Heart disease can be traced back to ancient Egypt long before modern medicine could help the civilization.
Even with today’s advances in heart care, heart disease remains the leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), about 659,000 people in the U.S. die from heart disease each year – that’s 1 in every 4 deaths.
When was heart disease discovered?
The American College of Cardiology reports that the earliest documented case of coronary atherosclerosis – a build-up of plaque in the arteries that can cause a heart attack – was in an Egyptian princess who lived between 1580 and 1550 B.C. The study found that heart disease was more common in ancient times than previously thought.
Between then and now, humans have been working to improve how we care for heart disease – and for a long time, there was not a lot we could do.
History Tells the Story
History tells the story of advances in heart care – which was still somewhat limited as the 20th century began. But big changes were looming.
President Dwight D. Eisenhower’s heart attack in 1955, which shocked and worried a nation who knew there was little that could be done for heart attack victims, was somewhat of a turning point in care.
“Up until this time, people were told to stay on bedrest for four to six weeks, which turned out to be wrong,” says Dr. David Bull, VP and Medical Director of the Baystate Health Heart and Vascular Service. "A prominent physician, Dr. Paul Dudley White, was called in to consult President Eisenhower’s condition and care and he immediately began to get him out of bed and walking, which soon became standard practice.”
“Game Changers” in Heart Attack Care
Not long after in the early 1960s, the first coronary care unit – specially designed, staffed and equipped areas in the hospital – opened at Bethany Hospital in Kansas. The new critical care unit, which helped greatly to reduce mortality from heart attacks – people were at high risk of dying within the first 24 hours – further offered the use of the world’s first life-saving portable defibrillator used to shock the heart back to normal rhythm for those having sudden cardiac arrest.
The Baystate heart expert says the biggest advances, which he called “game changers,” came in the 1960s and 1970s with the ability to perform coronary revascularization, either bypass surgery or angioplasty.
More than 80% of western Massachusetts residents requiring heart surgery have it at Baystate Medical Center, which is also the only area hospital to provide angioplasty – as well as valve surgery. With the introduction of angioplasty and stenting, which restores blood flow to the heart by using a thin, flexible catheter with a balloon at its tip to open the clogged artery, the volume of bypass procedures has decreased. Bypass surgery, introduced at Baystate in 1978, now comprises approximately 50% of the total number of open-heart procedures, with the remaining volume including valve, aneurysm and congenital procedures.
Life-Saving Advances in Heart Disease Treatment
“Back in the 1960s, when a patient arrived at the emergency department door with crushing chest pain there wasn’t much doctors could do other than admit the patient and treat the pain. Today we know that every minute counts when a person with heart attack symptoms arrives at our Baystate Emergency Department. It can mean the difference between life and death, as well as saving precious heart muscle. At Baystate we are very successful at treating patients within 90 minutes of their arrival to successfully reopen the blocked vessel causing the heart attack,” says Dr. Bull.
Other advances over time have offered new hope to those with atrial fibrillation. Cardiac ablation, also referred to as catheter ablation, is performed by an electrophysiologist who has specialized training in the diagnosis and treatment of heart arrhythmias. It is a non-surgical procedure that involves inserting one or more long, thin, flexible tubes into the blood vessels of the groin and guiding them to the heart. A burst of radiofrequency energy is transmitted through the catheter to destroy the areas of tissue giving rise to the abnormal electrical signals causing the arrhythmia.
Alternatives to Open Heart Surgery
The opening of the Davis Family Heart & Vascular Center in 2012 at Baystate Health made it possible for cardiologists to start performing TAVR (Transcatheter Aortic Valve Replacement). During TAVR, a failing aortic valve is replaced through a small incision in the patient’s leg and a catheter is placed into the heart itself (like angioplasty) – avoiding the need for open heart surgery to replace the valve.
Since the opening of the Davis Family Heart & Vascular Center, Baystate has introduced many advanced therapies such as LVAD and WATCHMAN.
An LVAD is a mechanical pump that is surgically implanted inside the chest to help the heart do its job. The device is placed in the heart’s left ventricular and pumps blood from the weakened left side of the heart to the rest of the body. When the pump is implanted, it’s connected to a controller outside of the body. An LVAD always needs to be connected to a power source, whether that means being plugged into an outlet or using its battery pack.
LVADs may be used as “destination therapy,” meaning they are considered long-term treatment for heart failure. Or they may be considered “bridge-to-transplant therapy,” meaning they are placed temporarily until heart transplant becomes an option.
WATCHMAN is a one-time procedure that lowers your lifetime risk for stroke if you have AFib (not caused by a heart valve problem) and you have also experienced serious bleeding while on blood thinners. It is a minimally invasive surgery where a left atrial appendage (LAA) closure device is implanted into the heart. The device closes off your LAA to keep blood clots from escaping—which reduces your risk for stroke permanently.
Understanding the Root Causes of Heart Disease
As for prevention, it wasn’t until the advent of the Framingham Heart Study in 1948 that doctors began to understand the root causes of heart disease.
Initial results from the study published in the late 1950s established a number of risk factors – high blood pressure, high cholesterol and smoking – which doctors could now help patients address with lifestyle changes and the use of statins, first introduced in 1978, which drastically reduced cholesterol levels.
The Future of Heart Care
Looking toward the future, Dr. Bull notes that heart and vascular procedures will become less invasive, diagnoses will become even more precise, and better medications will be invented and approved for use. “Advances in endovascular procedures allow us to treat aneurysms without open surgery, resulting in quicker recovery time and less time in the hospital for patients,” he says.
“We have made great advances over the years in the treatment of cardiovascular disease and in understanding what contributes to the disease, such as diet, smoking, high blood pressure and inactivity. Yet heart disease is still the number one killer today of men and women,” says Dr. Bull.
“If we can reverse the epidemic of diabetes and obesity, become more active and leave behind our sedentary lifestyles, then we should be doing really well,” he adds. “We’ve learned more about the interplay between genetics and environmental factors in the development of heart disease. Understanding a patient’s genetics allow us to treat them medically to hopefully prevent heart disease before it starts.”