CHAPTER 1: A HISTORY OF THE CARDIAC DISEASES, AND THE DEVELOPMENT OF CARDIOVASCULAR MEDICINE AS A SPECIALTY

INTRODUCTION

The history and our still emerging understanding of the heart are a remarkable story, with origins in antiquity, centered initially on clinical observations. Thought at one time to be the center of the soul and impervious to disease, the heart was long a source of mystery and wonder, studied in science and fascinated about in literature and the arts. Most historians agree that William Harvey’s discovery of the circulation of blood in the early 17th century is a good place to start the modern history of cardiovascular medicine. Following Harvey, cardiology pursued a pathway of descriptive anatomy and pathology in the 17th and 18th centuries, auscultation and its correlations in the 19th century, an understanding of cardiac disease and its pathophysiology in the second half of the 19th and first half of the 20th centuries, and major advances in the diagnosis and treatment of heart disease from there into the 21st century.^2,3,4,5 What has emerged in the 21st century is a medical specialty with incredible tools of diagnosis, including blood biomarkers and multiple imaging modalities; numerous medical treatment options that include drugs, biologics, and devices; and surgical options involving complex operations that both repair and replace dysfunctional anatomy.

What has also emerged in the 21st century is a far less positive story: the growing global epidemic of atherosclerotic heart disease and its ischemic complications; an epidemic created by the exportation of tobacco products around the world; a change in dietary patterns with decreasing amounts of fresh fruits and vegetables; and an increase in more sedentary lifestyles, in some ways facilitated by technology.^6,7,8,9 The United Nations and the World Health Organization have identified the noncommunicable diseases as major global public health problems that threaten or limit the overall financial and social stability of the global community in both developed and developing nations.¹⁰ The increasing burden of obesity has led to major increases in diabetes, which is expected to increase the incidence of cardiac diseases.¹¹ The aging of the population has also been associated with a marked increase in the incidence of atrial fibrillation and the attendant risk of embolic stroke.¹²

The introduction of the first instruments of precision—blood pressure measurement, the chest x-ray, and the electrocardiogram—in the 1890s and early 20th century, led to the creation of the specialty of cardiology. Since the 1950s, following the advent of cardiac catheterization and surgery, cardiology has evolved ...