Hurst’s the Heart, 14th Edition: Two Volume Set
The heart … is the beginning of life; the sun of the microcosm … for it is the heart by whose virtue and pulse the blood is moved, perfected, made apt to nourish, and is preserved from corruption and coagulation; it is the household divinity which, discharging its function, nourishes, cherishes, quickens the whole body, and is indeed the foundation of life, the source of all action. —William Harvey, 16281
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.2-5 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.6-9 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 into multiple, highly specialized disciplines focusing on coronary artery disease, heart failure, arrhythmias, imaging, and preventive care. Early diagnosis of cardiac risk and aggressive medical treatment of cardiac diseases coupled with increasing attention to prevention have led to a gradual decrease in mortality for cardiac disease.13 A hallmark of cardiovascular medicine in the early 21st century has been its emergence at the forefront of the evidence-based medicine movement with an intense commitment to quality care14-16 through continuous investigation and incorporation of new knowledge into clinical practice guidelines by the major professional societies and public health organizations.17,18 Moving toward 2020, we see the adoption of digital and mobile technologies in medical care for prevention, diagnosis, and treatment. At the forefront of these movements is a focus on cardiac health and fitness and the potential for more tools for patients to directly monitor and manage their cardiac disorders, including heart failure, arrhythmias, and hypertension.19 There is also the issue of how to use “big data” in both research and the clinical management of cardiovascular disease. This will include routinely incorporating genomics and other “omics” in the assessment of cardiovascular risk and disease.
Many of the initial key discoveries are now recalled as eponyms attached to diseases or physical signs. As the number of investigators has grown exponentially and internationally, it is increasingly difficult to assign singular credit to contributions for which many are ultimately responsible. Taking all of these considerations into account, *Deceased we have chosen to provide a condensed narrative by subject, selectively highlighting important events and key figures in the grand story of cardiovascular medicine written by our illustrious predecessors.1-5,20-26
|February 5, 2018
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