Hand on the pulse

As a cardiologist entering his 40th year of practice, Dr. Peter Magnusson has seen dramatic advances in medicine. He embarked on his career during the peak period of deaths from heart attacks, when a trip to the hospital offered no assurance of recovery. Now, thanks to breakthroughs in treatment, hospitals have a much higher success rate in treating cardiac-arrest patients.

A particular incident crystallizes the change.

In the summer of 1962, while working as an orderly in a Chicago-area hospital, Magnusson came upon a semi-private room shared by two men who had suffered heart attacks, admitted at roughly the same time. One died during his second day in the hospital.

“Within an hour or two,” Magnusson recalled, “the other man decided that, ‘If I stay here, I’m not going to survive this’—so he decided he was going out through the window.

“Fortunately, this was the second floor, and his window was right over the emergency room entrance, and he landed on the roof, 4 feet down. He was OK.”

Nowadays hospitals are less daunting; they can save around 95 percent of their cardiac-arrest patients. Back in the ’60s, though, doctors could only prescribe morphine, oxygen and a month of bed rest … then hope for the best.

“There was essentially no effective treatment for heart attacks,” Magnusson said. “You just went into the hospital and waited to see whether you were going to die or not. The mortality rate at the time was on the order of 25 percent—assuming you got to the hospital.

“Obviously there’s been a dramatic change since then.”

Magnusson, who joined the staff at Enloe Medical Center 25 years ago, had a front-row seat for many of the milestones.

In 1970, during his final year of medical school at the University of Illinois campus in Chicago, he observed one of the earliest bypass operations. As part of his internship at Harbor-UCLA Medical Center—a pioneer in treating heart attacks in the field—he rode with paramedics who’d resuscitate patients with defibrillators (electric stimulation) before transport to the hospital. During his fellowship at Cedars-Sinai Medical Center, also in Los Angeles, he saw the first use of “clot-busting drugs” as a heart-attack treatment.

“I feel very fortunate to have been involved in all that and use that to treat patients,” Magnusson said.

Current care for heart attacks focuses on the axiom “time is muscle”—treat the patient as quickly as possible to minimize damage to heart tissue.

“We’re now able to bring treatment virtually to a patient’s house,” Magnusson said. “That’s a huge difference from 50 years ago.”

Enloe Medical Center is a designated receiving hospital for a type of serious heart attack known as a STEMI: ST-segment elevation myocardial infarction. North State paramedics have portable electrocardiogram devices to help diagnose heart attacks; once they’ve identified a STEMI, they transmit readings directly to Enloe.

As the patient comes via ambulance, the cardiology team readies the cardiac catheterization laboratory (or cath lab). There, the cardiologist will perform an angiogram—an examination of artery blockage, via a tiny camera strung into the blood vessel—before determining the course of action.

“The EKG doesn’t always tell you everything,” explained Dr. Christopher Massa, a Chico cardiologist who, like Magnusson, treats heart attacks at Enloe. “It’ll tell you maybe one artery is blocked, but you may have severe blockage in other ones.”

Some patients require bypass operations, in which surgeons transplant a blood vessel to redirect blood flow. Many patients need only catheterization: the insertion of a small balloon on the end of a catheter that, when inflated, expands the artery walls. Typically, to avoid a spring-back to the smaller size, the cardiologist will then insert a stent, a small support Massa compares to scaffolding. Stents have become more flexible thanks to improvements in technology; some stents get permeated with medicine.

The treatment process is so streamlined that the “door to balloon time”—the period from diagnosis to treatment—often spans less than an hour. Enloe’s average is 56 minutes.

What is the future of cardiac care?

“The promise at this point is really continued efforts at prevention,” Magnusson said. “That’s really where the gains are going to be. In terms of technology and treatment of heart attacks, we’re pretty close to a limit as to what we can do at this point.”

Knowledge has progressed along with technology. According to the National Institutes of Health, in the 1960s “the effects of smoking, cholesterol, high blood pressure and obesity on the development of heart disease were unknown.” Today, “the concept of risk factors … is well-established.”

Magnusson tries to inspire patients by example. At age 71, he remains an avid bicyclist, skier and walker. He watches what he eats and recommends the Mediterranean diet: emphasis on fresh produce, nuts, olive oil instead of butter, small meat portions (preferably poultry or fish). Not only is it heart-healthy, he said, “it’s delicious!”

Massa, who came to Chico after completing his training in 2000, also sees prevention as the next big frontier.

“We’re very good at treating heart attacks,” he said, “but there still are a lot of heart attacks that don’t make it to the hospital. They just die suddenly, at home, with no warning.

“The only thing that will lower the risk is lifestyle change. That’s a big push in our offices, and in the cardiac rehab program after someone has had a stent or surgery, to turn people’s choices around.”