cardiology(redirected from Cardiovascular medicine)
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a branch of medicine concerned with the structure, function, and diseases of the heart and blood vessels, the causes, mechanisms of development, clinical symptoms, and diagnosis of the diseases, and the development of methods of treatment (including surgical), prevention, and rehabilitation of individuals with injuries to the cardiovascular system.
Before the appearance of the field of cardiology proper, questions of the cardiovascular system were taken up necessarily by internal medicine, surgery, pediatrics, neuropathology, physiology, normal and pathological anatomy, and pharmacology. The findings of these studies had created a body of knowledge of the cardiovascular system when, because of the increasing incidence of cardiovascular diseases, cardiology evolved into an independent medical discipline in the 19th and 20th centuries. The evolution of cardiology as an independent study was also the result of the development and perfection of techniques for studying the blood vessels and heart, the accumulation of data on the causes and mechanisms of development of cardiovascular diseases, and the development of techniques for preventing and treating these diseases. While retaining its connection with many medical sciences, cardiology makes use of certain methods of investigation unique to itself.
Fragmentary information on the structure of the human cardiovascular system can be found in the oldest sources. The Greek physician Galen (second century a.d.) developed the first diagram of blood circulation. This scheme lasted until the 17th century, when it was challenged by the English scientist W. Harvey in his Exercitatio anatomica de motu cordis et sanguinis in animalibus (1628). Harvey’s discovery of the circulation of the blood marked the beginning of a rapid accumulation of both anatomicophysiological and clinical data on the cardiovascular system. Coronary circulation, certain heart defects, and angina pectoris were described between the 17th and the 19th centuries. The diagnosis of many heart diseases was facilitated by the introduction in 1819 of mediate auscultation (using a stethoscope) by the French physician R. Laennec.
Great contributions to the knowledge of the anatomy and physiology of the cardiovascular system were made in the 19th century by the Czech physiologist J. Purkinje (1839), who studied the cellular structure of the myocardium, the German physician W. His (1890–94), the German pathologist L. Aschoff, the Japanese pathologist S. Tawara (1906), and the Englishmen A. Keith and M. Flack (1907), who discovered and described the elements of the system of nervous excitation in the heart. The German physiologist K. Ludwig discovered the general vasomotor center in the medulla oblongata. He also suggested methods of recording blood pressure and determining the rate of blood flow. A substantial contribution to cardiology was made in Russia by S. P. Botkin, who found the place for the most effective auscultation of diastolic murmurs in aortic insufficiency (third and fourth intercostal spaces, or points of Botkin).
The blossoming of physiology at the turn of the 20th century, particularly the work of the Russian scientists I. M. Sechenov, I. F. Tsion, and A. B. Fokht, the Russian physiologists I. P. Pavlov, V. Ia. Danilevskii, L. A. Orbeli, K. M. Bykov, and V. N. Chernigovskii, the French physiologist C. Bernard, and the English scientist E. H. Starling, encouraged the development of a functional approach in cardiology. New methods of examination were introduced. In 1903 the Dutch scientist W. Ein-thoven recorded the electric currents generated by the human heart (electrocardiography); this method was subsequently improved and developed as a result of the work of the Russian physiologist A. F. Samoilov and the Soviet internists V. F. Zele-nin and L. I. Fogel’son, the English physician T. Lewis, and the German physician R. F. Wenckebach. In 1905 the Russian physician N. S. Korotkov proposed the acoustic method of determining blood pressure. The introduction into clinical practice of cardiac fluoroscopy and roentgenography, contrast angiocardiography, roentgenkymography and electrokymography, phase roentgenocardiography, cardiac and vascular catheterization, radiocardiography, phonocardiography and ballistocardiography, a dye-dilution technique to study hemodynamics, ultrasound cardiography, and immunology were of great value in diagnosing cardiovascular diseases. The Soviet physiologist E. B. Babskii proposed an original method of studying cardiac activity called dynamocardiography.
The founder of clinical cardiography is considered to be the English physician J. Mackenzie, who published the first scientific work devoted to a comprehensive study of arrhythmias (1902), a work on the nature, diagnosis, and treatment of heart diseases (1908), and a study of angina pectoris (1923). The works of the French physician H. Huchard, known for his manual of cardiology (1893), the English physicians T. Lewis and G. Pickering, the German physician E. Romberg, and the American physician W. Osier played a major role in elucidating the pathology of blood circulation. One of the greatest contemporary cardiologists was the American physician P. D. White, who carried out major clinical and epidemiological studies on atherosclerosis and coronary insufficiency, malignant endocarditis, syphilis of the cardiovascular system, and arrhythmia. The American scientists C. Wiggers and L. Katz investigated the dynamics of blood circulation. V. P. Obraztsov and N. D. Stra-zhesko described in detail the clinical picture of coronary thrombosis and myocardial infarction (1909). G. F. Lang proposed and elaborated a neurogenic concept of hypertension that was further developed by A. L. Miasnikov and his co-workers. G. F. Lang developed a classification of cardiovascular diseases, approved by the 12th Ail-Union Congress of Internists in 1935, according to which every disease must be characterized from a variety of aspects—etiological, pathologicoanatomical, patho-logicophysiological, functional, and symptomatological. The same congress also adopted a classification system for circulatory insufficiency proposed by Strazhesko and V. Kh. Vasilenko. The studies of N. N. Anichkov and S. S. Khalatov on the creation of experimental cholesterol atherosclerosis enabled them to formulate a cholesterol theory of atherosclerosis, which won wide acceptance and made it possible to reveal the main pathogenetic mechanisms of this disease.
The research of Soviet cardiologists showed that disturbances of nervous regulation with subsequent humoral disorders play a leading role in the appearance and progress of hypertension, atherosclerosis, and coronary insufficiency. A. L. Miasnikov successfully elaborated these ideas. The studies of P. E. Lukom-skii and B. V. Il’inskii on atherosclerosis and coronary insufficiency are widely known. The role of neurologic factors in the mechanism of development of atherosclerosis was demonstrated by I. V. Davydovskii and E. M. Tareev. Various aspects of angina pectoris and myocardial infarction were explored by G. F. Lang, M. S. Vovsi, M. M. Gubergrits, V. F. Zelenin, and M. N. Tumanovskii. D. D. Pletnev and V. Kh. Vasilenko studied the complications connected with myocardial infarction (for example, thromboembolism).
Rheumatic heart disease is a major problem in cardiology; it has been studied by both pathologists (V. T. Talalaev, M. A. Skvortsov, N. A. Kraevskii, and A. I. Strukov) and clinicians (M. P. Konchalovskii, M. V. Chernorutskii, N. D. Strazhesko
A.I. Nesterov, E. M. Gel’shtein, and I. A. Kassirskii). Theclinical aspects of malignant endocarditis were studied by G. F.Lang, N. D. Strazhesko, N. A. Kurshakov, N. S. Molchanov, and E. M. Tareev. Various functional disturbances of the myo-cardium were also studied by la. G. Etinger, V. Kh. Vasilenko, and A. A. Kedrov. Many aspects of pulmonary heart wereworked out in detail by the Soviet scientists B. E. Votchal, V. F.Zelenin, V. Kh. Vasilenko, B. E. Kogan, B. I. Kushelevskii, P. E. Lukomskii, V. V. Parin, and N. N. Savitskii.
Radioactive istopes have been used to investigate the cardiovascular system since the middle of the 20th century. Certain older methods (phlebography, oscillography) found application in clinical practice in conjunction with improved electronic apparatus.
V. N. Vinogradov, P. E. Lukomskii, E. I. Chazov, and Z. I. Ianushkevichius were awarded state prizes for organizing the care of patients with myocardial infarction and introducing new methods of treatment (anticoagulants, fibrinolysin). V. V. Zaku-sov and others worked out certain problems in the pharmacotherapy of cardiovascular diseases.
A high level of technical development, as well as modern diagnostic methods, has made surgical intervention feasible in cardiovascular diseases. The development of surgical treatment of heart defects helped to stimulate extensive study of the diagnosis and clinical aspects of these diseases. Operations were performed for coronary insufficiency and removal of thrombi. In 1967 a Cape Town surgeon, C. Barnard, performed history’s first transplant of a heart from one man to another. By 1972 more than 200 such operations had been performed (USA, France, USSR).
Surgery of the heart and blood vessels has been progressing successfully in the USSR through the work of A. N. Bakulev, B.V. Petrovskii, P. A. Kupriianov, A. A. Vishnevskii, V. I.Kolesov, N. M. Amosov, and E. N. Meshalkin, all of whomwere awarded the Lenin Prize. The State Prize was awarded toA. A. Vishnevskii, N. L. Gurvich, V. A. Negovskii, and B. M.Tsukerman for developing electroimpulse therapy and introduc-ing it into clinical practice.
Important contributions to heart surgery have been made abroad by C. S. Beck, C. P. Bailey, A. Blalock, L. O’Shaughnessy, P. D. White, A. Dogliotti, W. B. Cannon, M. de Bakey, D. Cooley, and R. C. Lillehei.
Experimental cardiology, a complex of physiological, pathophysiological, biochemical, and morphological studies conducted for the purpose of studying the circulatory system, both healthy and diseased, is an independent branch of cardiology. The main concerns of modern experimental cardiology are the clinical physiology of circulation; the regulation of vascular tone in health and in sickness; the physiology and pathology of coronary circulation (specifically, myocardial infarction), the contractile function, automatism, and excitability of the heart, normal and pathological; compensatory hyperfunction, hypertrophy, and insufficiency of the hypertrophic heart; the physiology and pathology of pulmonary circulation; the physiology and pathology of regional and capillary circulation; and the pathogenesis of atherosclerosis. These objectives are being pursued successfully both in the USSR and abroad.
The All-Union Scientific Medical Society of Cardiologists (affiliated with the International Society of Cardiology and the European Society of Cardiology) and republic societies of cardiologists were organized in 1963. The International Association of Cardiologists was established in 1950. It includes European, Asian, Pacific, and inter-American associations of cardiologists.
Cardiological care in the USSR is provided in the cardiology departments of hospitals and in the cardiorheumatological offices of polyclinics, in which patients are treated and given advice and efforts are made to control cardiovascular diseases. Specialized service for patients of acute myocardial infarction includes specialized first aid teams, infarct departments, and intensive care units in hospitals.
The journal Kardiologiia has been published in Moscow since 1961. Articles on cardiology are published in other medical periodicals as well. The international cardiological journal Cor et vasa (Prague) was founded in 1959.
The following journals are published abroad: Kardiologia pol-ska (Lodz, since 1957), Archiv fur Kreislaufforschung (Dresden-Leipzig-Darmstadt, since 1937), Zeitschrift fur Kreislaufforschung (Dresden-Leipzig-Darmstadt, since 1909), Circu-lation (New York, since 1949), American Journal of Cardiology (New York, since 1958), American Heart Journal (St. Louis, since 1925), British Heart Journal (London, since 1939), Japanese Heart Journal (Tokyo, since 1960), Acta cardiologica (Brussels, since 1946), Cardiovascular Diseases and Cardiovascular Surgery (Amsterdam, since 1957), Minerva Cardioangiologica (Turin, since 1953), and Journal of Cardiovascular Surgery (Turin, since 1960).
Cardiological research in the USSR is carried out by the A. L. Miasnikov Institute of Cardiology of the Academy of Medical Sciences of the USSR, the Institute of Rheumatism of the Academy of Medical Sciences of the USSR, the A. N. Bakulev Institute of Cardiovascular Surgery of the Academy of Medical Sciences of the USSR, the Institute of Experimental and Clinical Surgery of the Ministry of Public Health of the USSR, the A. V. Vishnevskii Institute of Surgery of the Academy of Medical Sciences of the USSR, the Institute of Circulatory Pathology of the Ministry of Public Health of the RSFSR (Novosibirsk), the Institute of Pharmacology and Chemotherapy, the M. D. Tsi-namzgvrishvili Institute of Clinical and Experimental Cardiology (Tbilisi), and the Institute of Cardiology and Heart Surgery (Yerevan). Aspects of the physiology and pathology of blood circulation are also concerns of the Institute of Normal and Pathological Physiology of the Academy of Medical Sciences of the USSR, several institutes of the Academy of Sciences of the USSR, and a number of clinics of medical colleges and institutes of advanced training for physicians.
Major scientific cardiological centers abroad include the Institute of Blood Circulation (Prague), the Cardiological Center (East Berlin), the National Heart and Lung Institute (Bethesda), the Cardiovascular Institute (San Francisco), the Cardiovascular Institute of the Michael Reese Hospital (Chicago), and the National Cardiological Institute (Mexico City).
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I. K. SHKHVATSABAIA