of periodic chest discomfort. Nor did he notice that he was getting short of breath after minor exertion. But when the chest discomfort persisted and people remarked on his breathlessness, after six months he finally consulted his longtime doctor, Douglas Heller in Kingston, New York, who immediately did an EKG.
That test, taken at rest, showed no cardiac abnormality. “But based on your symptoms,” Heller said he told him, “you have to go for a stress test.” He sent Jeff to a top-notch cardiologist in Kingston, Dr. Ali Hammoud, who administered an echo EKG that uses noninvasive ultrasound rather than a radioactive dye to assess heart function before and after exertion on a treadmill.
The test showed Jeff ’s heart function was mildly abnormal at rest and decidedly abnormal with exercise. Hammoud ordered an angiogram that revealed an 80 percent blockage in the left main coronary artery, the infamous “widow maker,” as well as blockage in another artery. An ambulance ride to Vassar Brothers Hospital in Poughkeepsie followed, where Jeff met with Dr. Jason Sperling, a cardiovascular surgeon with superb credentials.
Hammoud and Sperling both said they recommended bypass surgery rather than the much simpler fix of inserting a stent to open a narrowed artery.
“A stent could be used, and it is OK for some patients with left main blockages,” Sperling said. But he added that his surgical approach, using the internal thoracic arteries for the bypass grafts Jeff needed, was associated with better long-term survival and “should be a lifelong fix.”
Although most cardiac surgeons use veins to bypass arterial blockages, Sperling explained that vein bypasses sometimes also become clogged. The thoracic arteries, on the other hand, “seem to be immune to atherosclerotic buildup,” he said. Stents, even the latest medicated versions, don’t last indefinitely.
In most bypass surgeries, the chest wall bones and muscles are separated to allow access to the cardiovascular anatomy. When the thoracic arteries are used for the grafts, they can be harvested through the same incision, whereas veins must be taken from elsewhere, usually the legs. In either case, sections of the “donor” arteries or veins are stitched to the damaged arteries to create bypasses around the obstructions.
Happily, Jeff sailed through the surgery and, after exemplary postoperative care at Vassar Brothers, was sent home in four days with instructions to gradually increase his physical activity and not lift anything heavier than 5 pounds to allow his chest bones to grow back together.
Although coronary artery disease does not always produce symptoms, they should not be ignored but rather brought to a doctor’s attention with minimal delay. Symptoms may include unusual fatigue; decreased endurance during physical activity; shortness of breath, chest pain or discomfort upon exertion; dizziness or palpitations; unexplained arm or jaw pain; and indigestion unrelieved by antacids.
When my brother saw Heller, his internist, he was glad the doctor did not simply say he was fine because his EKG showed nothing abnormal. Instead, he sent him to the cardiologist, Hammoud, for further testing.
Hammoud said his decision to send Jeff for surgery rather than stenting was endorsed by interventional cardiologists, the doctors who insert stents. They reviewed Jeff ’s angiogram and agreed that bypass surgery was a better option given the severity of left main blockage, the extent of his disease and his otherwise good health, Hammoud said.
The left main artery supplies blood to two-thirds of the heart, and if it becomes totally obstructed, the patient usually dies without immediate medical intervention. When there is an 80 percent blockage, a complete closure can occur at any time if a small clot or piece of plaque should fill in the remaining opening in this artery.
Still, surgery, especially heart surgery, is not a walk in the park, so it’s important to review the benefits, risks and recovery issues with the surgeon and, if possible, one’s doctor and family members before deciding how to proceed.
Short-term surgical risks include heart attack, stroke, kidney problems, even death, all of which occur most often in people who, unlike Jeff, were in poor shape to begin with. The overall mortality rate is about one in 200.