Milestones in knowledge of heart and vascular disorders

Palaeolithic era Spain Oldest anatomical drawing in El Pindal cave of a mammoth with a dark smudge at the shoulder, which is -thought to represent the heart.

2698-2598 BCE China Huang Ti, the Yellow Emperor, was thousands of years ahead of his time in writing in Nei Ching (Canon of Medicine): "The blood current flows continuously in a circle without a beginning or end and never stops" and "all the blood is under control of the heart". He also recorded the association between salt intake and a "hardened pulse".

1550 BCE Egypt Papyrus Ebers stated that after death the heart becomes the witness of the body's behaviour during life. To avoid -incriminating testimony, the Egyptians buried the heart separately from the body.

600 BCE Greece Alcmaeon noted empty arteries in animals after death and inferred that arteries normally contained air.

400 BCE Greece

Hippocrates, the Father of Medicine (460-370 BCE), challenged the belief that illness was caused by the gods; he believed illness was caused by an imbalance of the four bodily humours: yellow bile, black bile, blood, and phlegm. He was also the first to recognize stroke.

310-250 BCE Egypt Erasistratus described the heart, veins, arteries and valves, but claimed that

arteries contained "pneuma" (air or spirit or soul), which was replaced each time a person breathed; when an artery was cut, blood rushed in as the pneuma escaped.

131-201 CE

Graeco-Roman physician Claudius Galen, with knowledge gained from animals killed by Roman gladiators, described the heart and the movement of blood in the arteries, but claimed that the liver was the centre of the circulation and that the blood passed from the right to the left side of the heart.

980-1037 Persia Avicenna (Ibn Sina) stated that the heart is located centrally to all organs of the body, and that the left side of the heart was created as a store of spirit and soul.

1210-1288 Syria Ibn al-Nafis described the pulmonary and coronary circulation in

The Perfect Man.

1452-1519 Italy Leonardo da Vinci incorrectly drew the liver as the centre of circulation. But he stated "vessels in the elderly through the thickening of the tunics, restrict the transit of the blood." This is one of the earliest descriptions of arteriosclerosis.

1509-1553 Spain Michael Servetus described the pulmonary circulation in his book

Christianismi Restitutio.

1510-1559 Padua, Italy Matteo Realdo Colombo described the heart valves.

1525-1603 Rome, Italy Andrea Cesalpino noted that the circulation system is a closed system, and was the first in modern times to coin the term "blood circulation".

1553-1619 Padua, Italy Hieronymus Fabricius demonstrated valves in veins, which help to "prevent dilatation of veins".

1555 Padua, Italy Andreas Vesalius (1514-1564) stated that the heart, and not the liver, was the centre of the circulation.

1559 Italy Riva di Trento discovered that there are two coronary arteries, each supplying blood to half of the heart.

1628 England William Harvey (1578-1657), a physician, published his thesis that the heart pumped blood around the body, in De Motu Cordis.

mid-1600s Switzerland Jacob Wepfer found that patients who died with "apoplexy" had bleeding in the brain. He also discovered that a blockage in one of the brain's blood vessels could cause apoplexy.

1706 France Anatomy professor Raymond de Vieussens first described the structure of the heart's chambers and vessels.

1712-1780 England John Fothergill both forecast the role of psychosocial factors and advised that a restricted diet "might greatly retard the progress" of coronary _heart disease.

1677—1761 England Stephen Hales, -an English clergyman and scientist, first measured blood pressure by inserting a brass tube into the artery of a horse. This was a scientific experiment, published in 1733, demonstrating that the heart exerts pressure in order to pump blood. The horse died.

1745-1827 Italy Alessandro Volta discovered that electric energy was produced by heart muscle contractions.

1749-1832 England Edward Jenner, better know for smallpox vaccine, made the essential link between angina pectoris and disease of the coronary arteries.

1752-1832 Italy Antonio Scarpa described arterial aneurysm.

1772 England William Heberden (1710-1801) described angina pectoris: "they who are afflicted with it, are seized while they are walking (especially if it be uphill, and soon after eating) with a painful and most disagreeable sensation in the breast, which seems as if it would extinguish life if it were to increase or to continue; but the moment they stand still, all this uneasiness vanishes". He was also the first to write about hyperlipidaemia as a risk factor when he noticed that the serum of an obese patient who suddenly died was "thick like cream".

1775 Scotland John Hunter (1728-1793), a surgical pathologist, wrote "in a sudden and violent transport of anger, he fell down and expired immediately", illustrating the importance of

emotion, stress and anger in precipitating coronary death.

_Hunter himself suffered from angina pectoris and died suddenly after a violent argument with a hospital colleague.

1785 England William Withering described the use of digitalis in coronary heart disease in his monograph An Account of the Foxglove. Foxglove had been used for centuries by American Indians.

1791 Italy Luigi Galvani discovered that electrical stimulation of a frog's heart led to contraction of the cardiac muscle.

1799 England Caleb Hillier found something hard and gritty in the coronary arteries during an autopsy and "well remembered looking up to the ceiling, which was old and crumbling, conceiving that some plaster had fallen down". He discovered, however, that the vessels had hardened, and stated that "a principle cause of the syncope anginosa is to be looked for in disordered coronary arteries".

1815 England London surgeon Joseph Hodgson claimed inflammation was the underlying -cause of atherosclerosis and it was not a natural degenerative part of the ageing process.

1815 France M.E. Chevreul named the fatty substance extracted from gallstones "cholesterol" from the Greek "khole" (bile) and "stereos" (solid).

1819 France Rene Theophile Laennec (1781-1826), invented the stethoscope. He rolled paper into a cylinder while examining a young woman with cardiac symptoms as he was reluctant to apply his ear to the chest.

1838 France Louis René Lecanu showed that cholesterol was present in human blood.

1841 Austria Carl Von Rokitansky championed the thrombogenic theory, proposing that deposits observed in the inner layer of the arterial wall derived primarily from fibrin and other blood elements rather than being the result of a purulent process. This theory came under attack from Rudolf Virchow.

1843 J. Vogel showed that cholesterol was present in atherosclerotic plaques.

1844 Denmark First pathology report of plaque rupture in a coronary artery in Bertel Thorvaldsen, the celebrated neoclassical Danish artist and sculptor, who died of sudden cardiac death in the Royal Theatre in Copenhagen.

1850 Ventricular fibrillation first described.

1850s Ophthalmoscope invented, allowing direct visualization of arteries at the back of the eye.

1852 England Fatty material in the coronary arteries described by Sir Richard Quain, which he attributed to nutrition. He linked the fatty heart to "languid and feeble circulation, a sense of uneasiness and oppression in the chest, embarrassment and distress in breathing, coma, syncope, angina pectoris, sudden death..."

56-1967

1856 Germany Rudolf Virchow, a Pole, believed that disease occurred at cellular level, and also described cerebral emboli causing stroke. Virchow also emphasized the societal causes of disease as "disturbances of human culture".

1867 England Lauder Brunton, pharmacologist, discovered that amyl nitrite relieved angina.

1872 France Gabriel Lippmann invented the capillary .electrometer, the precursor of the electrocardiograph.

1893 Holland Willem Einthoven (1860-1927) introduced the term electrocardiogram or ECG/EKG; distinguished five deflections -PQRST (1895); constructed the first electrocardiograph in 1901, which weighed 270 kg, occupied -two rooms and required five people to operate it; transmitted the first ECG from hospital to his laboratory 1.5 km away via telephone cable (in 1905); published the first normal and abnormal ECGs (1906) and won the Nobel Prize (1924).

1895 Germany Physicist Wilhem Konrad Roentgen (1845-1923) discovered X-rays, which are still used to visualize the heart.

1896 Italy Scipione Riva-Rocci invented the sphygmomanometer to measure blood pressure.

1897 The introduction of modern aspirin. In one of life's little ironies, Bayer's first aspirin advertisements said that the drug did "not affect the heart".

1906 Germany M. Cremer, first oesophageal ECG by a professional sword swallower. First fetal ECG from the abdominal surface of a pregnant woman.

1907 England First case report of atrial fibrillation by Arthur Cushny, professor of pharmacology at University College, London.

1912 James B. Herrick described heart disease resulting from hardening of the arteries.

1912 First human cardiac catheterization (no X-ray visualization) by Frizt Bleichroeder, E. Unger and W. Loeb.

1915 USA Establishment of organization in New York City, which became the American Heart Association.

1920 USA First ECG of acute myocardial infarction by Harold Pardee.

1923 USA First operative widening of scarred cardiac valve by E. Cutler and S.A. Levine.

1925 United Kingdom Widening of narrowed mitral valve by Souter, who stretched the valve ring with his fingers.

1928 United Kingdom Sir Alexander Fleming discovered penicillin, which is used to treat rheumatic fever.

1928 "Apoplexy" divided into categories based on the cause of the blood vessel problem, and replaced by the term "cerebral vascular

1929 Germany First documented right heart catheterization in human by Werner Forssmann using radiographic techniques.

1931 USA First description of the use of exercise to provoke attacks -of angina pectoris by Charles -Wolferth and Francis Wood.

1931 USA First artificial cardiac pacemaker, which stimulated the heart by transthoracic needle, developed by Dr Albert Hyman.

1937 USA First prototype heart-lung machine built by physician John Heysham Gibbon, and tested on animals. He performed the first human open heart operation in 1953 using the machine.

1938 USA First human heart surgery, first surgical correction of a congenital heart defect: closure of patent ductus arteriosus performed by surgeon

Robert E. Gross.

1944 China First repair of patent ductus arteriosus in China.

1944 USA First operation on "blue baby" (Fallot's tetralogy) at Johns Hopkins.

1944 USA/Sweden First repair of -coarctation of aorta by Crafoord and Grosse.

1947 USA First defibrillation of human heart during cardiac surgery, by Claude Beck in Cleveland.

1948 USA "Blind finger" closed heart surgery for mitral stenosis reintroduced by Dr Dwight Harken and Dr Charles Bailey.

1948 USA California physician Lawrence Craven noticed that 400 of his male patients who took aspirin for two years had no heart attacks. By 1956, he had chronicled the health of 8000 patients taking aspirin and found no heart attacks in the group.

1948 USA Start of the Framingham Heart Study where, for the first time, a large cohort of healthy men and women were studied prospectively.

1949 USA Portable Holter Monitor invented by Norman Jeff Holter to record ambulatory ECG.

1950 The International Society of Cardiology established, later joined with International Cardiology Federation and renamed World Heart Federation.

1950 Canada First pacemaker invented by John Hopps.

1952 USA First prosthetic valve implanted in aorta by surgeon Charles Hufnagel.

1952 USA First successful human open heart surgery under hypothermia by Walton Lillehei and John Lewis, who implanted the first synthetic valve in a five-year-old girl who had been born with an atrioseptal defect (hole in her heart).

1952 USA External cardiac pacemaker designed by Paul Zoll.

1953 USA First demonstrated coronary artery disease among young US soldiers killed in action in Korea (later observed in the casualties of the Viet Nam War too) by William F. Enos, Robert H. Holmes and James Beyer.

1954 United Kingdom First carotid endarterectomy by Eastcott, Pickering and Rob.

1954 India Called on WHO to address the coming epidemic of cardiovascular disease in developing countries.

1955 United Kingdom First reported mitral valve replacement by Judson Chesterman.

1950s Minimization of bias for the reliable assessment of cardiovascular treatments by introduction of randomization into clinical trials (at instigation of Sir Austin Bradford Hill).

1956 USA First report of the successful ending of ventricular fibrillation in humans by externally applied countershock published by Dr Paul Zoll.

1957 First battery-powered external pacemaker.

1958 USA Seymour Furman inserted a pacemaker in a patient who lived for 96 days.

1958 Sweden Internal long-term cardiac pacing by Ake Senning.

1958 Start of development of a selective coronary angiography procedure by Mason Sones.

1959 WHO established Cardiovascular Diseases programme.

1960s High blood pressure identified as a treatable risk factor for stroke.

1960 USA First Coronary Care Unit in Bethany, Kansas.

1960 Framingham, USA Cigarette smoking found to increase the risk of heart disease.

1960 USA First replacement of heart valve with Starr-Edwards mechanical valve, developed by Albert Starr (left) and Lowell Edwards.

1961 USA Framingham Heart Study investigators coined the term "risk factors" for the development of coronary heart disease. High cholesterol level, blood pressure, and electrocardiogram abnormalities found to increase the risk of coronary heart disease.

1961 USA First use of external cardiac massage to restart a heart by J.R. Jude.

1961 USA First direct current defibrillation with external paddles by Bernard Lown and Barough Berkowitz.

1960s First human implant of totally implantable pacemaker.

1964 USA First transluminal angioplasty performed on a narrowed artery in the leg by Charles T. Dotter.

1965 USA Michael DeBakey and Adrian Kantrowitz implanted mechanical devices to help a diseased heart.

1967 South Africa First whole heart transplant from one person to another by Dr Christiaan Barnard.

1967 USA Saphenous vein coronary bypass graft by Dr Rene Favaloro.

1967 Framingham, USA Physical inactivity and obesity found to increase the risk of heart disease.

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