Heart Disease. Heart disease entails any abnormality—anatomic or functional—that reduces the heart's life‐sustaining action in providing essential nutrients to cells and removing the waste products of metabolism via the circulating blood. Although the importance of this circulation was recognized by European physicians as early as the seventeenth century, doctors in America and elsewhere as late as 1900 were unable to do much more for patients than listen to heartbeats with stethoscopes and prescribe rest and a few ordinary medications, such as digitalis for congestive heart failure. The electrocardiograph, developed in Holland in 1902 to record the heart's electrical activity, was first installed in the United States at New York's Mount Sinai Hospital in 1909. One year later, Arthur Hirschfelder of Johns Hopkins University published
Diseases of the Heart and Aorta, the first American monograph on heart disease. In 1912, James B. Herrick of Chicago first described what he termed coronary artery thrombosis (occlusion by clot), which later came to be known as myocardial infarction.
An emerging cadre of heart specialists created a national organization, the American Heart Association (AHA), in 1924, and started a professional periodical, the
American Heart Journal, in 1925. Robert E. Gross of Boston in 1938 ligated a patent ductus arteriosus (a condition that arises when the channel between the pulmonary artery and the aorta fails to close at birth), thereby performing the first successful
surgery for congenital heart disease. Two years later, board examinations were initiated to certify cardiologists. Alfred
Blalock and Helen Taussig at Johns Hopkins in 1944 performed the first “blue baby” operation, using diagnostic cardiac catheterization to correct a septal defect with severe pulmonary stenosis (a narrowing of the valve that regulates blood flow into the lungs). Their success aroused excitement throughout the medical profession. Federal legislation in 1948 funded the National Heart Institute (renamed in 1972 the National Heart, Lung, and Blood Institute—NHLBI). In 1948, too, the AHA transformed itself from a professional society to a citizens‐based advocacy group dedicated to fund‐raising, publicity, and support of better health care and expanded research, becoming the major popular voice of the “heart lobby.” The American College of Cardiology, a select professional society, was formed in 1949.
The year 1948 also witnessed the launching of the Framingham (Massachusetts) Heart Study, which continued into the twenty‐first century. This study, which periodically monitors over 5,200 men and women for coronary risk factors, established, among other findings, the role of high blood cholesterol in causing artery obstructions. John E. Gibbons of Philadelphia in 1953 developed an extracorporeal pump oxygenator (heart‐lung bypass machine) to maintain continual blood flow during invasive surgery, thereby inaugurating the era of open‐heart surgery. Successful recoveries from myocardial infarctions, such as those experienced in 1955 by President Dwight D.
Eisenhower and the future President Lyndon B.
Johnson, generated popular acclaim for advances in cardiovascular knowledge and techniques. Prosthetic heart valves were developed in 1960 by Dwight Harken of Boston and Albert Starr of Portland, Oregon.
The era of modern cardiovascular surgery, often called the “golden age” of cardiology, began in the mid‐twentieth century. Open‐heart surgery became routine in the 1950s; the first coronary bypass operation occurred in 1968; angioplasty (balloon dilation to open or repair obstructed vessels) was implemented in 1980; artificial pacemakers to compensate for diseased myocardial pathways were first implanted in 1959. Improved diagnostic techniques, such as echocardiology, permitted precise delineation of the location, nature, and degree of disease in the heart and arterial system. Pharmacological therapies included cyclosporine, an immunosuppressant introduced in 1981, to prevent rejection of donor organs, thereby allowing a resurgence of heart transplantation. Many
hospitals set up special coronary‐care units. Most important, widened public awareness of lifestyle values such as low‐fat diets, regular physical exercise, not smoking, and avoidance of obesity and high blood pressure created a “prevention culture” for Americans eager to minimize their susceptibility to heart disease.
By the end of the twentieth century, about seventeen thousand physicians practiced cardiology—more than any other non–primary care, nonsurgical specialty, and the death rate from heart attacks had fallen 58 percent from 1963 levels, while the rate for all cardiovascular diseases during the same interval had dropped 55 percent. Still, heart disease caused more deaths than all other illnesses combined. Annual costs to the nation in lost productivity and health expenses exceeded sixty billion dollars.
Hospitals attributed 20 percent of their total charges to care of cardiovascular patients. Fifty thousand Americans waited for heart transplants, but the number of available hearts, at most, allowed only 5 percent to receive them. Better control of health risk factors remained the key strategy for reducing heart disease as the new century began.
See also
Health and Fitness;
Medical Education;
Medicine: From the 1870s to 1945;
Medicine: Since 1945;
Pharmaceutical Industry;
Tobacco Products.
Bibliography
Paul Dudley White , My Life and Medicine: An Autobiographical Memoir, 1971.
Louis J. Acierno , The History of Cardiology, 1994.
W. Bruce Fye , American Cardiology: The History of a Specialty and Its College, 1996.
Stephen Westaby with and Cecil Bosher , Landmarks in Cardiac Surgery, 1997.
Richard J. Bing , Cardiology: The Evolution of the Science and the Art, 1999.
Charles T. Morrissey
