James Herrick (1861-1954): Consultant physician and cardiologist

In 1910, James Bryan Herrick published the first clinical and laboratory description of sickle cell anemia. Two years later, he published a case report on coronary thrombosis. Together, these case reports solidified his reputation as one of the premier diagnosticians of his generation. Now regarded as a central figure in the history of American medicine, Herrick played an integral role in the clinical adoption of the electrocardiograph and the professionalization of cardiology in the United States. Although a full decade passed before the medical profession recognized his clinical description of coronary thrombosis and myocardial infarction, it has had profound implications for cardiovascular medicine and prevention over the past hundred years. As a consultant physician, Herrick advocated in favor of incorporating chemistry and laboratory evaluation into clinical practice.

[Sudden death in Versailles: A review of a cardiovascular treatrise by Dionis (1710)]

In 1710, the surgeon Pierre Dionis publishes a Dissertation on sudden death. Echoing and expanding the work of his Roman colleague Jean Marie Lancisi, he describes and analyzes dozens of cases of sudden death observed by him. A large number of cases was followed by autopsies allowing clinicopathological confrontation. Are proposed causes of death (pulmonary embolism, myocardial infarction, hemorrhagic stroke, arterial rupture, etc.), pathophysiological mechanisms based on the ancient theory of humors, and preventive actions to avoid these unexpected deaths. In this article, we oppose these old data to those of current literature.

Did Winston Churchill suffer a myocardial infarction in the White House at Christmas 1941?

While staying in the White House over Christmas 1941, Churchill developed chest pain on trying to open a window in his bedroom. Sir Charles Wilson, his personal physician, diagnosed a 'heart attack' (myocardial infarction). Wilson, for political and personal reasons, decided not to inform his patient of the diagnosis or obtain assistance from US medical colleagues. On Churchill's return to London, Wilson sought a second opinion from Dr John Parkinson who did not support the diagnosis of coronary thrombosis (myocardial infarction) and reassured Churchill accordingly.

Association between ambient temperature and acute myocardial infarction hospitalisations in Gothenburg, Sweden: 1985-2010

Cardiovascular disease (CVD) is the number one cause of death globally and evidence is steadily increasing on the role of non-traditional risk factors such as meteorology and air pollution. Nevertheless, many research gaps remain, such as the association between these non-traditional risk factors and subtypes of CVD, such as acute myocardial infarction (AMI). The objective of this study was to investigate the association between daily ambient temperature and AMI hospitalisations using a case-crossover design in Gothenburg, Sweden (1985–2010). A secondary analysis was also performed for out-of-hospital ischemic heart disease (IHD) deaths. Susceptible groups by age and sex were explored. The entire year as well as the warm (April−September) and cold periods (October–March) were considered. In total 28 215 AMI hospitalisations (of 22 475 people) and 21 082 out-of-hospital IHD deaths occurred during the 26-year study period. A linear exposure-response corresponding to a 3% and 7% decrease in AMI hospitalisations was observed for an inter-quartile range (IQR) increase in the 2-day cumulative average of temperature during the entire year (11°C) and the warm period (6°C), respectively, with and without adjustment for PM₁₀, NO₂, NO_x or O₃. No heat waves occurred during the warm period. No evidence of an association in the cold period nor any association between temperature and IHD deaths in the entire year, warm or cold periods - with and without adjusting for PM₁₀, NO₂, NO_x or O₃ was found. No susceptible groups, based on age or sex, were identified either. The inverse association between temperature and AMI hospitalisations (entire year and warm period) in Gothenburg is in accordance with the majority of the few other studies that investigated this subtype of CVD.

[To the centennial of the myocardial infarction. Priorities of domestic researchers in the study of the problem of modern cardiology]

There are domestic priorities in the 100-year history of myocardial infarction research a description of the disease clinical picture by V.P.Obrazcov and N.D.Strazhesko, development of mammary-coronary bypass by V.I.Kolesov, intracoronary thrombolysis by E.I.Chazov et al.

Coronary heart disease and heart attacks, 1912-2010

This paper was originally written for a conference entitled ‘The Future of Medical History. Now it ought to be clear – certainly to historians – that the future of anything is hard to predict; but at least in the short term, any future for medical history seems likely to include the history of disease, and the history of coronary heart disease (CHD) provides an excellent example of what the history of disease has to offer to a wide range of audiences.

Rokitansky's diseases and cause of death : A short pathological and historical discourse

Carl Rokitansky was one of the foremost experts and pioneers in pathological anatomy of the 19th century. Virchow and Rokitansky paved the way for the modern specialty of pathology, as we know it today. Whilst Virchow was the doyen of histopathology, Rokitansky's merit was his excellent gross pathology establishing thereby a nosological classification of disease. For this achievement, Virchow called Rokitansky the Lineè of pathology. In spite of his importance little is reported on Rokitansky. If the cause of death is mentioned, it is always stated incorrectly. This error may be due to a misleading certificate of death, which was issued without autopsy. This essay aims to describe Rokitansky's illnesses, particularly in his last months, and to deduce from available evidence the most probable cause of his death - with short explanations for non-medical readers. Briefly, Rokitansky suffered from arteriosclerosis leading to stenocardial attacks (angina pectoris). Rokitansky tried to relieve himself from pain by using chloroform. His personal description of the symptoms in his autobiography and the circumstances of his death clearly indicate a heart attack as the cause of death.

Systems of care for ST-segment elevation myocardial infarction: impact of different models on clinical outcomes

ST-segment elevation myocardial infarction (STEMI) is one of the greatest medical emergencies, for which organization of care has a determinant impact on patient outcomes. The purpose of this paper is to review systems of care for STEMI patients. Although primary percutaneous coronary intervention (PCI) is the preferred option for patients with STEMI, offering easy and emergent access to this procedure often remains difficult because of geographic and diverse structural difficulties. intravenous fibrinolysis, especially when administered early after symptom onset and as part of a pharmacoinvasive strategy (i.e., followed by rapid coronary angiography with PCI when necessary), offers a reasonable therapeutic option in selected cases and has yielded satisfactory clinical results. Network organization is central for optimizing patient care at the acute stage of myocardial infarction. This review describes different clinical experiences with network implementation both in Europe and in North America. In all instances, early recognition of STEMI and, particularly in the pre-hospital setting, shortening time delays is central for the achievement of optimal clinical results. Overall, the encouraging results described in the models presented here, as diverse as they might be, should be an encouragement to promote and implement regional protocols according to the specific local constraints and to monitor their effectiveness by recording simple quality indicators in ongoing registries.

The evolution of management of acute coronary syndromes (unstable angina and non-ST segment elevation myocardial infarction): Part l

As I advanced through medical school at Johns Hopkins, and throughout my subsequent training, I was constantly reminded of the contributions made to medicine by our predecessors. Many of whom were at Johns Hopkins, but many were not. As I continue active involvement in the education of medical students and physicians, it seems to me we have not done a good job of relating the history of how the modern management of patients with cardiovascular disease developed to our students, house staff, and fellows.

Myocardial infarction and angina pectoris in the history of Polish medicine. Part 1. Discovery and understanding of the disease

This review presents the most important achievements associated with the understanding of angina pectoris and myocardial infarction in Poland. The author describes the contribution of physicians living on Polish soil to scientific knowledge in this field. The beginning of Polish interest in cardiac diseases are associated with an eminent medieval physician, Thomas of Wrocław. In Part 1, a history of studies on myocardial infarction ends with establishing the first diagnosis of myocardial infarction as the cause of death in patients with angina in the mid-19th century. While discussing the contribution of Polish physicians to the worldwide knowledge about myocardial infarction, crucial facts associated with understanding of angina pectoris in other countries have been presented. The discovery of the pathomorphological features of ischemic heart disease and its relation to clinical signs or symptoms has been reminded to the readers. Eminent and well or less known Polish forefathers of medicine are recalled, including Adam Christian Thebesius, Józef Chrzczonowicz, Jan Cenner, Andrzej Janikowski, Józef Rompalski, Józef Pawiński and Edward Korczyński.

Myocardial infarction and angina pectoris in the history of Polish medicine. Part 2. Diagnosis and early attempts at treatment: the 19th and 20th centuries

In the second part of the article, developments following the "discovery" of ischemic heart disease and gaining understanding of its nature have been presented starting from the first intravital diagnoses of myocardial infarction in the history of the world medicine established by Adam Hammer in Austria (1878) and Edward Korczyński in Krakow (1887). The contribution of Polish clinicians at the turn of the XX century to the first modern attempts at elucidating the nature of myocardial infarction based on the knowledge of anatomopathology and physiology prevalent at the end of the 19th and the beginning of the 20th century has been described. A special role in understanding pathological mechanisms of myocardial infarction was played by such Polish researchers as Władysław Biegański, Józef Pawiński, Zdzisław Dmochowski, Władysław Antoni Gluziński and Marian Franke. The author has described the beginnings of introducing electrocardiography to the diagnostic evaluation of cardiovascular diseases advocated by Napoleon Cybulski and Józef Latkowski. The discovery of adrenaline by Cybulski and Szymonowicz, an event of great importance in the history of cardiology, as well as the introduction of nitroglycerine to clinical practice by Korczyński soon after the preparation was employed for the first time in the world has been presented. The paper further discusses the rapid development of medical knowledge and therapeutic progress in symptomatic treatment of myocardial infarction within the past fifty years--pharmacotherapy and also early attempts at interventions aiming at restoring blood flow in the occluded infarct-related artery. While presenting the role of Polish physicians in the history of cardiology, the author recalls the most important world discoveries associated with understanding the nature of myocardial infarction, initial diagnostic and therapeutic attempts.

Eisenhower's 1955 heart attack: medical treatment, political effects, and the "behind the scenes" leadership style

During his first term as President of the United States, Dwight D. Eisenhower suffered several serious illnesses. Particularly important was the massive heart attack he experienced in the fall of 1955. Drawing on primary sources as well as prior scholarship, this article analyzes varying interpretations of Eisenhower's 1955 medical treatment in light of his previous illnesses and their management. It explores the handling of public disclosure by the White House, by Eisenhower himself, and by his medical team. And it reconsiders Republican strategists' efforts to allay public concerns about the President's health. Current understanding is called into question in several respects. Although it sharpened speculation about his fitness and willingness to run in the 1956 presidential campaign, the 1955 heart attack made Eisenhower more likely, rather than less likely, to run. Although often sick, and in several instances critically so, Eisenhower was clearly the dominant player--intentionally "behind the scenes"--both in the management of his illnesses and in the health-perceptual aspects of his drive toward a second term. These findings should lead us to a better reading of Eisenhower as a president and to a better appreciation of health's linkage to legacy in presidential politics.

How many people have had a myocardial infarction? Prevalence estimated using historical hospital data

Background

Health administrative data are increasingly used to examine disease occurrence. However, health administrative data are typically available for a limited number of years – posing challenges for estimating disease prevalence and incidence. The objective of this study is to estimate the prevalence of people previously hospitalized with an acute myocardial infarction (AMI) using 17 years of hospital data and to create a registry of people with myocardial infarction.

Methods

Myocardial infarction prevalence in Ontario 2004 was estimated using four methods: 1) observed hospital admissions from 1988 to 2004; 2) observed (1988 to 2004) and extrapolated unobserved events (prior to 1988) using a "back tracing" method using Poisson models; 3) DisMod incidence-prevalence-mortality model; 4) self-reported heart disease from the population-based Canadian Community Health Survey (CCHS) in 2000/2001. Individual respondents of the CCHS were individually linked to hospital discharge records to examine the agreement between self-report and hospital AMI admission.

Results

170,061 Ontario residents who were alive on March 31, 2004, and over age 20 years survived an AMI hospital admission between 1988 to 2004 (cumulative incidence 1.8%). This estimate increased to 2.03% (95% CI 2.01 to 2.05) after adding extrapolated cases that likely occurred before 1988. The estimated prevalence appeared stable with 5 to 10 years of historic hospital data. All 17 years of data were needed to create a reasonably complete registry (90% of estimated prevalent cases). The estimated prevalence using both DisMod and self-reported "heart attack" was higher (2.5% and 2.7% respectively). There was poor agreement between self-reported "heart attack" and the likelihood of having an observed AMI admission (sensitivity = 63.5%, positive predictive value = 54.3%).

Conclusion

Estimating myocardial infarction prevalence using a limited number of years of hospital data is feasible, and validity increases when unobserved events are added to observed events. The "back tracing" method is simple, reliable, and produces a myocardial infarction registry with high estimated "completeness" for jurisdictions with linked hospital data.

[Machado, Moix and Montalbán: smoke gets in your lives]

The writers Antonio Machado (pulmonary chronic disease), Terenci Moix (emphysema) and Manuel Vázquez Montalbán (acute myocardial infarction) died of the complications derived from their inveterate habit-forming tobacco. They were aware of the prejudices that a such addiction was causing and tried, in some moment, to leave it. In addition, the testimonies of their contemporary or their same writings offered dramatic samples of this struggle. Nevertheless, they relapsed and tobacco caused them a premature death before 65 years. With a panoramic of 60 years among the last two authors and Machado, a brief historical perspective is offered on the acquisition of scientific knowledge that changed the attitudes towards tobacco during this period of time.

The president and the pheochromocytoma

President Eisenhower experienced an acute heart attack in September 1955 and died of ischemic cardiomyopathy 14 years later. The autopsy revealed, unexpectedly, a 1.5-cm pheochromocytoma in the left adrenal gland. In view of these hitherto unreported findings, the investigators analyzed the blood pressure pattern of the president throughout his life. Although hypertension was documented on and off from 1930 until his death, it is unknown whether the pheochromocytoma was present during his presidency. During the later part of President Eisenhower's life, excessive systolic and diastolic blood pressure spikes were documented, although he concomitantly had severe ischemic cardiomyopathy. In conclusion, most likely, the pheochromocytoma was the underlying cause of this erratic blood pressure pattern and may have worsened the course of the president's ischemic cardiomyopathy.

Acute myocardial infarction and acute coronary syndrome: then and now (1950-2005)

Advances in the prevention, diagnosis, and treatment of acute myocardial infarction (AMI) and acute coronary syndrome (ACS) have been remarkable since the mid-20th century. Even the clinical terminology used to describe some of the various components of ACS have undergone change, while the latter term itself represents a fairly recent addition to the medical lexicon. Although there have been dramatic changes in the diagnostic and therapeutic interventions used and impressive declines in morbidity and mortality, the differential diagnosis and complications of AMI and ACS remain as challenging now as they were a half century ago. This article presents in detail the medical understanding of AMI in the mid-20th century and how physicians of that era managed it and its complications, and contrasts this with current evidence-based knowledge and interventions.

A personal history of markers of myocyte injury [myocardial infarction]

BACKGROUND

The measurement of proteins in blood to reflect damage to the heart is one of the most successful examples of easily measured biomarkers identifying a serious major health problem. The concept of using a blood test to reflect organ or cell injury requires a substance that is very abundant in the target cell, has a means of reaching blood, a reasonable half-life in blood, and ideally a specific form reflective only of the target cell in tissue. The myocyte's major role is contraction so proteins involved in contraction or the energy to support it should be good candidate markers.

CONCLUSIONS

All the various biomarkers that have been used to detect cardiac damage are involved in contraction or energy metabolism, but the markers evolved empirically starting with transaminases in the 1950s leading to troponins in the 1990s. This history is reviewed with reflections on my experiences with developing assays for CK-MB and Troponin I.

The discovery of aspirin's antithrombotic effects

Aspirin has long been established as a useful analgesic and antipyretic. Even in ancient times, salicylate-containing plants such as the willow were commonly used to relieve pain and fever. In the 20th century, scientists discovered many details of aspirin's anti-inflammatory and analgesic properties, including its molecular mechanism of action. In addition, the latter half of the century brought reports that daily, low doses of aspirin could prevent myocardial infarction and stroke. This finding was first reported by Lawrence Craven, a suburban general practitioner in Glendale, California. Unfortunately, Craven's work went largely unnoticed, and decades passed before his observations were verified by clinical trial. We present Craven's story, which demonstrates the value of a single physician's commitment to lifelong learning. In addition, we summarize the work of the physicians and scientists who discovered the molecular mechanisms by which aspirin exerts its antiplatelet effects. Collectively, these discoveries exemplify the complementary roles of basic science and clinical observation in advancing medicine.

The exciting story of cardiac biomarkers: from retrospective detection to gold diagnostic standard for acute myocardial infarction and more

This paper reviews the history of the contribution of the laboratory medicine to clinical cardiology and discusses the most important steps in this field. Until 20 years ago, the clinical laboratory only placed at the cardiologist's disposal a few assays for the retrospective detection of cardiac tissue necrosis, such as enzymatic methods for creatine kinase and lactate dehydrogenase activities. However, in the latter part of the 20th century, highly sensitive and specific assays, such as cardiac troponins, as well as assays for markers of myocardial function, such as cardiac natriuretic peptides, rapidly changed the scenario of clinical management of patients with cardiac diseases, assigning to the laboratory a pivotal role in the overall diagnostic flow. This is witnessed by the recent incorporation of these markers into international guidelines and in the redefinition of myocardial infarction. For the foreseeable future, new serum markers of myocardial ischemic, i.e. reversible, injury or related to coronary plaque instability and disruption are expected.

The elusive clot: the controversy over coronary thrombosis in myocardial infarction

After Heberden's description of patients with "angina pectoris" in 1768, for over 125 years most physicians believed that the disease was immediately fatal. The growing realization early in the twentieth century that in fact patients could survive an acute myocardial infarction led to a search for mechanisms and treatment. Coronary thrombosis was the primary candidate for the inciting event, but this supposition was based on rather piecemeal and uncritical reports. It became apparent that coronary thrombosis and acute myocardial infarction (AMI), terms that had often been used interchangeably, actually represented separate pathological entities. A few physicians even proposed that AMI caused coronary thrombosis rather than the other way around. The reasons for some investigators rejecting the coronary thrombosis hypothesis were ultimately shown to be the result of faulty pathological techniques and interpretations. This debate ended only when in vivo studies (i.e., coronary arteriography in living patients during AMI episodes) finally settled the matter. These events indicate that older theories, even when derived from faulty reasoning or poorly substantiated documentation, might ultimately prove valid. Newer investigative techniques can suddenly clarify issues that have previously seemed irresolvable. The identification of coronary thrombosis in AMI has led to major advances in the treatment of this serious and ubiquitous disease.

KEYWORDS

coronary artery disease, coronary thrombosis, angina pectoris, acute myocardial infarction, coronary arteriography, anticoagulation.

Apheresis in donor and therapeutic settings: Recruitments vs. possibilities—a multicenter study

In our country, the first apheresis was performed in the late 1960s (by manual technique), and the first cell separator was used in 1979. The number of blood component collections performed from 1994 to 2004 was: 11,170 (total), i.e., 8540 (NBTI), 1180 (IT-MMA), 1050 (BTI of Novi Sad) and 400 (BTI Nis). The number of PBSC harvests during 1996-2004 was 386 for treatment of 272 patients. For treatment of myocardial infarction, "cell-therapy" by autologous stem cells was introduced in 2004 at the MMA. The results of PE treatments performed (7632 sessions) by our group for various immune-mediated and other disorders were generally beneficial, but the effect is not associated with bone marrow remission. TC procedures (total number=1279) resulted in a significant fall in the blood cell counts and hemorheological improvement, as well as the removal and replacement of abnormal red blood cells. Greater standardization of different apheresis protocols is required.