Your Heart is for Living, Not Dying
( Originally Published 1956 )
THE PAIN struck Tom Newton as he was running to catch the 8:05 train home. It left him short of breath, and as he walked down the ramp he thought: "Must've been that ham-burger I wolfed down in the station. Sure, that's what it is—and on top of that, running for the train. Guess I'll have to remember that I'm not exactly a kid any more."
A heart attack? Up till then Tom would have laughed at the idea. Of course, he hadn't seen his doctor for some time. How could Tom have known just how likely a candidate he was for an attack of coronary thrombosis?
"Sure, I've put on a little weight," he had told me shortly before. "But who doesn't by the time he's 43?"
"That's when you should start keeping your weight down," I told him.
A little later when I noticed him munching some tablets, I didn't have to ask any questions.
"I carry them with me all the time," he explained defensively, "for a nervous stomach."
"Are you doing anything about your diet?" I asked.
"Look," he said, "don't look at me with that good-healthfor-all gleam in your eyes. I'm all for it—only I don't happen to need it. I've never been sick a day in my life. This nervous stomach—it's nothing—I've had it since college-exam days, and I know what to do for it."
"Have you been sleeping all right lately?" I persisted. "Fine," he said, "except when I'm under too much pressure from the job."
"How often is that?" I asked.
"Well—come to think of it—most of the time," he admitted. "But that's just been recently. I'm a healthy specimen, I tell you. I don't drink more than one cocktail a day, and I don't smoke a lot."
"Do you exercise?" I asked.
"Sure. Violently." He laughed. "I run for the train twice a day."
But now, on the train, Tom wasn't laughing. He ducked into the first empty seat in the nearest car, and waited for the pain in his chest to subside. Instead, it came on again, full-grown. Searing as though it were a small, hot bulb, the pain remained constant. It concentrated on an area no larger than a quarter. He clutched at the oppression, which seemed to center four inches below his necktie.
"No more hamburgers for me," he gasped, feeling through his pockets for the antacid tablets. "Got to chew a couple of these. Must hurry . . . hurry. . .
A second acute ball of pain stopped him before he could swallow the fragments of medicine in his mouth. Then a third left him struggling for breath. The pulsating pains merged into a white-hot bar high up across his chest.
It was then that Tom thought: "Could this possibly be—a heart attack? This horrible pain! I don't know what to do...."
Everything in his body strained toward the left side of his chest. Now his body was nothing more than a container for that searing rod of pain. He tried to clutch at the pain again with his left hand. He couldn't. The whole arm had become numb. He began to knead the useless arm with his right hand, and the pain radiated from his left shoulder down to his elbow.
At that moment Tom knew. He was having a heart attack. By this time the train was rumbling through the long tunnel out of the station and under the East River.
In a haze of pain Tom turned to find that a woman was sitting beside him. She was staring at him as he frantically rubbed his arm.
"I—I'm very ill," he told her.
What can you do for a sick man sitting beside you on a train? The woman wiped Tom's face with a tissue she took from her purse, tried to fan him, and looked around for the conductor.
As the conductor entered the car and began to move slowly down the aisle collecting tickets, she called to him: "Conductor, please come here. This man is very sick. We'd better get him to a hospital right away."
"We can't stop now until we get to Jamaica," Tom heard the conductor answer.
"Jamaica . . . how far? . . . how long? It's an eternity. Oh, God, can I last? . . . an eternity!" Tom was vaguely aware that the woman was still wiping his forehead and trying desperately to fan him with her handkerchief, as he sank slowly into unconsciousness.
Then they were at Jamaica. There were the railroad men in coveralls and uniforms, who helped him off the train and onto the platform. They let him crumple down on a bench, while someone went to call an ambulance. He heard his train pull out for home, and wondered when Janice would begin to worry. Maybe she wouldn't worry. His office hours had been so long and erratic lately, she might go to bed without even wondering where he was.
Suddenly, childishly, he wanted Janice to worry about him.
He felt someone rifling through his pockets. "Janice?" he murmured. No, it was a policeman searching for his wallet.
"He's not drunk, officer," an overalled man was saying. "They took him off the train—he's sick."
"The ambulance," Tom groaned, "won't it ever get here?" He was too exhausted to care whether he lived or died. The time seemed endless as the minutes dragged on.
"Always . . . wanted to make a graceful exit," he thought incoherently, "but here . . . cold station platform . . . gloomy . . . alone. Pretty sordid. Can't hold on much longer. . . ."
Then he gave in to the pain and slipped away into unconsciousness again. He didn't wake until he felt someone putting a small pill under his tongue. It was a man in white. That and the wail of the siren told him he was in an ambulance on his way to a hospital.
"All I could think of then was that I was still alive," Tom told me afterward. "I didn't die. I thought I was going to, but I didn't. It was like being sentenced, then getting a reprieve. You don't know how grateful I am. The only thing I can't understand is: Why didn't I ever have any warning of this thing?"
"You had warnings, Tom," I told him. "Plenty of them. You just wouldn't recognize them. Remember our talk before your illness?"
"Yes," said Tom slowly. "I do remember now. You tried to point out those warning signals to me. But I was pretty cocky then. I wouldn't listen to you, much to my regret."
A heart attack is an intensely personal experience. If you feel an unusual pain in your chest, as Tom did, don't pass it off as indigestion. Find out what it is while there's still time to do something about it. Or you may awake at night and find you are unable to breathe comfortably lying down. You feel you need two pillows instead of one. Even if that feeling subsides in five minutes, it should alert you to your potential danger.
Perhaps you have developed a tightness or constriction in your chest. Or maybe you have noticed that you can't accomplish as much as you did a few months ago without getting out of breath.
You may have several of these symptoms—or none of them. Science does not yet have the tools and technique that would permit a doctor to say: "A blood clot is beginning to form in one of your coronary arteries. In a few weeks it will completely plug up that artery, causing a heart attack."
When President Dwight D. Eisenhower was examined with an electrocardiograph in August, 1955, his doctors saw no danger signals. Yet the next month, on September 24, a blood clot plugged up his coronary artery.
We learned in a previous chapter how one meal rich in fats can produce a coronary heart attack. Before his heart attack Eisenhower ate the following breakfast: fried cornmeal mush smothered in rich chicken gravy. It is quite likely that he may never feel free to eat such a meal again.
Tom doubtless triggered his heart attack with his rushing for the train and the food he had eaten that day. Yet, he had received other telltale signs: his nervous indigestion, his sleeplessness, and his pallor. "Working too hard at the office," he would say. "Guess I'll have to take a vacation one of these years."
If you are overweight and feel even slightly under par, check up on your health.
A famous graphologist who studied samples of President Eisenhower's handwriting executed some months before, and immediately preceding, his heart attacks, found signs of extreme fatigue, which had apparently gone unnoticed. The handwriting experts contend that signs of imminent illness, both physical and mental, can often be seen in certain changes in the individual's writing. As far back as the time of the English poet Coleridge, in the early nineteenth century, it was noted that his depressed moods revealed themselves in an uneven, downward slant in his handwriting.
These facts are merely mentioned to illustrate that fatigue signs are not always easily discernible. Is it because we don't want to recognize them? Too often the average man, tired to to the point of exhaustion, will say: "Nothing wrong with me that a few cocktails won't cure." He continues to keep going, on nervous energy and false stimulation, refusing to admit any loss of vigor.
Why not face it? Your heart is in your hands. This is the age of the coronary-disease epidemic. Doctors are trying a cure-through-prevention. But the greater part of this job must be done by you alone.
This disease is a prejudiced killer. It stalks through our land, striking down the hard-working, the able, the energetic —males by preference. It is a vicious killer of the mature man —the man who is probably near the top of his business and who, like Tom, prides himself on being a healthy specimen, whose boast is, "Never sick a day in my life."
Coronary heart disease is characterized by a sudden, severe pain in the heart region or the pit of the stomach. Until about forty years ago, it was called "acute indigestion." Sudden death is not uncommon. Today, with our faster pace of living, it strikes not only the older man. Men in their thirties and forties are claimed as its victims.
There are nine million known sufferers from organic cardiovascular disease in America. But how many more have heart disease without knowing about it? It affects 20 out of every 1,000. Most frequently it comes to the man with the grim determination to do a job "if it kills me." Too often it does just that.
Your heart is a masterpiece of nature. It is not a delicate or fragile organ, but a strong, hardy mechanism. Day after day, year after year, it performs a tremendous amount of work, never stopping for even a few seconds. This miniature pump is just about the size of your fist.
The work assigned to the heart by the body varies widely, yet the changing demands are met automatically. The heart pumps out five thousand gallons of oxygenated blood into the arteries to feed your tissues every twenty-four hours, about six ounces at each contraction.
Your heart began to function before you were born. It ceases when your life is terminated. By the time you reach forty your heart has already beat one and one-half billion times.
At birth the heart beats at a rate of 120 to 130 times per minute. During the first year of life the rate slows to 100 beats, and in the next four or five years it gradually declines to the normal adult level of 6o to 85 beats. When you sleep your heart beats only 50 to 6o times per minute. During strenuous exercise the rate may increase to 120 or more beats per minute. If you experience rage or fear, your heartbeat will increase accordingly.
The number of times the heart beats, or contracts, per minute—the pulse rate—is regulated directly by two groups of nerves; one group causes an increase, the other a decrease, in the number of beats. These regulators are indirectly influenced by many factors: physical activity, emotional disturbance, certain drugs, changes in temperature, or eating and drinking. Changes in the rate of beats are executed promptly, without hesitation.
Each day the heart pumps approximately 4,320 gallons of blood through 6o,000 miles of blood vessels. The quantity of blood it pumps varies from hour to hour. Yet the heart seldom complains. It adjusts its blood flow to your body's needs.
Compared with mechanical motors, the heart is weak; its energy is rated as only 1/240 horsepower. But the average heart pumps nine or ten tons of blood every day, handling the body's entire stock of blood about once a minute. If the labor Tom's heart has performed over the years were concentrated in a single moment, it would be enough to lift two giant ocean liners—the Queen Mary and the Queen Elizabeth, for instance—out of the water simultaneously.
The heart must have energy to perform its herculean tasks. The ordinary actions of everyday living result in tremendous fluctuation in the output of blood by the heart. Getting out of bed and walking increases this output by some 50 per cent, as does the digestion of a large meal. The energy demand for walking up a long flight of stairs may raise it by 100 per cent or more.
Even where disease exists, the heart is often capable of meeting the requirements of normal life. When the organ is functioning normally the ordinary fluctuations are of no moment.
How is it that the heart is often able to perform work far beyond that usually demanded of it? This ability is due to the cardiac reserve—an indefinable factor, which cannot be measured in terms of work accomplished or the amount of blood pumped. One explanation of the cardiac reserve is this: The heart, unlike most individuals, relaxes as often as it works. It rests between strokes. It is working slightly less than half the time.
When the blood leaves your heart through the aortic valve it enters the great artery called the aorta. It is carried by the aorta into the arterioles and into the capillaries to nourish all parts of the body.
But your heart does not profit a bit from all the blood it distributes. It must receive its own nourishment from other sources, principally the coronary artery. As the heart pumps its refreshed oxygen-carrying blood through the body, it also pumps some of this life-giving blood to its own private coronary arteries.
The volume of blood supplied by the coronary arteries fluctuates, depending upon the amount of work that the heart is called upon to do. This variation in the blood circulating in the heart can be maintained only if the coronary arteries re-main elastic. These arteries, which seem to form a crown around the heart, must retain their ability to stretch so they can carry additional blood to the heart when the body's activity requires it.
Think of the coronary arteries as the fuel lines that keep the motor running. They supply the blood which carries nutriment and oxygen to keep the heart going. The oxygen is responsible for the removal of the irritating wastes that re-main after the heart muscles contract.
Do you like to kid yourself by thinking there's no connection between the foods you eat and thickened, hardened arteries? Imagining yourself immune you think that "pass the potatoes and gravy, honey" will do you no harm. That you can eat all of the high starch, high fat junk you have a mind to.
You may think that only with advancing age is one troubled, if one is to be troubled at all. But did you know that there is plenty of evidence to show that coronary disease was found in three-fourths of 300 young men, averaging 22 years of age, who were killed in battle in Korea?
The excessive starches, the high fats—especially in combination—have a good deal to do with the yellowish, fatty material that deposits itself in scattered patches beneath the slick lining of the arteries, usually at the point where they branch. What do you suppose happens when these deposits start blocking the arteries?
The heart muscle warns you with a severe pain that is felt beneath the breastbone, across the upper part of the chest, or down the left arm. This condition is angina pectoris. It is due to a failure on the part of the coronary circulation to sup-ply the heart muscle with sufficient oxygen.
The pain generally comes during strenuous activity. The heart muscle needs more oxygen than can be supplied to it through the partially blocked artery. Irritating waste from muscle contraction accumulates and causes the pain. When you rest and allow the heart to slow down, its work load is less, and the coronary circulation catches up. Oxygen can now be supplied through the narrowed branch in sufficient amounts to wash out and dispose of the irritating waste, and the pain disappears.
This is only a warning! Disregard it and you invite the real No. 1 killer or crippler to enter your life. Such lesions on your arterial walls may slow down the circulation of blood to the extent that a clot forms at the point of narrowing—a clot that completely stops the blood flow which feeds your heart. Your coronary artery is plugged and you have coronary thrombosis—a clot on the heart.
This is fundamentally an arterial disease. Immediately following the occlusion, the heart muscle is starved for oxygen. Waste accumulates, and severe pain is experienced. Without the proper blood supply for energy the heart cannot pump blood. And without nutriment and oxygen that part of the heart muscle will die. With a myocardial infarct, tissue dies in the heart just as surely as a finger constricted by a tight rubber band will die. And with the same relentless pain.
Here is one encouraging aspect of coronary thrombosis: If the patient is under proper care, small, new blood channels from other near-by arterial branches open up, become larger, and grow over to help take care of the defunct artery's work load.
The larger the occluded artery, the greater the area that will have to be healed. The larger the scar area is, the more serious the outlook. Don't demand too much of the heart while it is in this weakened state or it will fail. Or the wall may rupture. Your physician will probably require that you rest in bed for four or five weeks, until complete healing has occurred and the wall of the heart is strong again.
With modern treatment your chances of survival from an initial attack of coronary occlusion are close to 90 per cent. Eighty to eighty-five per cent of coronaries who recover from such attacks are able to return to their jobs and to resume fairly normal lives.
The electrocardiogram—a record of the changes in electric potential during the heartbeat—can pretty well locate where a clot has occurred and what areas of the heart are blocked. It can tell how serious the damage is and how treatment should be tailored.
Blood-thinning drugs can't dissolve a clot blocking an artery, but they can prevent the clot from spreading.
The modern regimen of strict rest, oxygen, proper diet, and plenty of lecithin has contributed to boosting the survival from these attacks. Knowledge of the heart is constantly increasing.
The well-known New York heart specialist Dr. Arthur M. Master says: "There is no justification for the pessimism and psychological invalidism. Many of the patients who survive the acute attack live for many years and approach the ordinary life span."
Don't you be a heart-pessimist.
He's the man who continues on his precarious way. He says, "I've got heart trouble, but there isn't anything I can do about it."
Listen to your heart's warning. You can increase your chance for survival. If necessary, say:
"I've got heart trouble, but there must be something I can do about it. Tell me what it is, and I'll do it!"
The next chapter can help you.