Setting the Stage
Medical practice has come a great distance over time, especially within the past century. Cardiology is one of the most important medical practices known to man, as the health of the heart is of obvious importance to life itself. One might track down the history of cardiology all the way back to William Harvey, where he defined the heart’s function and demonstrated the circulation of the blood.
Harvey stated in his 1628 publication, De Motu Cordis, that, “It has been shown by reason and experiment that by the beat of the ventricles blood flows through the lungs and it is pumped to the whole body. There it passes through pores in the flesh into the veins through which it returns from the periphery finally coming to the vena cava and right auricle. It must then be concluded that the blood of the animal body moves around in a circle continuously, and that the action or function of the heart is to accomplish this by pumping. This is the only reason for the motion and beat of the heart”.
Another notable, game-changing physician was Thomas Young. An English physician, Young was best remembered for his translation of Egyptian hieroglyphics and also for his research into the physics of light. Young set the stage for the study of pulse by building a kymograph in the early 1800’s, which consisted of a smoked drum where a stylus would inscribe impulse waves. This concept remained dormant for around 50 years. That is until Karl Ludwig adapted this kymograph in order to record oscillations of the pulses.
While Ludwig was a great physiological practitioner, he was also a well-developed teacher of his craft. Practically every important or notable physiologist of the succeeding decades were trained in Ludwig’s laboratory. Though Ludwig is credited with starting a wave of research and interest of the pulse, there was previously a whole system of diagnostic medicine in China which dates back thousands of years.
There were several other great minds that helps set the stage for the field of cardiology such as Sir John Floyer, Dominic John Corrigan, and Andreas Vesalius, there is no doubt that William Harvey set the stage for the history of cardiology. With all of the innovation and research being conducted after Harvey’s book, it wasn’t until the early 1900’s that the most modern and effective landmark invention for cardiology was contributed by William Einthoven. The electrocardiograph (ECG/EKG) delivered what is objectively considered one of the most widely used and treasured tools in diagnostic clinical medicine.
It was said back in 1911 by the great forerunner of electrocardiography, Augustus Waller, that he did “not imagine that electrocardiography is likely to find any very extensive use in the hospital”. Although there was much research centered on the electrical activity of the heart, it was believed to be a rare luxury to be able to afford the occasional luxury of a record of cardiac action.
Einthoven’s curiosity for the electrography dated back to 1887, where he witnessed Waller exhibit the use of the capillary electrometer to record an “electrograph” of the heart. He then began research and exploration of the use of the capillary electrometer in recording miniscule electrical currents. By 1895, Einthoven recognized and categorized waves, and the confines of capillary electrometers led Einthoven to develop a string galvanometer to record cardiac electrical activity. “Einthoven’s triangle” was a mathematical relation between the three leads, which was a notion that amplified the electrocardiographic investigations to be made among hospitalized patients.
Einthoven, now labeled the “father of electrocardiography”, was recognized and honored with the Nobel Prize in Medicine in 1924 for his important contributions to the study of electrocardiography. His developmental research helped to lay the groundwork for other worthy innovations and progressions in the cardiology field later in the 20th century.
It has been recorded that there are roughly 500,000 lives saved per year by open-heart surgery in the United States alone. This procedure is perhaps the most detrimental cardiology advancement that mankind has seen thus far. Such a brilliant landmark and achievement was only made possible through years of research by scientists such as Wilfred Bigelow, John Lewis, and John Gibbon.
In 1949, Bigelow performed open-heart procedures on animals using the hypothermia method. Catching wind of this, Lewis and other physicians researched the usefulness of hypothermia in human beings. Lewis successfully conducted the first closure of an atrial septal defect in a 5-year old girl using the op-heart hypothermic method in 1953. Research continued to spread on the applicability of hypothermia in clinical settings.
Gibbons made use of the heart-lung machine, which was used to offer more security to vital organs during a procedure, during a milestone procedure in 1953. He was able to repair an atrial septal defect using this machine, which eventually empowered other surgeons to take a crack at cardiac valve repair and replacement. The next major milestone came in 1956 when Walton Lillehei revised pure mitral regurgitation with suture plication of the commissures under direct vision. This procedure sparked surgeons around the globe to become involved with direct vision repair, further allowing prosthetic valves to be familiarized for cardiac valve replacement.
Open-heart surgery was improved upon in the years to come. In 1964, Vasilii Kolessov accomplished the first internal mammary artery: coronary artery anastomosis. Rene Favalaro used a saphenous vein autograft to exchange a stenotic fragment of the right coronary artery. Dudley Johnson improved upon the bypass technique to comprise the left coronary arterial systems. In 1968, Charles Bailey, Teruo Hirose, and George Green used the internal mammary artery instead of the saphenous vein for bypass grafting, which has turn out to be one of the most prevalent procedures to date.
The Framingham Study helped to set the stage as a model for other medical study through the 20th and 21st century. With a solid escalation in deaths accredited to heart disease, the causes of many of these deaths was still yet to be proven. Prior to the Framingham Study, there were only small case-controlled studies being performed. Between 1948 and 1951, there were 1,980 men and 2,421 women who were enrolled in an observational study in Framingham, Massachusetts.
The reports from the long-term study established that high blood pressure, smoking, and high cholesterol levels were chief influences of heart disease. This may seem like a no brainer to us now, but at the time this was revolutionary information. The Framingham Study has delivered evidence fundamental to the credit and management of atherosclerosis.
It can also be noted that the Framingham Study was the earliest major cardiovascular study which incorporated female contributors. This study was an essential breakthrough in the history of cardiology, and has also helped set the stage for other longitudinal cohort studies.
Dating all the way back to 1844, Claude Bernard was using catheters in his recordings of intracardiac pressures in animals. Doing so, he devised the term “cardiac catheterization”. Fast forward to 1929, Werner Forssmann executed the first recorded human cardiac catheterization on himself in Eberswald, Germany.
The goal of performing self-catheterization was to find a harmless and operative way to insert drugs for cardiac resuscitation. Forssman anesthetized his left elbow, injected a catheter into his antecubital vein, and established the location of the catheter tip in the right atrium through use of radiography. He went on to range his tests to comprise the intracardiac injections of contrast material through a catheter located in the right atrium.
1941, Andre Cournand and Dickinson Richards used the cardiac catheter as a diagnostic apparatus for the first time. They used catheterization procedures to measure right-heart pressures and cardiac output. Their milestone achievements awared them a shared Nobel Prize in Medicine along with Forssmann in 1956.
Forsmann’s influences paved the way for the expansion of coronary angiography. Mason Sones implemented selective coronary arteriography in a sequence of more than 1,000 patients in 1958, which sparked a phase of quick growth of coronary arteriography. Another notable pioneer in coronary angiography was Melvin Judkins, a radiologist who studied alongside Sones. Judkins generated his own arrangement of coronary imaging in 1967, which presented a sequence of particular catheters and perfected the transfemoral approach.
With the history and evolution of ultrasonography dating all the way back to 1880 with Pierre and Jacques Curie discovering piezoelectricity, it was not until 1954 when Inge Elder and Hellmuth Hertz first reported the uninterrupted recording of activities of the heart walls. In 1956, Elder and Hertz were able to describe the use of ultrasonic cardiogram for mitral valve diseases.
Elder was able to classify numerous structures on the echocardiogram, and then presented a film to the European Congress of Cardiology in 1960. Doppler echocardiography was developed in 1960, which made the ink-jet printer extremely useful. For their contributions to the cardiology field, Elder and Hertz were presented the Lasker Prize in 1977, which is comparable to the American Nobel Prize in Medicine.
The American successes in initial clinical echocardiography are attributed to Harvey Feigenbaum, who steered research in the fresh field of cardiac ultrasonography. Feigenbaum commenced the first academic course devoted exclusively to cardiac ultrasonography in 1968, and in 1972 he composed the earliest book on echocardiography. As his book gained acceptance and applicability, newer techniques in echocardiography were established. Such techniques includes transesophageal, 2-dimensional, and Doppler echocardiography.
There have been several other extraordinary achievements made to promote the advancements of cardiology, such as thrombolytic therapy, coronary care units, automated implantable cardiac defibrillators, etc. It is from our appreciation and respect for the great minds behind these progressions that we highlight their successes. The future of cardiology is bright, and this is because of the groundwork laid down from its forefathers.
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