Polite Dissent

Batman: Gotham Knights #73 “Payback”
A.J. Lieberman, writer
Diego Olmas, penciler

The Set-Up: Three people in Gotham City suffer sudden cardiac death: a traffic copter pilot, a business woman, and a train engineer. Autopsies showed that not only did all three of these people die of a heart attack, but that they all had a particular model of pacemaker made by WayneTech. Batman deduces that somehow someone is overriding the pacemaker’s frequency leading to a rapid heart rate which causes a heart attack. He accuses Hush, but he knows nothing about the pacemakers.
It turns out that the Joker has taken up bird training and has been using a clicker to train his birds. Coincidentally, he has discovered that this clicker causes WayneTech pacemakers to speed up so much that they cause heart attacks. He decides to use this information to get back at Hush and Batman.

Topic One: A big typo. This is one of those typos that strikes me as funny because it actually changes the meaning of the sentence significantly.

Medical examiner: “…Each one of these people died of amyocardial infarction.”

It should be a myocardial infarction, not amyocardial infarction. Myocardial infarction is the medical term for a heart attack. There is a blockage in one of the arteries that supplies the heart with blood and consequently part of the heart dies from lack of oxygen. If a big enough portion of the heart dies, the patient will too.

Amyocardial is not a word. But bear in mind that the prefix “a-” when added to medical terms means “without” or “absence of” — for example asplenia refers to someone who is lacking a spleen. Therefore amyocardial infarction would be an infarction not involving the heart.

Topic Two: The autopsies. Sloppy, sloppy work. Autopsies use a Y incision, not the chainsaw-style down the middle incision shown here. The medical examiner is also mixing specimens up. The three pacemakers should be kept separate and labeled, not all kept in one bin.

Topic Three: The pacemakers. Well drawn. Good job.

Topic Four: Could the Joker’s plan really work? Could you increase a pacemaker’s rate enought that it would be fast enough to kill someone? Theoretically yes, but death would probably be from a fatal rhythm, not a heart attack.

There is a rare phenomenon known as runaway pacemaker. In these instances, the pacemaker’s rate increases to an incredibly rapid level. In the early days of pacemakers (the 1970s), this led to a few deaths from a lethal arrhythmia known as ventricular fibrillation. In today’s modern pacemakers, runaway pacing can happen, but only very rarely, and there have been no deaths associated with it for many years. There are two main reasons for this: 1) pacemakers have a programmed upper limit to their rate, and 2) the faster the pacemaker fires, the lower the voltage, so at high rates it doesn’t give off enough electricity to start a contraction. The most common symptoms of runaway pacing are dizziness, light-headedness, and the sensation of an irregular heart beat.

Theoretically, I could imagine that a rapid heart rate from a malfunctioning pacemaker might cause a heart attack in a susceptible individual, but there have never been any recorded cases of this happening. If a malfunctioning pacemaker were to cause a rapid heart rate leading to death (a very big if), it would be more likely from a fatal heart rhythm than from a heart attack.