The Case of the Doctor Whose Brain Was Stronger Than His Heart

Albert B. Lowenfels, MD

Disclosures

December 07, 2012

How Would His Condition Be Treated Today?

At the time of Hunter's death, little was known about diseases of the heart, and angina pectoris was a rare and poorly understood condition.[3] An early 17th-century description based on a single patient described the characteristic symptoms of the disease, including radiation of pain to the left arm. William Heberden, a noted 18th-century physician, published a more detailed description based on about 100 patients.[4] He noted several key features: the association of symptoms with exertion, the predominance in men (only 3 of the 100 patients were female), and the onset of disease in older patients. Heberden noted the disease was often progressive, ending in sudden death, but had no concept of the cause of the disease.

During the intervening years since Hunter's death, there have been dramatic changes in the diagnosis and management of angina pectoris. Nitroglycerine, a potent vasodilator, first became available for medical use in 1878, nearly a century after Hunter died. None of the tests or procedures now so widely used to diagnose cardiac disease was available during Hunter's lifetime. Even something as simple as measuring blood pressure only came into wide use about a century later. Cardiac catheterization was first performed in the 1930s, eventually leading to coronary angiography and then to procedures to restore coronary blood flow either by insertion of internal coronary artery stents or by surgical grafting procedures. Beginning in 1967, cardiac transplantation became available for patients with advanced disease.

If John Hunter were alive today, his disease, rather than being mysterious and untreatable, would be readily diagnosed and could be treated effectively. Rather than suffering for decades before dying of his illness, Hunter could have been treated in his 40s, when symptoms first began.

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