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Healthy heart is the heart of the matter

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Tom Jackson

tjackson@tampatrib.com

Published: July 1, 2009

Recent bulletins announcing the deaths of gentlemen well-known in the Bay area stand in stark confirmation of Rao Musunuru's assertion that, when it comes to heart disease, a patient's first symptom is often his last.

Musunuru, the distinguished cardiologist who hangs his shingle at Regional Medical Center Bayonet Point, reaffirmed that chilling axiom Tuesday afternoon between patients, most of whom would hear the same sermon - a sermon most of whom had heard before.

Billy Mays, the Tampa-based human megaphone, and Jeff Swanagan, former director of The Florida Aquarium, died within hours of each other Sunday, both barely into their second half-century; both, evidently, from bad hearts; and both without benefit of Musunuru's wisdom, which we soberly impart today.

To begin, the doctor says, if you are on the high side of 40, have no family history of heart disease and are without symptoms, do not use the ticker-related expirations of Mays and Swanagan as an excuse to demand tests from your doctor.

In all likelihood, Musunuru says, you (or your insurer, or some combination) will spend $1,000 without expanding your knowledge base.

Mind your risk factors

Remarkably, coronary arteries - those indispensible tubes of life with the diameter of a strand of spaghetti - can be 40 percent or even 50 percent blocked and still disguise their potential for harm from sophisticated probes.

On either side of the test, the doctor's advice will be identical: Manage your risk factors. For openers, don't smoke. "Smoking is still the No. 1 cause of preventable deaths." Otherwise: Eat right, stay active, control your weight, mind your cholesterol, track your blood pressure.

"Patients come to me," the doctor says. "They want the stress test, they want the MRI. I ask them, 'Why do you want to spend all that money to find out what's wrong with you? I'm going to tell you free right now.' ... But you want a test that will tell you to behave better?"

Push away, push up, live

It is in the nature of humans to misbehave, often wantonly, then summon medical science to repair self-inflicted damage.

But the tragic lesson of Mays and Swanagan is, oftentimes, there isn't time for physicians to intervene. Like when the plaque comprising an undetectable 40 percent blockage inexplicably erupts, tearing the artery.

Just as it would with a wound to the skin, immediately the body goes to work sending platelets and fibroids to seal the rip.

"The body doesn't know any better," Musunuru says. Add a blood clot to a 40 percent plaque blockage and you have a design for "electrical irritation," the penthouse of a cascade event that, undetected and untreated, triggers fibrillation - a condition in which the heart quivers, but does not pump - and cardiac arrest.

Better we should embrace Musunuru's free, but priceless, advice. Push away from the table. Push up from the couch. Put your sneakers on the sidewalk. Go.

Keyword: The Jax Files, for Tom Jackson's bonus musings.

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