Prescription to reduce heart palpitations, a mid-18th century prescription in the New Kingdom of Granada

The human being, throughout history, has used plants to prevent and cure diseases. It is important to know that for a long time, the mechanism through which those plants worked was unknown, making herbal medicine a purely empirical science. Medical prescriptions in the 19^th century in the Kingdom of Nueva Granada were considered a significant medical advance as a result of knowledge and medical practices in the old continent. Medical literature of the time achieved, despite the lack of studies, the development of new schemes with exact dosages and new therapeutic possibilities. The medical prescription presented in this article was used in the management of heart palpitations, a frequent symptom nowadays, described as thoracic and/or neck beating, underlying various cardiac and non-cardiac diseases. The recipe for the palpitations of the historical archive "Cipriano Rodríguez Santa María" is a mixture of herbal agents that, as reviewed in the medical literature, showed to have anti-inflammatory, anxiolytic, and antioxidant effects, among others, allowing a beneficial effect on cardiac palpitations. Due to the lack of information on the posology, safety in its use, contraindications, and possible adverse effects, its potential use should have been underestimated at that time for the control of palpitations or as phytochemical agents directed to treat diseases causing this symptom.

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The authors explore two heart rhythm troubles described on the occasion of the medical exami- nation of the Italian astronomer Galileo Galilei and the French politician Talleyrand. According to modern scientific knowledge, the pathological context of respectively the 17th and 19th c., and the personal medical history of the patients, some retrospective original and objective diagnoses are proposed.

Michel Mirowski and the beginning of a new era of fighting sudden arrhythmic death

Prior to the implantable cardioverter-defibrillator (ICD), life-threatening ventricular arrhythmias were treated using anti-arrhythmic drugs. The concept of an implantable defibrillator to prevent sudden arrhythmic death was first published by Michel Mirowski in 1970. Despite critical opinions by leading physicians, Michel Mirowski continued development of his vision. Hallmarks in the development of the ICD include the following: internal-external defibrillator used during surgery on humans in 1971/1972; fully implantable defibrillator tested in canines in 1975; defibrillator successfully implanted in a 57-year-old woman in 1980; second generation devices introduced in 1982; US Food and Drug Administration device approved in 1985. Today it is hard to imagine modern medicine without ICD therapy. This article provides the reader a history of the development of the ICD.

The heartfelt music of Ludwig van Beethoven

Musicologists, historians, and physicians have speculated that Beethoven experienced cardiac arrhythmias, and that they manifest in specific compositions. Based on what is known about Beethoven's medical issues, this seems a reasonable assumption to make. This essay strengthens the hypothesis that Beethoven suffered from cardiac arrhythmias by placing Beethoven's music in its historical context, and by identifying several compositions that may reflect Beethoven's experience of an arrhythmia.

[Electrical stimulation of the heart: history, current trends and prospects]

Part 1 of this review is devoted to the history of development of temporary and continuous electric stimulation (ES) of the heart. Up-to-date concepts of bradyarrhythmia are considered along with the most important techniques for its management with the use of two-chamber and frequency-adaptive systems. Algorithms for the choice of optimal ES regimes taking account of the type of bradyarrhythmia are discussed. Current concepts of physiological ES of the heart are considered. The authors describe their own experience with the application of ES of the heart.

Nineteenth century "Traube's pulse" and current "Cardiac alternans": significant features in the history of cardiology

Pulsus alternans is nowadays considered, in the third millennium, a clinical finding indicative of decreased myocardial contractility and an effective expression of ventricular dysfunction. In recent years, clinical scientific studies have evidenced the relevant connections between cardiac alternans and the risk of heart arrhythmias. Pulsus alternans was described in detail for the first time in its meaning as clinical sign of cardiac disease by Ludwig Traube in 1872. Traube had great competence in physical semeiotics and, besides being considered one of the founders of experimental pathology, this German internist accurately presented a situation characterised by a succession of higher and lower pulses. It is not by chance that one of the current synonyms of pulsus alternans is precisely Traube's pulse. The present clinical-historical approach has been selected not only for diachronic purposes, but also to illustrate, on epistemological grounds, the notable articulation and considerable complexity of an only apparently straightforward concept such as that of pulsus alternans. Its comprehension has undergone progress and its definition evolution, and the expression has included through time different physiologic, pathophysiologic and pathologic phenomena. Although now a century and a half old, the concept of pulsus alternans remains extremely modern and fascinating.

The development and application of the implantable cardioverter defibrillator

Several years ago, implantable defibrillators were recommended only for survivors of cardiac arrest. With improvement of surgical techniques and advancement in technology, defibrillator implantation is now considered an outpatient procedure. Clinical trials have now demonstrated improvement in survival in high risk patients who receive defibrillators which has greatly increased the number of defibrillators implanted. This manuscript reviews important features of the development of implantable defibrillators and reviews current indications for use.

Arrhythmogenic right ventricular cardiomyopathy: a survey of the investigations at the University of Padua

The purpose of this paper is to review the history of the clinico-pathologic investigations performed at the University of Padua on an old morbid entity ("parchment heart"), which, in the 1960s, led to the clinical description of the disease, in the 1980s to the revival of the scientific interest, and in the mid 1990s to the understanding of the genetic background. All the steps of the progressive knowledge are reviewed: necropsy of young people who died suddenly, in vivo diagnosis by ECG, echocardiography, angiocardiography, endomyocardial biopsy, nuclear magnetic resonance, and diagnostic criteria. Familial occurrence with autosomic dominant transmission and various penetrance was documented. Gene defects were recently mapped both to chromosome 14q23-q24 and 1q42-q43, thus providing evidence for genetic heterogeneity. The pathologic substrates of arrhythmogenic right ventricular cardiomyopathy pointed to an acquired progressive myocardial atrophy with fibro-fatty replacement of dying myocytes. Nowadays the disease is definitively regarded as a primary myocardial disorder and it has been included in the revised WHO classification of cardiomyopathies.

Historical perspectives of cardiac electrophysiology

The diagnosis and treatment of clinical electrophysiology has a long and fascinating history. From earliest times, no clinical symptom impressed the patient (and the physician) more than an irregular heart beat. Although ancient Chinese pulse theory laid the foundation for the study of arrhythmias and clinical electrophysiology in the 5th century BC, the most significant breakthrough in the identification and treatment of cardiac arrhythmias first occurred in this century. In the last decades, our knowledge of electrophysiology and pharmacology has increased exponentially. The enormous clinical significance of cardiac rhythm disturbances has favored these advances. On the one hand, patients live longer and thus are more likely to experience arrhythmias. On the other hand, circulatory problems of the cardiac vessels have increased enormously, and this has been identified as the primary cause of cardiac rhythm disorders. Coronary heart disease has become not just the most significant disease of all, based on the statistics for cause of death. Arrhythmias are the main complication of ischemic heart disease, and they have been directly linked to the frequently arrhythmogenic sudden death syndrome, which is now presumed to be an avoidable "electrical accident" of the heart. A retrospective look--often charming in its own right--may not only make it easier to sort through the copious details of this field and so become oriented in this universe of important and less important facts: it may also provide the observer with a chronological vantage point from which to view the subject. The study of clinical electrophysiology is no dry compendium of facts and figures, but rather a dynamic field of study evolving out of the competition between various ideas, intentions and theories.

Past and future aspects of clinical electrophysiology

The diagnosis and treatment of clinical electrophysiology has a long and fascinating history. From the earliest time, no clinical symptom impressed the patient (and the physician) more than an irregular heart beat. Although ancient Chinese pulse theory laid the foundation for the study of arrhythmias and clinical electrophysiology in the 5th century BC, the most significant breakthrough in the identification and treatment of cardiac arrhythmias first occurred in this century. In the last decades, our knowledge of electrophysiology and pharmacology has increased exponentially. The enormous clinical significance of cardiac rhythm disturbances has favoured these advances. On the one hand, patients live longer and thus are more likely to experience arrhythmias. On the other hand, circulatory problems of the cardiac vessels have increased enormously, and this has been identified as the primary cause of cardiac rhythm disorders. Coronary heart disease has become not just the most significant disease of all, based on the statistics for cause of death. Arrhythmias are the main complication of ischemic heart disease, and they have been directly linked to the frequent arrhythmogenic sudden death syndrome, which is now presumed to be an avoidable "electrical accident" of the heart. A retrospective look--often charming in its own right--may not only make it easier to sort through the copious details of this field and so become oriented in this universe of important and less important facts; it may also assist the observer in a chronological vantage point of the subject. The study of clinical electrophysiology is no dry compendium of facts and figures, but rather a dynamic field of study evolving out of the competition between various ideas, intentions and theories.

Quibus cor palpitet: Hyena cor

The search for a genuine thought in ancient times makes medical archeology part of our contemporary knowledge, not to say a patrimony to be harbored. A Roman encyclopedia is a compilation of the prevailing knowledge of scientific and medical matters at the time. In this paper an original Roman prescription for a specific cardiac complaint is analyzed for its activity and efficaciousness. Further investigation of the effect of Selenium administration is warranted.

History of arrhythmias

A historical overview is given on the techniques to record the electrical activity of the heart, some anatomical aspects relevant for the understanding of arrhythmias, general mechanisms of arrhythmias, mechanisms of some specific arrhythmias and nonpharmacological forms of therapy. The unravelling of arrhythmia mechanisms depends, of course, on the ability to record the electrical activity of the heart. It is therefore no surprise that following the construction of the string galvanometer by Einthoven in 1901, which allowed high-fidelity recording of the body surface electrocardiogram, the study of arrhythmias developed in an explosive way. Still, papers from McWilliam (1887), Garrey (1914) and Mines (1913, 1914) in which neither mechanical nor electrical activity was recorded provided crucial insights into re-entry as a mechanism for atrial and ventricular fibrillation, atrioventricular nodal re-entry and atrioventricular re-entrant tachycardia in hearts with an accessory atrioventricular connection. The components of the electrocardiogram, and of extracellular electrograms directly recorded from the heart, could only be well understood by comparing such registrations with recordings of transmembrane potentials. The first intracellular potentials were recorded with microelectrodes in 1949 by Coraboeuf and Weidmann. It is remarkable that the interpretation of extracellular electrograms was still controversial in the 1950s, and it was not until 1962 that Dower showed that the transmembrane action potential upstroke coincided with the steep negative deflection in the electrogram. For many decades, mapping of the spread of activation during an arrhythmia was performed with a "roving" electrode that was subsequently placed on different sites on the cardiac surface with a simultaneous recording of another signal as time reference. This method could only provide reliable information if the arrhythmia was strictly regular. When multiplexing systems became available in the late 1970s, and optical mapping in the 1980s, simultaneous registrations could be made from many sites. The analysis of atrial and ventricular fibrillation then became much more precise. The old question whether an arrhythmia is due to a focal or a re-entrant mechanism could be answered, and for atrial fibrillation, for instance, the answer is that both mechanisms may be operative. The road from understanding the mechanism of an arrhythmia to its successful therapy has been long: the studies of Mines in 1913 and 1914, microelectrode studies in animal preparations in the 1960s and 1970s, experimental and clinical demonstrations of initiation and termination of tachycardias by premature stimuli in the 1960s and 1970s, successful surgery in the 1980s, the development of external and implantable defibrillators in the 1960s and 1980s, and finally catheter ablation at the end of the previous century, with success rates that approach 99% for supraventricular tachycardias.

The history of the coronary care unit

The first coronary care units were established in the early 1960s in an attempt to reduce mortality from acute myocardial infarction. Pioneering cardiologists recognized the threat of death due to malignant arrhythmias in the postinfarction setting, and developed techniques for successful external defibrillation. The ability to abort sudden death led to continuous monitoring of the cardiac rhythm and an organized system of cardiopulmonary resuscitation, incorporating external defibrillation with cardiac drugs and specialized equipment. Arrhythmia monitoring and cardiopulmonary resuscitation could be performed by trained nursing staff, which eliminated delays in treatment and significantly reduced mortality. These early triumphs in aborting sudden death led to the development of techniques to treat cardiogenic shock, limit infarct size and initiate prehospital coronary care, all of which laid the foundation for the current era of interventional cardiology.

A decade of discoveries in cardiac biology

The heart is the first organ to form in the embryo, and all subsequent events in the life of the organism depend on its function. Inherited mutations in cardiac regulatory genes give rise to congenital heart disease, the most common form of human birth defects, and abnormalities of the adult heart represent the most prevalent cause of morbidity and mortality in the industrialized world. The past decade has marked a transition from physiological and functional studies of the heart toward a deeper understanding of cardiac function (and dysfunction) at genetic and molecular levels. These discoveries have provided new therapeutic approaches for prevention and palliation of cardiac disease and have raised new questions, challenges and opportunities for the future.

Cardiac Surgery for Arrhythmias

Cardiac arrhythmia surgery was initiated in 1968 with the first successful division of an accessory AV connection for the Wolff-Parkinson-White Syndrome. Subsequent surgical procedures included the left atrial isolation procedure and the right atrial isolation procedure for automatic atrial tachycardias, discrete cryosurgery of the AV node for AV nodal reentry tachycardia, the atrial transection procedure, corridor procedure and Maze procedure for atrial fibrillation, the right ventricular disconnection procedure for arrhythmogenic right ventricular tachycardia, the encircling endocardial ventriculotomy, subendocardial resection procedure, endocardial cryoablation, the Jatene procedure, and the Dor procedure for ischemic ventricular tachycardia. Because of monumental strides in the treatment of most refractory arrhythmias by endocardial catheter techniques during the past decade, the only remaining viable surgical procedures for cardiac arrhythmias are the Maze procedure for atrial fibrillation and the Dor procedure for ischemic ventricular tachycardia. Nevertheless, the 25-30 years of intense activity in the field of cardiac arrhythmia surgery provided the essential foundation for the development of these catheter techniques and represent one of the most exciting and productive eras in the history of medicine. In one short professional career, we have witnessed the birth of arrhythmia surgery, its adolescence as an "esoteric" specialty, its prime as an enlightening yet exhausting period, and finally its waning years as a source of knowledge and wisdom on which better methods of treatment have been founded. One could hardly ask for a more rewarding experience.