The rise of cardiovascular medicine

Abstract

Modern cardiology was born at the turn of the nineteenth to twentieth centuries with three great discoveries: the X ray, the sphygmomanometer, and the electrocardiograph. This was followed by cardiac catheterization, which led to coronary angiography and to percutaneous coronary intervention. The coronary care units and early reperfusion reduced the early mortality owing to acute myocardial infarction, and the discovery of coronary risk factors led to the development of Preventive Cardiology. Other major advances include several cardiac imaging techniques, the birth and development of cardiac surgery, and the control of cardiac arrhythmias. The treatment of heart failure, although greatly improved, remains a challenge. Current cardiology practice is evidence-based and global in scope. Research and practice are increasingly conducted in cardiovascular centres and institutes. It is likely that in the future, a greater emphasis will be placed on prevention, which will be enhanced by genetic information.

Figure 1

First human ECG. From Einthoven W. The galvanometric registration of the human electrocardiogram. Pfluger's Arch f.d. ges Physiol 1903;99:472–480.

Figure 2

Transfemoral implantation of the Edwards Sapien prosthesis. From Buellesfeld L, Windecker S. Transcatheter aortic valve implantation: the evidence is catching up with reality. Eur Heart J 2011;32:133–137.

Figure 3

Synergistic effects of two risk factors. Six-year incidence of coronary heart disease according to cholesterol levels at specified systolic blood pressures (men 45–62 years). From Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J III. Factors of risk in the development of coronary heart disease—six-year follow-up experience. The Framingham Study. Ann Int Med 1961;55:33–50.

Figure 4

Gene transfer. Viral vectors bind to cell surface receptors, initiating endocytosis. Once internalized, the viral particles avoid degradation and travel to ‘dock’ on the nuclear envelope membrane pores, and the genome is delivered into the cell nucleus. (Created by the US National Library of Medicine.) From Lyon AR, Sato M, Hajjar RJ, Samulski RJ, Harding SE. Gene therapy: targeting the myocardium. Heart 2008;94:89–99.

Figure 5

Genetics predict risk of first myocardial infarction. Quintiles of allelic dosage score comprises nine validated single nucleotide polymorphisms and risk of early onset myocardial infarction. Data from Kathiresan S, Voight BF, Purcell S, Musunuru K, Ardissino D, Mannucci PM et al. for the Myocardial Infarction Genetics Consortium. Genome-wide association of early-onset myocardial infarction with single nucleotide polymorphisms and copy number variants. Nat Genet 2009;41:334–341.