Medicine: Not So Mild

Many doctors reason that the victim of a mild heart attack is uniquely blessed. Standard treatment for such attacks involves no prolonged restrictions or use of anticoagulants; most patients are up and around after three weeks of bed rest and quickly return to normal activity. Such people, so the traditional medical argument runs, should thank their stars that the same factors that often produce fatal attacks in others have caused them only temporary indisposition. But last week Philadelphia’s Dr. William Likoff somberly warned the AHA that the “mild coronary” may have more cause for ap prehension than for gratitude.

Dr. Likoff — himself the victim of a severe coronary four years ago — based his case on a five-year study of 100 patients who had suffered mild heart at tacks (at an average age of 47.7) and recovered with standard treatment. After recovery, 46 of the 100 patients resumed regular activity, reported no angina or other subjective symptoms of coronary insufficiency. Nonetheless, ten of the 46 suffered second attacks within the five-year period, and one died. The other 54 patients, although apparently recovered, complained of chronic angina. Of these, 38 were again stricken before the five years had passed, and eight died. The overall rate of recurrence among both groups: 48%. Overall mortality rate for the victims of second attacks: 18%.

Electrocardiograms revealed that the second attack often struck the area of the heart weakened by the first. But regardless of location, said Dr. Likoff, the second attack usually was more serious than its predecessor and in nearly half its victims produced “major clinical manifestations” — shock, abnormal heart rhythms and indications of congestive heart failure.

The mild attack, he concluded, often is only a warning of worse to follow and should receive the same careful, intensive treatment prescribed for more severe heart cases. Said Dr. Likoff: “There appears to be every indication that the ‘mild coronary’ requires whatever protective measures are available, for an absolute mini mum of two years.”