The “Modern” View of Heart Failure

Abstract

The inauguration of a new journal provides a unique opportunity to look back on the way that we arrived at our present state of understanding. In the case of heart failure, it is possible to trace a remarkable history that, for Western medicine, extends back to clinical descriptions collected in works attributed to Hippocrates in ancient Greece. Since the fifth century BCE, physicians and scientists have approached this clinical syndrome in at least 9 different ways (Table). The increasing rapidity with which these views have changed illustrates how new knowledge has narrowed the gap between clinical medicine and basic science.1 View this table: Table. Changing Views of Heart Failure The present article describes how our understanding of heart failure has evolved over the past 2500 years. Having been active in this area since the 1950s and having shared many reminiscences with my father, Louis N. Katz, who played an active role in academic cardiology between the 1920s and 1970s, I have included several personal insights about progress since the beginning of the 20th century. Patients with what may have been heart failure are described in ancient Greek and Roman texts, but edema, anasarca, and dyspnea, the most common clinical manifestations mentioned in early writings, have other causes. Difficulties in evaluating these clinical descriptions are due partly to lack of pathophysiological understanding of disease, which was then viewed as an imbalance between opposing humors (Figure 1). Figure 1. Two views of the circulation. A, Galen’s view. Pneuma derived from air (blue) reaches the heart from the lungs via the venous artery (pulmonary artery) and arterial vein (pulmonary veins). Natural spirits that enter the heart from the liver (green), along with vital spirits (heat) generated in the left ventricle, are distributed throughout the body by an ebb and flow in the arteries (red). Animal …