To understand the real basis for hope, following a heart attack, let us look briefly at that vital organ that for centuries has been referred to in our common language as the source of feeling (as in such expressions as "heartbreak," "affairs of the heart," "heartless," and so on). As you can see from the accompanying diagrams the heart is a large muscle (about the size of your fist), which is divided into four chambers. The two smaller chambers at the top of the heart are called the auricles; the two larger ones at the bottom, ventricles. The auricles receive that impure blood that is being returned to the heart through the veins. This blood, because its supply of oxygen is almost exhausted, appears blue. The larger chambers, or ventricles, pump the fresh blood, after it has been oxygenated by the lungs, out through the arteries again, to nourish every part of the body.
The heart muscle itself, of course, has to receive nourishment. This is accomplished by means of a pair of blood vessels, called coronary arteries, that in diameter are about the size of soda straws. They encircle the heart, supplying it with the blood it needs to keep it functioning. When the inner lining (called the intima) of these arteries is filled with fatty deposits, they may become blocked, cutting off the heart's own blood supply, and "starving" a section of that vital organ. When this occurs, the muscle can no longer function in the affected area. Depending on the size and the location of the area involved, the result is that the heart is either crippled, until healing occurs and a scar forms, or it stops beating altogether and death ensues. When a patient survives a heart attack, as Dave did, the healing or repair of the damaged portion is as dramatic as any biological process known to science. This is the way it works: Nature rushes defensive forces to the scene. Undamaged arteries now grow buds into the tissues where famine exists. Thus a new network of blood vessels gradually spreads through the disaster area, creating what physicians call "collateral circulation." In this way, the heart "detours" around the road blocks that have clogged the coronary artery. The normal "traffic" of blood flow may thus continue, and the heart can go on pumping. The patient survives, and a scar of healing grows across the portion of the heart muscle that was damaged.
Treatment following a heart attack will vary according to the nature of the case. Sometimes anti-coagulant medicines are used to prevent further blood clotting. These are used only under the supervision of the doctor, and after a time are usually discontinued altogether. The diet thereafter must be watched closely, however. In my own practice, as I pointed out in another chapter, coronary patients who followed the strict diet I devised and prescribed for them lived twice as long as those who did not adhere to such a low-fat, low-cholesterol diet. During the critical two-week period immediately following the attack, if there are no complications, the patient is often allowed to sit up in a chair. Usually another one to three weeks of absolute rest is required before limited physical activities are allowed. This restriction avoids serious complications that might develop if any strain is placed upon the heart while it is healing. The electrocardiograph, a machine that records the electric pulsations made by the heart when it beats, is used in all hospitals to follow the patient's progress after he has survived a coronary occlusion (heart attack). By studying the tracings made by the up-and-down motion of the recording needle-pen, the physician can determine exactly which portion of the heart is damaged, and how it is responding to treatment.
After the initial rest-period stage of recovery, the doctor offers the patient guidance that, in its details, will differ according to individual needs. In general, however, the following rules of health and manner of living are followed by most physicians and patients:
Diets. Diet is also crucial, both to recovery and in adding years to the remaining lifespan after an attack. . We present the following dietary principles for those individuals who, because of high blood pressure, a heart condition, or some other cause, are required by their doctors to follow a low-fat, low-salt (sodium) diet.
