Have a Heart Attack and Call Me in the Morning?

An intentional heart attack may cure some congenital heart defects, says a report in tomorrow's Circulation. In patients with a specific inherited heart problem, doctors induced a small heart attack to kill off abnormally swollen tissue, and in most cases the patients got better. But other cardiologists warn that even a small heart attack might lead to more problems later on.

People who suffer from hypertrophic obstructive cardiomyopathy (HOCM) have an overgrowth of tissue that partially blocks the outlet of the left ventricle. This leads to shortness of breath, fast irregular heart beat, and fainting spells. In the most severe cases, patients can die suddenly from overexertion. Doctors sometimes cut away the obstruction, but a less invasive method has been attempted recently. By injecting alcohol into the heart muscle, the cardiologist can poison a section of the overgrown heart muscle, thereby shrinking the obstruction.

To assess the safety and effectiveness of this treatment, William Spencer and his colleagues at Baylor College of Medicine in Houston injected alcohol into the hearts of 33 HOCM patients with severe symptoms. The injection causes the tissue to shrink and scar. "It looks as if a surgeon had gone in and cut that area out," says Spencer. Within 6 weeks, the patients could walk for 50% longer on a treadmill than they could before. Moreover, the blockage had shrunk by an average of 28%. No adverse effects were found up to 6 months after the procedure. The researchers believe the ethanol injection "is potentially a new landmark in the treatment of this disease."

Other experts are more cautious. Barry Maron, a cardiologist at the Minneapolis Heart Institute Foundation, called the technique promising, and useful in some cases. But he warned that any heart attack is dangerous to the heart and can lead to worse arrhythmia and other complications. "It's far, far too early to say this should replace surgery," he says.

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