Treating heart attacks: Changes from Eisenhower’s era to the present day

During a round of golf one autumn afternoon in 1955, President Dwight Eisenhower experienced what he assumed was indigestion. After he awoke at 2 a.m. the following morning with severe chest pain, his personal physician administered several shots of morphine. It wasn’t until 1 p.m. that afternoon that an electrocardiogram revealed that the president had experienced a heart attack.

Cardiologist Dr. Thomas Lee, professor of medicine at Harvard Medical School, detailed Eisenhower’s experience in the Oct. 29, 2020, issue of The New England Journal of Medicine. His piece focuses mainly on how Eisenhower’s cardiologist, Paul Dudley White, communicated the event to the public. As Dr. Lee wrote, “Heart attacks became less mysterious and frightening to millions of Americans that day.”

Eisenhower’s treatment also reveals the stark contrast with how doctors approach heart disease today, some 65 years later. “It’s amazing how much cardiovascular medicine has progressed during the lifetimes of people who are still walking around today,” says Dr. Lee, former editor in chief of the Harvard Heart Letter. Highlights of these advances include better procedures, medications, and targeted advice about lifestyle habits.

A shocking reality

The hospital experience also has changed quite a bit. In the 1950s, heart patients were placed in beds throughout the hospital, away from nurses’ stations where it was quieter and therefore easier to get some rest. “There weren’t any bedside monitors because there was no point — there wasn’t anything doctors could do,” says Dr. Lee. It wasn’t unusual for patients to be discovered dead in their beds, presumably after developing an irregular heart rhythm. Damage from a heart attack sometimes causes the heart’s lower chambers (ventricles) to quiver rapidly and irregularly. Known as ventricular fibrillation, this aberration can lead to sudden cardiac arrest (when the heart abruptly stops beating).

Devices that deliver an electric shock to restore the heart’s normal rhythm, called defibrillators, didn’t come along until the late 1950s. The portable versions, automated external defibrillators (AEDs), arrived on the scene in the late 1970s; they’re now found in shopping malls, offices, airports, and other public places. The first implantable cardioverter-defibrillator (ICD), a miniature version that’s placed under the skin below the collarbone, followed soon after in 1980.

Survival advances in the ’60s

If someone has a cardiac arrest, a bystander can push hard and fast on the person’s chest to keep blood flowing to the brain until a defibrillator can be used. This technique — -cardiopulmonary resuscitation, or CPR — was developed in 1960.

The 1960s also ushered in the concept of the hospital coronary care unit. Heart patients were grouped together, where they could receive continuous heart rhythm monitoring, CPR, and defibrillation. Together, these advances halved the number of deaths in hospitalized heart attack patients.

Restoring blood flow

Meanwhile, surgeons were advancing procedures to fixing narrowed or blocked coronary arteries, the root cause of most heart attacks. The first coronary artery bypass surgery was performed in 1960. A less invasive alternative, angioplasty, was first done on a coronary artery in 1977. The tiny mesh tubes (stents) that prop open arteries during angioplasty were introduced nearly a decade later.

Soon after his heart attack, Eisenhower received the clot-preventing medications warfarin and heparin. Although still used today in certain settings, these drugs have largely been replaced by newer, safer anti-clotting drugs developed in recent decades.

But for slashing heart-related deaths, Dr. Lee gives the most credit to two other classes of drugs. One is beta blockers (first developed in 1962), which slow the heartbeat and lower blood pressure. The other is the group of cholesterol-lowering drugs known as statins, first described in 1976.

Healthier lifestyles

Like 57% of American men in 1955, Eisenhower smoked cigarettes. At the time of his heart attack at age 62, he was smoking four packs a day. It wasn’t until 1960 that the landmark Framingham Heart Study (see “The Framingham Heart Study”) reported that cigarette smoking increased the risk of heart disease. Today, just under 14% of Americans smoke, and experts recently confirmed that even a single daily cigarette raises your risk.

The experience of another president, Bill Clinton, offers some useful lessons. Clinton had high cholesterol but stopped taking his statin, Dr. Lee notes. That likely contributed to the progression of his heart disease, which eventually required a quadruple bypass in 2004 when he was 58. Soon after, he went on a mainly plant-based diet. “He’s done a great job cleaning up his lifestyle, and I think a lot of people were inspired to eat better as a result,” says Dr. Lee.

The Framingham Heart StudyIn 1948, the Framingham Heart Study recruited 5,209 men and women ages 30 to 62 living in a town just west of Boston.Careful monitoring of these volunteers enabled researchers to identify the major contributors to cardiovascular disease, which they dubbed “risk factors.” In addition to the identification of smoking as one such risk factor in 1960, other key lifestyle-related findings (reported in 1967) were that physical activity lowers the risk of heart disease and obesity increases the risk. Evidence that psychosocial factors such as stress and anger could affect cardiovascular risk was published in 1978.The study also provided a wealth of other information about the roles of cholesterol, blood pressure, age, sex, and genetics. In 1971, the study began enrolling additional cohorts, including the children and grandchildren of the original group as well as two new groups of racially diverse participants.

Take-home advice

Remember these two tips: don’t brush off chest pain, assuming it’s indigestion, and stay on your statin if you’re taking one. But don’t be too hard on yourself. “Even the president of the United States can be susceptible to wishful thinking,” says Dr. Lee.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

But the Lord is faithful, and he will strengthen you and protect you from the evil one. 2 Thessalonians 3:3 NIV 

Look to the Lord and his strength; seek his face always. 1 Chronicles 16:11 NIV 

I love you, Lord, my strength.  The Lord is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge, my shield and the horn of my salvation, my stronghold. Psalm 18:1-2 NIV 

But I will sing of your strength, in the morning I will sing of your love; for you are my fortress, my refuge in times of trouble. Psalm 59:16 NIV 

Be on your guard; stand firm in the faith; be courageous; be strong. 1 Corinthians 16:13 NIV 

Ah, Sovereign Lord, you have made the heavens and the earth by your great power and outstretched arm. Nothing is too hard for you. Jeremiah 32:17 NIV

The Sovereign Lord is my strength; he makes my feet like the feet of a deer, he enables me to tread on the heights. Habakkuk 3:19 NIV 

For the word of God is alive and active. Sharper than any double-edged sword, it penetrates even to dividing soul and spirit, joints and marrow; it judges the thoughts and attitudes of the heart. Hebrews 4:12 | NIV

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