A Call to Arms! the Saturday Evening Post and Its Editor Strive to Bring Together Innovative Ideas and the People Behind Them. (Open Forum)

The Saturday Evening Post, May-June 2003 | Go to article overview
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A Call to Arms! the Saturday Evening Post and Its Editor Strive to Bring Together Innovative Ideas and the People Behind Them. (Open Forum)


Why do sudden cardiac arrests happen in the morning? And what is so different about 4:00 a.m. that makes it the "witching hour" for hearts to flutter, race, break their sinus rhythm, and go into ventricular tachycardia (very rapid heartbeat), then ventricular fibrillation?

Linda Isner told us, "In my support group there were three of us out of seven whose husbands had died at 4:00 a.m. All of our husbands were young. It's really very scary, and I hear about it all the time." Of course, she would hear about it-because her husband was so well known in cardiology.

In VF, the heart can't pump blood to the brain. It just quivers helplessly until someone with an AED shocks the heart's electrical system to stop the rapid shaking. For want of an AED, would a strong fist thrust to the chest do the same thing? I would try it on my husband if I didn't have an AED handy. Dr. Zipes says that it is worth a try since the rhythm could be ventricular tachycardia (fast heartbeat). He cautioned, however, that it wouldn't work if ventricular fibrillation had already set in.

In CPR classes, we were taught to put 90 pounds of pressure on the sternum to make sure we squeezed the heart enough to get some blood up to the brain. We were also instructed not to worry if we break a rib performing CPR, as broken ribs can mend, but straight brain waves cannot.

What would you do if your spouse tossed and turned at four in the morning? If he/she said his/her heart were beating rapidly? Maybe there was heartburn? Maybe the previous night's dinner was blamed?

If this should happen in our home, I would go for the AED right then, just in case. If his heartbeat was fluttering, I would call 911 while the electrodes in the self-prompting AED were readied.

Every home should have a stethoscope. Any child can be taught how to count a heartbeat. Just count the heartbeats for ten seconds, multiply by six, and you have the pulse rate-an important vital sign to give your cardiologist over the phone. This is something we can do in our homes.

Might SCAs happen at 4:00 a.m. after six to eight hours in bed because of stasis of the blood? Might blood become more stagnant and might the viscosity be thicker in the coronary capillaries so that oxygen doesn't flow as freely into the cells of the vital heart muscle?

But Dr. Zipes says that the early incidence is thought to be due to arousal response that causes platelet clumping and the increase in myocardial infarction, stroke, and sudden cardiac arrest.

While both are cardiologists, Dr. Doug Zipes refers to himself as an "electrician" and to Dr. Keith March as a "plumber" of hearts. Dr. Zipes is an outstanding electrophysiologist, and Dr. March is his intellectual counterpart in the study of cardiovascular circulation (the "plumbing" that brings blood to the heart).

Neighborhood Heart Watch's ambitious goal is to protect the 400,000 people predicted to die from SCA each year. If 80 percent of these people will die at home, perhaps we should fund Dr. Zipes and Dr. March so they can conduct rigorous scientifically accurate studies to learn what percentage of these unexpected home SCAs actually happen in the early morning.

We hope the NHW can launch a collaborative effort between the plumbers (this category includes cardiologists and interventional radiologists because they track the vessels) and the electricians (also called electrophysiologists because they know all about heart devices that improve any faulty heart electrical rhythms).

But Jeff Isner's work and the work of Keith March are miles apart from Dr. Zipes' electrophysiological work. Dr. Zipes, who is past president of the American College of Cardiology, is the leading electrocardiologist in the world.

We must go forward and try for a major gift from Ruth Lilly for Dr. Zipes' Neighborhood Heart Watch. Her generosity is admirable. Recently the pharmaceuticals heiress' gift of $100 million to the Modern Poetry Association, a group in Chicago that publishes Poetry magazine, made national headlines.

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