The delayed diagnosis of myocardial infarction: it took half a century!

IN 1940 the physiologist Carl Wiggers claimed, "De- layed recognition of important physiological discover- ies frequently continues untenable and wrong points of view.. . Greater mutual efforts ought to be made by clinicians and physiologists for better dissemination, digestion and absorption of important physiological discoveries."1l Although angina pectoris had been de- scribed by William Heberden in the 18th century, and some 19th century physicians recognized an associ- ation between this symptom and sclerosis of the coro- nary arteries found at autopsy, the syndrome of acute myocardial infarction was not recognized until the 20th century.2-5 The "wrong point of view" that led to the long delay in the recognition of acute myocardial infarction was the belief that sudden coronary occlu- sion was invariably fatal. This view predominated un- til 1912 when James Herrick proposed that myocardial infarction in man was not always fatal and could be recognized during life. Additional factors that contrib- uted to this delay included: (1) the inconstant relation- ship of symptoms to pathological findings in ischemic heart disease, (2) the excessive reliance on ausculta- tion as an indicator of cardiac disease, (3) the failure to routinely examine the coronary arteries or the myocar- dium at autopsy, (4) the reluctance or tardiness of clinicians to incorporate new pathophysiologic discov- eries into medical practice, (5) a willingness to accept theories of disease without scientific evidence to sup- port them, (6) the preoccupation with the new field of bacteriology, which distracted clinicians and biomedi- cal scientists from the more traditional organ-centered approach to disease, and (7) the lack of any diagnostic techniques with which to objectively identify coronary