Greetings, science enthusiasts! Today, we have an extraordinary adventure: a journey through time to explore the history of heart failure, from ancient observations to cutting-edge treatments.
Our journey began thousands of years ago when an ancient Egyptian dignitary was interred in a tomb in the Valley of the Queens. Pathological analysis of this individual, performed by Italian Egyptologist Ernesto Schiaparelli, unearthed evidence of pulmonary edema, indicating a probable case of heart failure. Even back then, humanity was inadvertently recording the signs of heart disease.
Fast-forwarding to ancient Greece, we find the renowned physician Hippocrates putting his ear to patients’ chests and hearing what he described as the sound of “boiling vinegar.” These were some of the earliest descriptions of symptoms related to congestive heart failure. Hippocrates even attempted early treatment by draining the fluid through a hole in the ribcage—a daring endeavour for the times!
Meanwhile, physicians of early Egypt and Galen of Greece dissected the heart’s contraction. They had misunderstandings, like believing the arteries were filled with air and the veins with blood, but they recognized the heart’s essential role in the body.
In the 17th century, William Harvey made significant strides by accurately defining the heart’s role in blood circulation and associating a dilated ventricle with heart failure. But it wasn’t until the early 20th century that EH Starling, in his “Law of the Heart,” elucidated the relationship between the heart’s dilation and performance.
Starling’s law teaches us that increased end-diastolic volume enhances cardiac performance—to a point. But like an overstretched rubber band, too much stretching will weaken the heart. This doesn’t explain all heart failure types, such as those without ventricular dilation, typical ejection fraction heart failure, or diastolic dysfunction.
The period between 1940-1960 saw the advent of cardiac catheterization and surgery, which enhanced our understanding of cardiac function in rheumatic and congenital conditions. But we still had a long way to go, as these advances did not fully address heart failure resulting from coronary artery disease, hypertensive heart disease, and dilated cardiomyopathies.
In the 1980s, treatment for heart failure was mainly bed rest, digitalis, and diuretics—strategies that alleviated acute symptoms but didn’t change the disease’s course. Around this time, the idea of strengthening the heart muscle to improve heart failure became popular. However, all trials with such agents ended prematurely as they unexpectedly worsened patients’ conditions.
The late 1980s brought about a paradigm shift as scientists began viewing heart failure as a syndrome affecting multiple organ systems. As an adaptive mechanism, the overactive neuroendocrine system in heart failure patients can lead to many symptoms, including fatigue, shortness of breath, oedema, and anasarca.
Drugs that lowered aldosterone levels, like spironolactone and ACE inhibitors, favoured heart failure by blocking the renin-angiotensin system. Paradoxically, beta-blockers—once considered malpractice for heart failure—were found to increase cardiac output in certain patients.
Despite pharmacological improvements, the death rate in heart failure patients didn’t change significantly until the recognition that cardiac arrhythmias were causing many sudden deaths in these patients. This led to implantable defibrillators, later upgraded to include devices for resynchronizing ventricular contractions.
As our population ages, heart failure will increase, straining our medical system. While we’ve made great strides in treating reduced ejection fraction heart failure, there’s still a lot of work ahead of us to treat average ejection fraction and acute heart failure.
From ancient Egyptian tombs to modern research labs, our understanding of heart failure has come a long way. But our journey isn’t over. As we unravel the mysteries of the heart, who knows what breakthroughs are just around the corner? Keep your eyes on the horizon, science fans, and stay curious!
