Heart failure: a 70 year Odyssey

Seventy years ago, in the spring of 1952, as a medical student at New York University and Bellevue Hospital, I was given the opportunity to assist in the management of patients with heart failure (HF). Treatment was quite limited at the time, consisting of a low salt diet (which was rarely followed), digitalis (now of questionable value), and meralluride (mercuhydrin), a relatively weak organomercurial diuretic which required painful intramuscular injection. Following hospital discharge patients with HF returned to the outpatient clinic for weekly injections of meralluride. Because of chronic nursing shortages, I volunteered to make the injections, which allowed me to establish personal relationships with HF patients, observe their suffering with severe dyspnoea and get a sense of the natural history of this condition. Few patients survived for more than 3 months after hospital discharge, and the patients ‘drowning’ in their pulmonary oedema often caused death. This experience, while sobering,...