The
Heart Attack that Cost Billions
By Dr. Syed Amir
Bethesda, MD
Almost half a century ago, on a Saturday afternoon
in September 1955, President Dwight Eisenhower,
the 34th US president, suffered a severe heart
attack while he was playing golf at Denver, Colorado.
The news of the president’s illness shocked
the nation and the world, spreading alarm across
the financial markets.
When the US stock market opened the following
Monday, the Dow Jones Average, a measure of the
value of the American stocks, plunged six percentage
point, representing a loss of $14 billion dollars
to investors. It was the largest single decline
in the value of stocks in the US since the great
depression of 1929. Even the assassination of
President Kennedy eight years later or the attempt
on the life of President Reagan in March 1981
had no comparable negative consequences.
The history of President Eisenhower’s heart
attack has over the years captured the attention
of both the medical researchers as well as the
general public, because the details of his illness
and the treatment given to him have been well
documented in the literature. Recently, on the
50th anniversary of the president’s near
fatal attack, one of the world’s most prestigious
medical journals, The New England Journal of Medicine,
published an article, jointly authored by several
cardiologists, that highlighted the relatively
poor state of medical knowledge of heart disease
existing at the time. When viewed in the context
of present-day medicine and the vast array of
therapies and therapeutic tools available to physicians,
it is easy to observe that in the intervening
five decades the science of cardiology has been
truly revolutionized.
President Eisenhower’s fateful day in Denver
where he was on vacation started uneventfully.
The first hint of trouble came in the afternoon
when he suddenly felt unwell while playing golf
at a country club. Initially, the problem was
deemed nothing worse than a mild stomach upset,
caused by the onions and hamburger he had eaten
earlier. He was treated with Milk of Magnesia,
standard treatment for gastric problems at the
time, and advised to rest. However, he was awoken
in the middle of the night by severe chest pains.
His wife called his personal physician, Dr. Synder,
at 2 a.m. Unsure of the nature of the disease,
his doctor administered amyl nitrate and an injection
of morphine which put him into a deep sleep. Unlike
now, there were no readily available tests to
make a definitive diagnosis. When the pain persisted
into the second day, army doctors were brought
in who came with the most advanced diagnostic
device at the time, the electrocardiograph (ECG).
Finally, it was determined that President Eisenhower
had suffered a myocardial infarction, the medical
name for a heart attack.
Even though the nature of the illness had been
identified, the state of the medical science at
the time was such that the doctors could do little
to help, even if the patient was the president
of the United States. Alternate medical advice
was then sought. Vice President Nixon believing
that army doctors were less practiced and skillful
than their civilian counterparts insisted that
Dr. Dudley White, the internationally renowned
cardiologist at the Massachusetts General Hospital
in Boston, should be consulted. Dr. White had
performed pioneering research in the field of
cardiology, extensively lectured about heart disease
and had authored close to a thousand research
papers and was the first to introduce the use
of ECG in the country.
Flown in from Massachusetts in a special military
plane, he carefully examined the patient and confirmed
the diagnosis. For all his clinical expertise,
the foremost cardiologist in the country could
do little to treat the disease or to prevent its
recurrence. As was the practice at the time, the
president was advised complete rest, placed in
an oxygen tent and administered injections of
heparin. He was lucky, as unlike many other heart
patients in those days, he recovered from his
heart attack largely on his own. Barely five months
after his illness, he was back playing golf. His
doctors reassured the nation that he had made
an excellent recovery, an assurance that enabled
him to easily win the election for a second presidential
term. Finally, he retired to his farm near Washington;
however, his heart disease had not been controlled.
He continued to experience episodes of disabling
cardiovascular complications, and died in 1969
following a severe heart attack.
President Eisenhower’s first heart attack
initiated a lively debate among doctors about
the causes of heart disease and how it could be
prevented. Until then, few well-designed, systematic
scientific studies had been conducted to address
these issues. What was known about the heart disease
was based on conjecture or drawn from empirical
evidence. Dr. White addressed a press conference
soon after attending the president and listed
several risk factors for heart disease; among
them old age, male sex, and an aggressive, ambitious
personality. Significantly, smoking was still
not recognized as a major risk factor. President
Eisenhower had been a heavy smoker for most of
his life, and while his doctors discouraged him
from smoking heavily, none appreciated the strong
link between smoking and heart disease. Similarly,
the definitive understanding of the role of cholesterol,
fat, diet and exercise in heart disease emerged
only decades later.
Today, President Eisenhower’s heart attack
illustrates the spectacular advances that have
been made since in the prevention, diagnosis and
treatment of heart disease. Although it remains
the single leading cause of mortality in the USA,
the death rates from cardiovascular diseases,
heart and stroke, have been declining steadily.
Procedures such as bypass surgery and angioplasty,
common these days, were unknown fifty years ago.
Similarly, cholesterol lowering drugs, such as
statins, and a range of other heart medications,
such as beta blockers, and ACE-inhibitors had
not yet been developed.
Perhaps, the greatest impact on the reduction
of heart disease has been made by the awareness
of the benefits of lifestyle changes. The beneficial
effects of regular exercise for both men and women
have now been established in a number of scientific
studies. A just-published study carried out in
Holland has shown that even a moderate level of
daily physical activity can add four productive
years to the life span, mostly by thwarting heart
disease. And, significantly, it is never too late
to start to exercise. While there continues to
be some disagreement about the nature of a healthy
diet, there is general agreement that it includes
an abundance of fruits, vegetables and nuts and
only small amounts of saturated fats, such as
ghee, butter or margarine. There is strong scientific
evidence that substitution of even 10 percent
carbohydrates, such as bread, sugar or rice, with
beans or healthful oils, such as olive or corn
oil, can produce significant reduction in blood
pressure.
The last chapter in the book on the treatment
and prevention of heart disease is yet to be written.
As medical science makes impressive advances,
new knowledge about disease processes will undoubtedly
unfold over time. While we may never see a dramatic
increase in the human life span, we are most likely
to see people living healthier, productive lives
in the future, largely free of the degenerative
diseases now associated with the old age.
------------------------------------------------------------------------------------
