Cardiac Infarct.pdf

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extracted text: CARDIAC INFARCT Walter Theimer Cardiac infarct is a fre quent cause of death. This ex plains the interest taken by life insurance companies in this particular disease. The Association of Life Insurance Companies at Karlsruhe has ma-de a study of heart in farct, frequently regarded as a “managers’ disease”, with the collaboration of many cli nics. Life insurance compa nies give financial support to research on cardiac infarct, Since they would obviously benefit from a decrease in infarct mortality. A High-Class Disease The analysis of 18,000 cases showed clearly that cardiac infarct is by no means a dis ease peculiar to “managers.” One-half of all cases are found in the upper classes, among manufacturers, office workers, government offi cials and in the professions with a university back ground. Manual workers par ticipate only to the extent of 20 per cent. The group known as managers has only the average mortality. Why the upper classes are more involved than others, is a problem still waiting for elu cidation. It is often said that psychological tension due to the race for customers and careers is responsible for the increase of infarct, and even automobile-driving is some times accused on account of the nervous tension it im plies. Yet these hypotheses are not proved. Members of the civil service have a safe career, but they get cardiac infarct much on the same scale as “managers” do. The fact that managerial people are not under greater danger from cardiac infarct than other upperclass people is cer tainly of interest to medical science and life insurance di rectors. Possibly nutrition and the general mode of liv ing have greater influence than people used to think. 58 Panorama The word “infarct” derives from Latin infarcire, to obs truct. A coronary artery is obstructed by a bolus, a small clot of coagulated blood. The bolus is produced at some place in the system and is carried into the coronary ar teries by the circulation. Why and where a bolus is produc ed, is another unsolved rid dle. Now in the region of the heart muscle supplied by the obstructed vessel the tissue dies because of lack of oxy gen and malnutrition. It be comes necrotic. Usually a white wedge is formed, its thin end pointing toward the bolus. About eight hours af ter the fixation of the bolus the well-known symptoms of breakdown appear. An infarct can end in death, but the pa tient may recover after two months. Infarcts can occur repeatedly. One prerequisite is a narrowing of the coro nary arteries, which may be due to sclerosis or perhaps even nervous tension. A deg ree of coronary sclerosis is practically normal in men of sixty and over. 76 per cent of the cases studied were men. Females have only a proportion of 24 per cent. Cardiac infarct is definitely a disease of men. One-fifth of the male cases occurred between the 55th and 59th years of life. Below 40 the proportion was less than 2‘per cent. The danger zone begins after 40. The in farct peak of women is be tween 65 and 58, a decade la ter than in males. The Preliminaries of Cardiac Infarct A high proportion of the patients had suffered from cardiac and circulatory trouble previous to * the infarct. An infarct often seems to come as a bolt from the blue, but in fact it is preceded by fairly long-term changes such as high pressure or an gina pectoris. The prelimina ry changes may pass un noticed. About 17 per cent of the cases had suffered from infarct before. The season is important. In farct is more numerous in winter and in the months of transition than in the sum mer months. January is the month most dangerous; Sun day is the day of an infarct minimum, while Monday is the peak. This may be due to ample and fat feeding on Sundays, combined. with smoking and drinking. Par ticularly the elderly are .in danger on Mondays. 85 per cent of the cases were smoker?. Still the pro blem of the connection beOCTOBEE 1961 ■59 MANY DIFFERENT KINDS OF GLASS NOW MADE Research is continually revealing new facts about the nature of glass and its potential uses, and is enabling glass manufacturing companies to make special types for different applications, according to a survey made by the National Geo graphic Society. As a result, glass is no longer a fragile mate rial of limited utility. In recent years scientists have created a number of tough and versatile “wonder glasses.” Some heat-resistant glasses, for example, can be baked until they are red hot and then plunged into ice water without breaking. A lead oxide glass cast in slabs 10 inches (25.4 centimeters) thick is almost as heavy as steel. It remains clear even when subjected to heavy atomic radiation. Tempered glass, made by heating glass until it begins to soften and then quickly cooling the surface, has the strength of cast iron. ♦ ♦ * tween smoking and heart in farct remains open. Despite the belief that fat food is responsible the recent study showed that light people are more endangered than hea vy ones. Tall men have more frequently infarct than smal ler men have. Yet on the whole it would seem that the influence of weight and size has been overrated. Thera peutically the narrowing of the coronary arteries is the point to be attacked? There are drugs widening those ves sels. In the case of sclerotic alteration this is possible on ly to a limited extent. Older men usually have a measure of sclerosis of the coronaries, and the trouble is part of the difficult problem of arte riosclerosis, refractory to ul timate explanation in spite of an enormous amount of research. Scientists are in clined to think that the ris ing consumption of fat plays some part. Yet this assump tion is far from proved, even if there are some impressive pointers. 60 Pamoxama
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