Heart Failure in the Ancient World

Heart failure has a fascinating history. Well, at least it’s fascinating to a history buff/nerd like me. I would think that heart failure has plagued mankind since its beginnings. That means our history probably goes all the way back to the primitive world.

Spirits and curses

People didn't know about diseases back then. When they felt ill they probably blamed it on evil spirits or a curse by an enemy. The treatment was to find a means of satisfying the spirit and getting it out of you. Those who suffered from heart failure probably had to slow way down and let others do the majority of their work. They probably did not live long.

Dawn of medicine

Spiritual connection

Let’s move forward in our history to 30,000 B.C. This period in time is often referred to as the "Dawn of Medicine." This was an era that gave birth to the medicine man or woman. This was a person who had access to medicinal herbs and incantations. These would put you in contact with the spirits and their herbs may have allayed your symptoms. The spiritual connection would have given you hope and ease your mind.^1-2

Various names

There were various names for the medicine man or woman. Depending on where you lived, it might be a seer, sorcerer, magician, healer, wizard, shaman, or priest. Yes, ancient healers were priests, and over time, these priests became your first doctors. Sometimes this era is referred to as the dawn of medicine.^1-3

Ancient Egypt

Writing

From here we can move forward to ancient Egypt. It was around 3,400 B.C. when people learned how to write.⁴ Ancient Egyptian medicine evolved into priests becoming doctors. They kept track of what herbs and incantations worked by writing them on papyrus.^1-3

Symptom was disease

In the ancient world, your symptom was your disease. This is because it was considered sacrosanct to a corpse besides for what was necessary for preparation for burial.^1-3 One papyrus of interest is the Ebers Papyrus. It is a medical Papyrus dated all the way back to 1,550 B.C. One symptom (disease) noted in it is shortness of breath. Historians often note this as one of the oldest descriptions of asthma.^1,6

Evidence of heart failure

But, is it possible that it may also have referred to heart failure? I ask this because there are many things that may cause shortness of breath. Asthma is one of them. Heart failure is another. Ancient priests/physicians would have no way of telling the difference. Modern researchers have performed CAT scans of Egyptian mummies that have clearly shown evidence of heart failure.^7-8

Defining diseases

Asthma

By 400 B.C., Hippocrates defined many diseases for the medical community. He also described the best treatments for these diseases. He defined asthma as feeling short of breath. The Greek term for asthma is, “Short, panting breaths.” Back then, if you were short of breath, regardless of the cause, you were probably diagnosed with asthma.⁹

Heart failure

Hippocrates also gave descriptions of heart failure. He described patients who were experiencing angina, or chest pain. He observed that these patients had swollen vessels in the neck, a classic sign of heart failure. His treatments were rather basic and involved eating healthy and exercise.¹⁰

Purging and bleeding

Although, if you were bad enough, he might recommend a herb to make you release your bowels. The ancient term for this was purging. Another treatment was to prick one of your veins to make you bleed. This was thought to cause balance inside your body. If you were short of breath, you may have had too much blood. So, bleeding might make you feel better.¹⁰ Believe it or not, bleeding was a remedy for many diseases and lasted as a treatment all the way into the 19th century.

Forbidden from inspecting

Galen

Galen was a physician around the time of Jesus. He took the writings of Hippocrates and added to them. He was a voluminous writer and wrote many medical books. It was his books that would be used by physicians for much of the next 1,800 years. We will get back to Galen in a moment.

Religion's role

So, throughout the ancient world, you were probably diagnosed with asthma. The reason for this is that most ancient physicians were forbidden from inspecting the bodies of the recently deceased. This was for religious purposes. Touching a body for reasons other than for burial rituals was considered sacrosanct.

Changes

Observations

This started to change in 1543. This was the year Andreas Vesalius published the first accurate book of human anatomy. When Vesalius was a student, his professors would read from Galen's anatomy books. As medical assistants would hold up an anatomical object, Vesalius observed that Galen's writings did not describe accurately what his assistant was holding up. By doing his own research, Vesalius learned that Galen was describing ape anatomy and not human anatomy.¹¹

Austopsies on humans

So, when he became the professor, Vesalius and his students did actual autopsies on human corpses. It is by this means that Vesalius was able to publish his book in 1543. Initially, Vesalius was mocked and ridiculed by his peers. But, over time, this would become a huge moment in our history.^1,11-13

Not always asthma

It started a revolution of sorts where physicians would work hard to actually understand human diseases, rather than just rely on old textbooks of Galen. It was in this way that physicians eventually learned that not all shortness of breath was asthma, that many times it might be heart failure.

Researching the heart

Blood circulation

That said, the term heart failure was not used back then. In 1628, William Harvey (1578-1657) decided to do some experimenting of his own. He discovered that blood circulates throughout blood vessels. This was a very exciting discovery. It gave researchers the motivation to begin investigating the heart.^14-15

Cardiac asthma

Raymond Vieussens (1635-1715) was among these physicians. In 1672, he published a book describing the coronary arteries. These are the arteries that feed the heart. He was the first to observe that diseases of the heart may also cause shortness of breath. This gave birth to the term cardiac asthma. From here until the 1970s, heart failure was often referred to as "cardiac asthma."^1,16

Similar symptoms

This made sense because the symptoms of heart failure and asthma were often the same: shortness of breath, chest tightness, coughing, and wheezing. Various other physicians described "cardiac asthma." By the 1930s, another term was used: "Heart failure."

Age-old disease

So, heart failure is an age-old disease. It has affected humans since the beginning of our existence. There were random descriptions of the heart as the cause of symptoms throughout history. Although, in many cases, shortness of breath, regardless of the cause, was considered asthma. That changed gradually over time. Today, heart failure is its own disease with its own treatments.