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damaged heart muscle
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damaged heart muscle

  Almost 1 year ago, my 47 year old husband suffered a massive heart attack.
  As a result, 36% of the center of his heart muscle was damaged.  He now
  has congestive heart failure and stable angina, and is on cumadin (coumadin), asprin,
  and 5 other kinds of heart medication.  He quit smoking the day of his
  heart attack, and is now back to working a 6 day workday.  He does wire
  assembly work.
  The quality of his life has changed dramatically, in all area.  I feel so
  sorry to watch this man on how this has torn his world from out under him.
  Shortness of breath, angina, depression, to name a very few.
  I have done lots of reading & research this past year, but I cant find the
  answer to two of my questions.
  1) What function does the center of the heart serve?
  2) The doctors tell me a heart transplant is his only cure, but he's
     not bad enough to have one yet.  Is there some surgical procedure
     that they could be overlooking.  This man has lots of life left in
     him.  Please help me.
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Dear Sue, thank you for your question.  I understand your frustration with what's
happened to your husband, but as you have witnessed, heart attacks (called
myocardial infarctions - MI) can have devastating consequences.  I presume
that your husband had an anterior MI from the information you've provided.
An anterior MI involves occlusion of the largest of the 3 coronary arteries
called the left anterior descending.  This artery supplies the anterior wall
of the left ventricle (LV)(also called the center of the heart) with essential
nutrients and oxygen.  When it occludes during an MI, the muscle tissue can
die if the artery is not reopened within 6-12 hours with thrombolytic medications
(t-PA) or angioplasty.  Since the anterior wall of the LV is so crucial to the
pumping function of the heart, damage to this muscle can compromise the function
of the left ventricle.  Heart failure occurs when the LV is too weak to pump
enough blood in the right direction - blood tends to back up into the lungs and
the symptoms of heart failure begin.  In the U.S., most patients that have had
an anterior MI undergo a heart catheterization to visualize the arteries and
to decide on the most appropriate treatments.  If your husband had this procedure
done, then he would have been treated with medications, angioplasty, or bypass
surgery.  Presently, it sounds like he's symptomatic from a heart failure standpoint
but the angina indicates he may have other blockages that need to be addressed.
Cardiac transplantation may become an option for him in the future, but patients
have to be in end-stage heart failure to qualify for a transplant (mainly because
the supply of organs is so small - the sickest patients thus get preference for
heart transplants).  Your husband does not appear to have end-stage heart failure
at this point.  In my opinion, there are two tests that could be done to further
evaluate your husband.  First, a PET scan is a stress test that uses medications
for the stress portion and also is a test to determine the metabolic activity of
the heart muscle.  In a PET scan, blockages in the coronary arteries are evaluated
with the stress portion to determine if any areas of the heart aren't getting
enough blood.  The metabolic portion evaluates areas of the LV to determine if
prior heart attacks have irreversibly scarred the heart muscle or whether there
may be "hibernating" muscle that would work more efficiently if normal blood flow
was restored with angioplasty or bypass surgery.  If a significant amount of hibernating
myocardium were found in your husband, then a cardiac catheterization could be
done to visualize the blockages and to determine if they would be best treated
with angioplasty or bypass surgery.  If only scarred heart muscle were found on
a PET scan, then angioplasty or bypass surgery  PET scans are only available at large,
tertiary medical centers.  In the meantime, your husband should be congratulated
for quitting smoking and should now follow a low-salt, low-fat, and low-cholesterol
diet.  We would be happy to evaluate your husband at Cleveland Clinic - to
schedule an appointment call 1-800-CCF-CARE and ask for an appointment in the
heart failure clinic at desk F-25.  I hope you find this information useful.
Please write back with more information if you have further questions.
diagnoses and therapies can only be provided by your physician.

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