introduced a urethral catheter into his left arm and under fluoroscopic control , aided by a nurse who held a mirror , advanced the urethral catheter into his right atrium . He walked to the X-ray department and recorded the event with a chest film . By 1936 , Andre Cournand and Dickinson Richardson were establishing the physiology and value of cardiac catheterization . These three men shared the Nobel Prize for Physiology of Medicine in 1956 . With their work , we were able to progress to diagnosing the heart in the office .
Next , we need to consider the Master two-step exercise test . Arthur M . Master , a New York cardiologist , built a small set of wooden steps , two steps up and down , in a small pyramid . Each step was nine inches high , and the patient walked back and forth for three minutes . An EKG before and after was studied for ST segment depression looking for ischemic heart disease . This equipment was easy to build , and when I began on June 26 , 1962 , our office was equipped with a Masters two-step piece of furniture . If the cardiologist thought a patient ’ s chest pain might be from the heart , the Master two-step exercise test was performed right in the office . This test was used for several years before office treadmills became available and routine .
An EKG was taken before , during and after exercise , making the Master two-step test a crucial diagnostic tool . These early EKGs were developed in lab areas right in the cardiology office . Most direct writer EKGs were not available until August of 1951 . In 1943 when I was still 10 , I built in our basement bathroom a photography lab to develop the EKGs my father had taken on house calls , so that he could read them as soon as possible .
At this point , it ’ s worth mentioning that every cardiologist had in his office a fluoroscope machine . You put on lead gloves and a lead apron and reviewed the beating heart , measuring heart size and contour and looking for pleural effusions . In our office , we made a drawing on our chart , but when I was a fellow at the University of Pennsylvania , on a piece of paper the size of the fluoroscope screen , the heart , lungs and diaphragm were sketched and made part of the patient ’ s permanent record .
Then the 1970s and 80s arrived and rapidly cardiac catheterization became almost routine . Coronary artery bypass surgery using veins harvested from the legs and sewn around the coronary artery obstruction became a routine procedure for a few skilled surgeons . Before bypass surgery , myocardial infarction was a dreaded illness . Twenty to 30 % of patients died in the first hours of a classic myocardial infarction and only 50 to 60 % were still alive after one year . Those now saved lived long enough to insidiously develop congestive heart failure , often with associated hypertensive cardiovascular disease and diabetes mellitus . Those in the office practice of cardiology treat a host of patients with low and normal ejection fractions with congestive heart failure that result from current modern surgery .
As the years passed , cardiac catheterization became more efficient , and coronary arteries could be opened without cracking the chest for coronary artery bypass surgery , which remains necessary sometimes , but less frequently than in the past . Those reading this paper are already aware of and understand current transplant , artificial heart and advanced valvular surgical procedures . Meeting our patients ’ needs , however , through holistic care as well as through our always-improving diagnostic tools remains of utmost importance .
So where do we go now ? The science of cardiology has created wonder and continues to advance , but the anxiety a patient brings into any doctor ’ s office is immutable . Science can never negate this fear , amplified when the cardiologist is the consultant , who is at first a stranger to the patient and their varied concerns .
We must not forget the heart is the center of love and emotion . The brain responds to the heart – not the reverse , as is often thought . The study of all ancient cultures , societies and religions , in writing and poetry , point out the centrality of the heart . My success as a cardiologist involved not only mastering and working with new technology , but also listening to patients ’ concerns and fears . I got my greatest pleasure at work in alleviating patients ’ concerns and helping them allay their anxieties .
Over the past 100 years , our diagnostic abilities have been continually expanding . Today , we have entered the age of artificial intelligence , which has given us another tool to use as we seek to understand our patients ’ medical needs . Thus far , however , ChatGPT and AI ’ s various offspring have not been shown to have a soul . AI programs can assist us in diagnosing problems and crafting possible treatments , but we must remember that our patients are people with specific concerns and anxieties that must still be addressed . A physician treating a patient must take the time to gently set aside his diagnosis , whether confirmed by artificial intelligence or by long experience , and hold the patient ’ s hand , offering comfort and home . Though much has changed over these past hundred years of cardiology , that aspect of caring for our patients has remained the same .
Too tedious perhaps my tale will be , And I would rather now cut short my song Than weary you by making it too long .
-Ludovico Ariosto , Orlando Furioso , 1516
Dr . Weiss is a retired cardiologist and Emeritus Professor of Cardiology at the University of Louisville School of Medicine .
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