Life isn’t fair

Tuesday, June 17, 2008

Life isn’t fair and the tales of Kelsey Grammer and Tim Russert show the two extremes when it comes to heart disease. Mr. Grammer has some chest pain, wanders into a hospital, finds out that he had a heart attack or myocardial infarction and walks out a few days later. Mr. Russert has no particular chest pain but drops dead because of his heart attack.

A heart attack means that part of the heart muscle has lost its blood supply, has died, and has been replaced by scar tissue. Injured heart muscle causes injured electrical systems and can lead to ventricular fibrillation, in which the heart jiggles instead of beats. No heart beat means no blood to the body, meaning sudden death.

And sudden death doesn’t really care if the heart attack was mild or not. The most common reason people die in the midst of a heart attack or myocardial infarction is an electrical short circuit caused by heart muscle that has been irritated.

In Mr. Russert’s case, bystanders were ready to use an automatic external defibrillator (AED) but the paramedics arrived at the same time to deliver shocks to the heart to treat the ventricular fibrillation. The treatment failed and they were unable to reverse Mr. Russert’s death.

The heart is a muscle just like any other in the body and has blood vessels that supply it with oxygen and nutrients to function. As opposed to arms and legs that can take a break when they get tired from lifting or running, the heart needs to keep beating.

Emergency departments have special plans to deal with patients having chest pain. The patient is descended upon by doctors, nurses, and techs. Lots of things happen at the same time until the diagnosis of an acute myocardial infarction is ruled out. Oxygen, monitors, EKGs, IVs, medications, people asking questions to find out what’s going on. Time is muscle. If part of the heart isn’t getting a blood supply, that muscle will die and be replaced with scar tissue; with the end result of a life-long weaker heart.

But the patient has to get to the hospital and many people die because of fatal heart rhythms like ventricular fibrillation. Classic television scripts are not real life.

Classic television: The monitor puts out a high pitched wail. The doc reaches for the paddle. “Everybody clear, I’m ready to shock.” The patient bucks on the table; the camera zooms onto the monitor screen waiting to see the telltale sign of a regular heart beat. The heart starts beating everybody cheers and the patient wakens almost immediately.

Real life: The electrical shocks are delivered with no change in the pattern on the heart monitor. Intravenous drugs are used to try to make the heart cells more likely to respond to defibrillation .More shocks, more drugs. All fail and the patient is declared dead. Resuscitation from death is not a given. More often than not the patient dies.

For those that survive, quality of life depends upon the length of time the brain was deprived of blood flow. The longer the time without oxygen, the more potential damage to brain function. The body doesn’t make more brain cells and when they are lost, they are lost forever. It is a tragedy when the body lives, but the brain doesn’t.

Kelsey Grammer is swimming in the ocean well away from any medical care and survives his heart attack. Tim Russert is sitting in the middle of a big city with an AED nearby and yet he dies. Philosophers try to explain life’s mysteries and explain events in the world. The answer seems easy to many of us in the ER…life isn’t fair.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.