Transcript The history of cardiac diagnosis

The Heart in Medicine
Dr Caroline Coats
Archivist, The British Cardiovascular Society
[email protected]
Cardiology: when did it start?
• 1628 William Harvey De motu cordis
• 1749 Jean Baptiste de Senac Traite de la
structure du coeur
• 1806 Jean Nicolas (Baron) Corvisart Essai sur
les maladies du coeur
• 1831 James Hope Diseases of the Heart
• 1902 James Mackenzie Study of the pulse
• The term Cardiology first used 1860
Cardiology Journals
• National
– 1908: Archives des Maladies du Coeur (France)
– 1908: Zentralblatt fur Herzkrankheiten, (Germany)
– 1909: Heart (UK)
– British Heart Journal 1939
– Heart 1994
– 1916: Malatti du cuore (Italy)
– 1925: American Heart Journal (USA)
• Continental and Global
– 1980: European Heart Journal
– 1981: International Journal of Cardiology
• Currently >100 print journals
Cardiac Societies
• 1922: The Cardiac Club (British Cardiac Society 1946).
• 1924: The American Heart Association
• 1927: Deutsche Gesellschaft fur Kreislaufforschung.
– Belgian (1934), Italian (1935), French (1937) and Swiss (1948)
Cardiac Societies were subsequently formed.
• 1949: American College of Cardiology
• Support for cardiac research came from cardiac
societies and governments
Milestones
Diagnostics
Therapeutics
Physiology
Anatomy
Surgery
The Pulse
• 5th C BC Chinese physician Pein Ts Lo; pulse
theory. Separate pulses connected to various
organs eg liver and spleen
• 3rd C BC
Herophilus of Alexandria said that
the pulse was created by “pneuma expressed
from the heart”
• Claudius Galen AD 131-201 wrote 18 books on
the pulse
Counting the pulse
• !n 1583 Galileo Galilei
invented the first
device to measure the
pulse rate, The
Pulsilogium
William Harvey 1628
“I am obliged to conclude that in animals the blood is driven
round a circuit with an unceasing, circular sort of
movement, that this is an activity or function of the heart
which it carries out by virtue of its pulsation, and that in
sum it constitutes the sole reason for the heart’s pulsatile
movement”
et Sanguinis in Animalibus
Pathology of the Heart
• Gioavanni Battista
Morgagni 1682-1771
• De sedibus et Causus
Morborum per
Anatomen
• 3 volumes 1761
• Described valve lesions
and calcified coronary
artery.
• Completed at age 79.
Invention of the stethoscope
• De l’auscultation
mediate ou traite du
diagnostic des
maladies des
poumons et du coeur
• 1819
René-Théophile-Hyacinthe Laënnec 1781-1836
Physiology….. methods of recording
• Thomas Young invented the first rotating
drum for recording in 1805
• J L M Poiseuille invented the mercury
manometer in 1828.
Dudgeons Sphygmograph
1876
Blood pressure measurement
• The Reverend
Stephen Hales 16771761
• The first to measure
BP – in animals
Diastolic blood pressure
James Mackenzie
Mackenzie’s clinical polygraph
The first human electrocardiogram
1887 Augustus Waller
The modern electrocardiogram
• Willem Einthoven
1860-1927 Professor
of physiology Leiden.
Invented the string
galvanometer in
1901.
Thomas Lewis 1881-1945
• Welshman born in
Cardiff. Student at
UCL and Physician at
UCH. Founded the
Medical Research
Society.
Been and gone
• Phonocardiography 1905 – 1965
– recording heart sounds and murmurs
• Ballistocardiography 1920- 1960,
recording cardiac pulsation
• Vectorcardiography 1925-1950
– recording the ECG in 2 and 3 planes
X-Rays
• 1895 Wilhelm Roentgen
– Discovery of X-Rays
• 1896 EH Williams
– Fluoroscopy
– 1st case was a man with an enlarged heart
– Difficult to image because it was moving
Cardiac catheterisation
• First done,in humans, on
himself, by Werner
Forssmann in 1928. Not
for diagnosis, but for drug
delivery.
• Andre Cournand and
Dickinson Richards New
York 1941
• John McMichael and
Peter Sharpey-Schafer
1943.
Angiocardiography
• Egas Moniz Lisbon
1931 pulmonary
arteriogram
• Agustin Castellanos,
Cuba, 1937, in
congenital heart
disease.
Coronary arteriography
• First performed by Mason Sones at the
Cleveland Clinic in 1962.
– He did this by accident
– It had been thought to be very dangerous
Interventional cardiology
1929
Forsmann
1977
Gruentzig
2002
Cribier
Catheterisation
Angioplasty
1st TAVI
1962
Sones
1986
Puel and Sigwart
2003
Industry
Coronary
angiography
1st coronary stent
Drug eluting stents
?dissolvable
Ultrasound - to echocardiography
• Based on the piezoelectric principle
discovered in 1880 by Pierre Curie.
• Ultrasound can be transmitted through
many substances with echoes being
reflected back at interfaces having
different acoustic impedance.
Cardiac surgery
• 1820 Dominique (Baron) Larrey Pericardial effusion
• 1893 TH Billroth “Any surgeon who would attempt an
operation on the heart should lose the respect of his
colleagues”
• 1896 Guido Farino stab wound of right ventricle
• 1925 Henry Souttar mitral valvotomy
• 1938 Ductus
• 1944 Coarctation
• 1945 Blalock-Taussig shunt
• 1947 Pulmonary valvotomy
• 1948 Mitral valvotomy
• Open heart surgery was needed especially for congenital lesions
Open heart surgery
• Hypothermia.
– Cooling body to 30C allowed about 7 minutes circulatory arrest.
– Devised in Toronto by W Bigelow in 1950
– Thomas Holmes Sellors closed 450 ASDs mortality 1.5%
Open heart surgery
• Cardio-pulmonary by pass (heart lung machine)
– Started in USA 1953 by John Gibbon
– then the Mayo Clinic with John Kirklin
– Denis Melrose, London (also potassium arrest)
• Cardiac transplantation 1967
– C Barnard. World wide moratorium
– Cyclosporine 1980 for rejection
• Off-pump bypass 1990
Heart Failure
Heart Failure
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Definition
c. AD 500 Egypt Sea Squill
1785 William Withering Foxglove (Digitalis purpurea)
1895 James Mackenzie atrial fibrillation
1920 Mercury (Mersalyl) chance discovery
1928 Lewis Special bed (dyspnoea and oedema)
Fluid drainage; legs, chest.
1958 First modern diuretic chlorothiazide chance
discovery via sulphonamide treatment
• 1960 onwards; several new drugs
Cardiac arrhythmias
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Digitalis
1914 Quinidine (discovered by a patient)
1961 Amiodarone (via a plant compound)
1950-1960 Pacemakers
1958 Transvenous pacing
1958 Implantable pacemaker
1950 onwards Electrical cardioversion
1980 Ablation of arrhythmias
Pacemakers
• 1932 Albert Hyman, engineer
• 1958 1st pacemaker implanted
• 1970 1st defibrillator implanted
Coronary artery disease
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1772 William Heberden “Angina pectoris”
1867 Amyl nitrite Lauder Brunton then GTN
1912 Myocardial infarction identified J Herrick
1950 First use of electrical defibrillation
1960 CPR, W B Kouwenhoven
• However cardiac massage was first used for
cardiac arrest-during surgical operations - in
1901 by K Igelsrud in Tromso and 1902 Lane in
London [via intact diaphragm]
Modern era of coronary disease
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1960 Cardio-Pulmonary resuscitation
1961 Coronary care unit Desmond Julian
1962 Beta blocking drugs James Black
1970 Thrombolysis Aspirin
Various procedures on coronary arteries
– [a] coronary by pass surgery
– [b] angioplasty & stents
– [c] primary angioplasty for acute MI
• 1985 Statins for lipid control