Cardiac Treatment

Shayne Woodward Shayne_Woodward at discovery.umeres.maine.edu
Tue Nov 2 08:16:12 EST 1999


I have an idea that hopefully someone can shed some light upon.  Take a
person who is reasonably young, in their twenties perhaps, who puts
themselves in a situation in which over a three to four week period
during finals they are limited to sleeping an average of 4 to 5 hours
per night, who are under a very considerate amount of mental stress
(breakup with boyfriend/girlfriend perhaps, keeping the grade), who
smokes an average of two full strength packs of cigarettes per day, as
well as consuming large amounts of caffeine.  This person then
experiences a coronary spasm, an MI, of which an echocardiogram shows
there is negligible damage, minimal troponin levels in the blood.  An
M-CAT is performed and reveals arteries are normal and clear.  I want
to make a strong point that after another four weeks have passed,
another echocardiogram is done and shows the heart to be in pristine
condition, as good as normal (in congruence with negligible damage
noticed earlier).  This person is treated with nifedipine daily
, yet every now and then, when under considerable stress, not
necessarily chest pains but a pain in the actual heart itself (nothing
usually worth taking nitro, maybe aspirin) occurs nonetheless. 
Remembering the echocardiogram revealed near perfectly, if not
perfectly, healed heart tissue, the pains still occasionally persist,
EVEN THOUGH THE HEART TISSUE IS COMPLETELY HEALED NEAR PERFECT.  Why do
these pains persist, even though all biological tissue related to the
heart is perfectly fine?  

Recall the stories we have heard of “phantom limbs” and what not of
people experiencing excruciating pain over a limb that is simply not
there.  A nerve center in the brain is being fooled by neurons that do
not exist anymore.  One case in particular comes to mind in which a man
lost his right hand in a motorcycle accident and underwent this
disorder.  The pain was so great, and because there was no medical way
around his dilemma, he even contemplated suicide.  He felt perfectly as
if his right hand was clenched tightly into a fist with such force that
his fingernails were biting into the skin.  In one particularly
brilliant experiment, a doctor devised a box in which the man put his
left hand into.  Looking down upon the box with a divider between his
eyes, mirrors were set up so that a virtual “right hand” was seen
through the mans eyes.  Putting his left hand into a fist, and thus his
virtual right, he slowly unclenched his hand.  His brain was again more
or less fooled and the pain never came back.  

To get to the point, say a nerve center in the brain of this cardiac
patient is experiencing a similar problem, which under certain
environmental conditions produces the pain the patient experiences. 
Let me also add that I feel it would be insignificant if the nerves in
or near the area of previously damaged heart tissue were damaged as
well, for they should be more or less routed to the nerve center I
mentioned previously.  Say the pain is “connected” to the nerve center
in the brain and is being fooled or tricked by certain environmental
stimuli.  This is much the same case as the phantom limb scenario.  To
prove this, say a real-time cat-scan or MRI is performed, indicating
brain activity in certain regions when the pain is being experienced. 
The specific region is located, identified, and assessed as being an
area in which physical surgery could be performed without major risk of
interfering with normal brain activity.  Or maybe laser optics, or
photodynamic therapy, or whatever, is used to remove this
 area of brain matter.  Assuming the nerve center is responsible for
the “phantom pain,” it should now be eradicated.  This is why I feel it
is irrelevant whether or not the nerves near the heart were damaged
assuming they were connected to this nerve center.  The pain should not
be experienced now.  Instead of pushing aside a problem that is not
going away entirely by the use of drugs, the actual root of the problem
is taken out of the equation.  

Does this idea seem preposterous, too far-sighted?  It has been in my
mind for a couple of days now and I feel it might be worth mentioning,
one never knows its implications.  Thank you for your time.

Sincerely,

Shayne R Woodward
Pre-med undergraduate
University of Maine, Orono




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