It is a commonplace in writings about heart failure (HF) that it has become an ‘epidemic’ in Western societies in particular. In truth, the incidence of HF is not rising, but the prevalence is. HF is thus not a true epidemic, which properly is a rise in the age-specific incidence. The major causes for its increasing prevalence are threefold: although the incidence of acute myocardial infarction may be falling, more patients survive acute coronary disease and go on to develop chronic HF; treatment of chronic HF has dramatically improved, and so many more patients survive for much longer; and the population generally is ageing — and HF is a disease of older people. Although HF is a modern blight, it has been known for thousands of years. There is some suggestion from the Ebers papyrus (dated around 1500 BCE) that the ancient Egyptians recognized it (‘When there is inundation of the heart, the saliva is in excess, and therefore the body is weak’), and Hippocrates (460–370 BCE) gave a muchquoted description of cardiac cachexia: ‘The flesh is consumed and becomes water … the abdomen fills with water; the feet and legs swell; the shoulders, clavicles, chest, and thigh melt away.’ It was not until after Harvey described the circulation of the blood that the HF syndrome truly began to be related to the heart, with Richard Lower perhaps giving the first textbook discussion of HF in 1669. Treatment for HF with venesection, perhaps one of the few instances in which the procedure might be helpful, was formally described in 1696. William Withering described the formaluse of Digitalis extracts, giving birth to clinical pharmacology, although cardiac glycosides had undoubtedly been used for hundreds,and perhaps thousands, of years previously.The modern era of HF treatment truly began with the discovery of mercurial, and then thiazide and subsequently loop, diuretics in thelate 1950s and early 1960s. Perhaps the most important single trialin HF therapy demonstrating the beneficial effects of angiotensinconverting enzyme (ACE) inhibitors was published in 1987.
Chapter. 3433 words. Illustrated.
Subjects: Cardiovascular Medicine
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