CHD - Coronary Heart Disease

.History of Cardiovascular Care > .

GTN - Glyceryl Trinitrate ⇼ 

Coronary Heart Disease and Heart Attacks, 1912–2010: Med Hist. 2011 Jul; 55(3): 307–312.: Joel D. Howell.

The most dramatic and fatal manifestation of the disease now called ‘CHD’ is what we now call a myocardial infarction, or ‘heart attack’.

Various technologies have continued to play a role in the twentieth-century history of CHD, albeit in more complicated ways than have often been appreciated. Consider the use of technology for diagnosis of asymptomatic disease. Early disease diagnosis has been a major goal ever since the realisation that while some people may survive a myocardial infarction, too many did – and still do – die at the initial manifestations of the disease. CHD’s natural history led physicians to search for ways of diagnosing the disease before it manifests as a possibly fatal heart attack. Starting in the 1920s–1930s, three different tools shared the stage.

One started in 1929 as the ‘Master’s two-step’, during which medical personnel monitored a person’s heart while she or he exercised. This test eventually became the twenty-first century multi-stage exercise test. But historically to focus exclusively on this test, as though it somehow led inevitably to current procedures for CHD diagnosis, would be to ignore two other tests that were also widely advocated for exactly the same sort of diagnosis. One was the anoxaemia test, in which patients breathed in oxygen-depleted air in order to deprive the heart of adequate oxygen and thus to produce cardiac ischaemia. Another was the ballistocardiogram, a test that recorded the body’s motions produced by the heartbeat. All three were thought to diagnose CHD in the 1940s and 1950s. To focus on only one implies a unanimity of thought that simply did not exist.

Treatment 1910-1960s:

1910-1930s:
* Absolute bedrest for 2-3 weeks
* At least 6 weeks of hospital stay followed by a prolonged recovery at home
* Resumption of normal activity was rarely encouraged
* Chest pain was sometimes alleviated with Morphine
* Digitalis (now commonly known as digoxin) was used for treatment of heart failure following a heart attack

1930-1950s
* Heart attack (acute myocardial infarction) was recognized as a medical emergency
* Intramuscular adrenaline was used if slowing or stopping of the heart rhythm was encountered
* Quinidine was used for suspected fatal irregular heart rhythm

1950-1960s:
* Heart attack (acute myocardial infarction) was recognized as the most common cause of death in Europe and North America
* Oxygen was recommended only if patients with heart attack developed excessive amount of fluid in the lung due to heart failure
* Nitroglycerin placed under the tongue was used to relax the heart arteries
*Physical and emotional rest was always recommended as the mainstay of treatment
* There was an increased awareness that prolonged bedrest could result in blood clots in legs and lungs. Therefore, absolute bedrest was shortened to 5 days and total duration of hospitalization was limited to about 1 month
* Blood thinners like heparin and warfarin at times were used in some centers to prevent a second heart attack and/or a blood clot in the lung
* Death and disability from heart attacks remained extremely high and most of the treatment was geared towards relieving pain and suffering only

• Myocardial revascularization had its beginnings in the early 1900s with extracardiac operations, such as sympathetic denervation and thyroid ablation.
• Evolved through neovascularization via pericardial poudrage and cardiopexy in the 1930s to 1950s,
• mammary artery myocardial implantation in the 1940s
• endarterectomy in the 1950s,
• saphenous vein– and mammary artery–coronary artery bypass grafting in the 1960s.