More Information Needed : Experts Question Report of Pilot’s Heart Attack

It is far from certain that pilot William K. Kramer had suffered a heart attack immediately before his Piper Archer collided with an Aeromexico DC-9, or that it somehow contributed to the accident Sunday, medical experts said Tuesday.

Several nationally known pathologists characterized as potentially premature a Monday statement by the Los Angeles County coroner’s office that Kramer had “suffered an occlusive coronary artery disease, or heart attack, within the minutes before his death.”

The pathologists said it is often difficult during an autopsy to pinpoint if a person had suffered a heart attack within the last day of life--much less within minutes of death.

They said that if such a definitive conclusion is reached, it usually requires tests that take several days to complete.

“It is unfortunately a hard thing for anybody who has experience in this to understand why they would make a statement like that,” said William G. Eckert, director of the Milton Helpern International Center of Forensic Sciences at Wichita (Kansas) State University.

Eckert and others said any conclusions about Kramer’s medical condition should be considered tentative until details of his autopsy are known, including what specific examinations were performed.

“I would have been much more guarded,” added a leading cardiovascular pathologist who spoke only on the condition that her name not be used.

Dr. Ronald D. Kornblum, acting coroner for Los Angeles County, declined through a spokesman Tuesday to provide details of the autopsy tests. The spokesman said the office was too busy performing autopsies and identifying victims of the crash.

But appearing before the Board of Supervisors, Kornblum suggested that there was no way of knowing for certain if Kramer had suffered a fatal heart attack before the collision.

“The heart attack might have killed him; chances are it did not,” Kornblum said. “It’s possible he was dead before impact, but there is no way to say that.”

Kornblum conceded that it was “possible” that Kramer’s heart attack might have been triggered by the frightening realization that the two planes were about to collide.

Kramer is still listed by the coroner’s office as having died as a result of multiple injuries suffered in the collision, with a recent heart attack being a “contributing cause.”

Focus of Investigation

The medical condition of Kramer has emerged as a focus of the investigation of Sunday’s crash because it may prove to be an essential clue in explaining how the accident occurred.

The National Transportation Safety Board has ordered Kramer’s heart tissue to be sent to the highly regarded Armed Forces Institute of Pathology at Walter Reed Army Medical Center in Washington for further examinations, according to John Lauber, the safety board member in charge of the crash investigation.

Kramer had a totally “clean record” when he had a medical examination in December, 1984, in Spokane, Wash., for renewal of his pilot’s license, according to Dr. William Hark, a physician with the Federal Aviation Administration.

“Kramer had a totally negative history of cardiac disease,” Hark, manager of the FAA’s aeromedical standard’s division, said in a telephone interview from Washington. Kramer was next due for a medical exam in December.

It is difficult to pinpoint when a heart attack begins. Some who suffer heart attacks have no symptoms, such as chest pain or shortness of breath, and are not even aware that they have had a heart attack, which is caused by a blockage in an artery supplying blood to the heart.

In interviews Tuesday, pathologists explained the methods they use to examine the heart after death--regardless of the suspected cause of death--and search for signs of heart disease.

Visually Inspected

First, the heart is visually inspected. Then it is cut into sections, and thin sections of the arteries and heart muscle are prepared for examination under the microscope.

Most people over 50 are found to have some evidence of atherosclerosis, deposits in the coronary arteries that can interfere with the blood supply to the heart.

If a person dies 24 or more hours after a heart attack, the pathologist can usually see visually and through a microscope characteristic changes in the appearance of the heart tissue, such as signs of inflammation and cell death.

Such signs are less likely to be present if a person dies within 24 hours after a heart attack, and particularly within six hours, according to Eckert and Dr. Colin Bloor, professor of pathology at the UC Medical Center, San Diego.

“Most pathologists are a little reluctant to be definite before six to 12 hours have passed,” Bloor said. “After 24 hours, usually it is very definite.”

Such diagnoses usually require more time for a pathologist to make because these more subtle changes can only be seen under the microscope, and the tissue requires special preparation.

The thin slices of tissue are treated with chemicals to remove extra water. Then the tissue is stained and examined. This process often takes several days.

“I was surprised that (the autopsy findings) were released so quickly,” Eckert said. “It is hard for me to believe that they had done a microscopic exam on the tissue already.”