Editor's Note
State of the Heart
During my residency in the mid-1970s, a cardiology fellow started appearing in the CCU with a little black box with multiple dials. He was recruiting patients to have their heart’s electrical system examined. My fellow residents and I heard that he would put catheters in those patients’ hearts, map electrical activity, induce dangerous rhythms such as ventricular tachycardia, and burn selected areas of the heart to treat the abnormal rhythms. We thought he was crazy.
Also during residency, I met a retired Mayo Clinic attending who had had a coronary bypass at the advanced age of 78. At that time, he was Mayo’s oldest bypass patient—somehow, he had survived. I thought his surgeons were crazy.
In 1977, a German radiologist named Andreas Gruentzig threaded a catheter into a patient’s coronary artery and inflated a balloon at the end of it, temporarily occluding the artery in order to squeeze it open. Most of the medical world thought he was crazy.
Since the 1970s, the crazy has become commonplace in cardiology. Angioplasties with stents have become the standard of care for acute myocardial infarction and unstable angina. That cardiology fellow’s black box has acquired more dials and more applications, allowing electrophysiologists to map and ablate abnormalities with the apparent ease of toasting bread. And as surgeons have refined their techniques and the patients who need their services have aged, performing bypass surgeries on octogenarians and even nonagenarians has become common.
But cardiology’s achievements haven’t been confined to fancy gadgets and techniques. Perhaps more than any other medical specialty, cardiology boasts numbers to prove its progress with regard to prevention. Partly stemming from populationwide risk-factor modification and partly from technical advances, the incidence of and mortality from coronary artery disease has steadily declined over the past 20 years. Realizing that lower is better for cholesterol in patients at risk, physicians jump in with statin drugs much earlier than they did 20 years ago, and recent nationwide data show the decline of average cholesterol levels.
The specialty also has continued to improve care for patients in crisis. Acknowledging that saving muscle is crucial, cardiologists rush MI patients from ER to cath lab with dizzying speed and interrupt the natural course of a heart attack. In many ways, cardiology is the poster-child for 21st century medicine.
But not all of cardiology’s progress is so mind-reeling. Many heart maladies enter the final common pathway of heart failure, and the standard treatments of ACE inhibitors and diuretics frequently seem like a mere finger in the dike. Newer heart failure treatments promise only modest gains.
Cardiology’s progress has changed not just patients’ lives but also physicians.’ Cardiology has morphed into multiple subspecialties including electrophysiology, interventional cardiology, preventive cardiology, and noninterventional cardiology. Previously the pinnacle of surgical specialties, cardiac surgery has seen its bypass caseload wither as angioplasty artists treat patients for whom surgery was once their only option.
Andreas Gruentzig died in a plane crash in 1985 and didn’t live to see his angioplasty method flourish. But he wasn’t the last of cardiology’s innovators. Many are working on inventions we can’t even dream of. Like Gruentzig, they may be called crazy, but history has proved that today’s crazy ideas can become tomorrow’s state of the art.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at
cmeyer1@fairview.org