What did people do for heart attacks before ~50 years ago

Factual Questions
1

Before 50-ish years ago as far as I know most treatments for a heart attack didn’t exist. Most medications and supplements for hypertension, cholesterol, triglycerides, homocysteine, etc. either hadn’t been invented or nobody knew they worked on these issues. Or people didn’t know these issues affected heart disease (ie people didn’t know cholesterol played a role in heart attacks). So medications don’t seem like they were viable to treat and recover from one.

No angioplasties existed, no stents, no bypass operations, etc. So using that as a means of recovering didn’t exist either.

Lifestyle changes existed, but I don’t know if the connection was as well defined (ie if people knew how risky smoking was to the heart as an example).

However I know people survived heart attacks in the 40s, 50s, 60s, etc and lived productive lives after that, for decades or more.

So how were they treated before we had the knowledge and invention of the medications, surgery and lifestyle changes we have now, since many people still survived them?

2

You can certainly survive a mild to moderate heart attack that destroys much but not all of the heart, and those are the ones that did. The others died, simple as that.

Even today, we’ll have EKG signs of a former heart attack and the patient expresses shock that they had a heart attack and didn’t know it. The heart really is a hearty (ha!) organ, and it will perform it’s own “bypass”: growing new vessels where it can to compensate for trauma done to it during a heart attack. Not as quickly as surgeons, of course, and it doesn’t always work, but sometimes it does.

I think my teacher said a person can live fairly normal lives with only about 30% of their heart’s contractility (ability to squeeze and pump blood) intact, but don’t quote me on that. :wink: 20% and you’re talking the frail gentleman who takes slow walks and falls asleep in his chair by the fire a lot.

Also, remember that the worst risk factor for cardiovascular health is obesity, and there wasn’t as much of that in years gone by. People also “exercised” more, only back then it was called chores. So as diet and activity level have changed, we’re seeing many more heart attacks and cardiovascular disease than we used to. That means we’re seeing a far greater proportion of the population on cardiac meds than there would have been 100 years ago, even if we had had those meds then.

Finally, there *were *cardiac medications back then, and some people did take them for life. Foxglove, the plant we make the cardiac drug digoxin from, has been used medicinally for weak hearts since Egyptian times. In the right dose, it increases the contractility of the heart, making it push the blood harder, but also slowing it down (if you have an atrial fibrillation, that’s a good thing.) Use too much, and it will kill you with digitalis toxicity. That’s why I’d use digoxin now instead of foxglove, because the dosing is so tricky, but foxglove certainly works. Hawthorn, hyssop, myrtle, rosemary, tumeric…all in a category of herbs called “cardiac tonics”, sometimes called “cordials” in old materia medicas.

3

George Burns says his wife Gracie Allen always had a weak heart and that’s why they adopted kids as she was told the strain of childbirth would kill her.

He also said when she’d get a spell she’d put a pill under her tongue, so I’m assuming that was some sort of nitroglycerin pills. I belive those were around since the late 1800s

4

There was nitroglycerine, digitalis, some treatments for hypertension, and as early as 1925, open heart surgery.

And there was certainly some knowledge of lifestyle. When Franklin Roosevelt starting showing signs of severe heart disease in 1944, his doctors told him to quit smoking (he didn’t), as did Lyndon Johnson’s after his 1955 heart attack (he did, at least for a while.)

5

My dad had a near-fatal heart attack back in the early 60s. He was in his early 40s. I was very little then, so what I remember is partly based on my recollection when I grew a bit older plus what I was told:

The only reason why he survived was because, at the time, we lived less than 10 minutes from a major medical center.

He wasn’t obese at all, but he 1) had a terrible diet (lots of red meat, no veggies to speak of), 2) a family history of hypertension, and 3) smoked like a chimney – my mother once told me he smoked something like 3 packs a day before the heart attack.

I remember us eating what I thought were “weird” things when I grew a little older. We had salad and at least one green veggie with dinner every night, for one. More poultry than beef. My dad started eating cereal as part of his breakfast. He was also told to cut his sugar intake, so we always had a bottle of Sucaryl on the counter. Oh, and nothing but skim milk in the fridge.

He also quit smoking cigarettes, but he graduated to Eriks (they were the cigars that looked like cigarettes – I remember them coming in a flattened box). He quit smoking those when was was about 8 or 9.

My dad died of cancer when I was 13. It was hereditary, the same one which killed his father and probably other male relatives before him. We were told by his oncologist that the reason he’d stayed alive since the heart attack was because of all his dietary changes. FWIW, I don’t ever remember my dad being on any kind of cardiac/hypertension med.

6

Aside from the aforementioned nitro and digitalis, I think treatment was pretty much bedrest. This jibes with what I’ve read, e.g., in Travels with Charley, Steinbeck, who had had a heart attack, says something about not wanting to live the life of invalidism that was expected at the time.

Sorry I don’t recall the exact quote, but here’s something from an Internet article: “Appropriate heart-attack care in the 1950s and '60s included prolonged bed rest with hospital stays of a month or more being common practice. We now know that this is not only unnecessary, but also counterproductive.” And here’s the link: http://www.implantsandperio.com/Articles/HeartAttacks.htm

7

There was no diabetes treatment before the 1920s so most people with no insulin died.

8

That’s only true for Type I (insulin-dependent) Diabetes, which is the much rarer form of the disease.

The first fairly effective treatment for Type II Diabetes - that we can find in writing in the “western” world - date from 1796, by Dr. John Rollo. He was focused on dietary change - high protein, low carb - and his recommendations continued to be used with a few tweaks until the 1980’s (when it was decided that, with insulin, a diabetic need not follow a very low carb diet.)

And, of course, there are those herbs again. Cinnamon, fenugreek, bitter melon - there are plants that have been used for thousands of years to help control blood sugar.

Medical care got *better *with the advent of the scientific method and the invention of antibiotics, but it’s foolish to think there was no medical care at all before that.

9

Supplements and vitamins can help with heart disease. But did people know about them back then? Things like red yeast rice, coenzyme Q10, niacin, omega 3s, etc all existed back then but I don’t think anyone knew the role they could play in heart health. Which is part of the problem. Even if you could buy niacin at a grocery store in the 1940s, people didn’t know the role it played in heart disease. I don’t even think the cholesterol hypothesis was known back then.

10

I don’t think people know those are beneficial to the heart now. Niacin may lower your cholesterol (which may or may not help). Omega 3s may or may not help. NIH is to undertake a large study on that very question. How does red yeast rice or COQ-10 help? COQ-10 helps the body in energy metabolism.

11

No, the understanding of specific micronutrients wasn’t there, but they knew that eating more fish (Omega 3s) and less red meat (cholesterol), and eating lots of vegetables (niacin) was good for you. Physicians certainly counseled people with symptoms of cardiac issues to eat more moderately. Those aren’t new dietary recommendations, they’re straight out of Hippocrates. They just get repackaged over and over and over again.

We do have documented use of red yeast rice in China to treat Blood and Spleen disharmonies (which could include high cholesterol levels as we test them now, but of course they didn’t test nor call them that then) from 800AD on. It’s possible it goes back further than that, but it’s hard to prove. It’s called Zhi Tai when powdered, or Xue Zhi Kang in alcohol extract. Blood and Spleen, in should be noted, don’t mean what we mean when we say blood and spleen. They mean, very roughly, the digestive system and the system which brings nourishment and moisture to the body.

12

Short answer: bed rest, back in the day.

Longer answer:
Most heart attacks don’t kill you.
When they do, it’s most often from an abnormal rhythm and not from the amount of damage to the heart muscle, although if a really important artery gets suddenly blocked, muscle loss alone can do you in.

More commonly, though, only the muscle distal to the blockage dies. If you look up a typical coronary artery diagram, you’ll notice that there are many vessels with many branches. What we usually call a “heart attack” occurs when one of those vessels becomes completely obstructed, say by a rupture in a pre-existing plaque. Depending on the location of the vessel and the quantity of muscle it serves, different things might happen; arrythmias, muscle loss and valve dysfunction are the most common. Occasionally spectacular events occur like a rupture of dying muscle between the two main chambers, causing a large shunt to develop (usually a couple days after the vessel closes).

Often, but not always, a fatal arrhythmia called ventricular fibrillation develops, and this is the thing that makes you just keel over mostly dead (unless you get a countershock to fix it). Even a fairly teeny heart attack can cause this, so unfortunately when we say “massive heart attack” it’s just to make survivors feel better. You hate to tell family Dad might have checked out from the occlusion of some tiny Left Anterior Descending diagonal branch.

Anyway, even without any treatment at all, most people survive the occlusion of a coronary artery unless it’s a real big one like the Left Main Coronary Artery. If a small enough amount of muscle is involved, they may have no residual deficit at all and do fine until the next occlusion (most people have disease in more than one coronary artery). It’s very common for a patient to present with an EKG that shows old, “silent” infarcts. If a lot of muscle is lost, the degree to which disability is present depends on a number of factors; sometimes patients get cardiac aneurysms from floppy scar tissue; sometimes they lose enough contractility to be cardiac cripples from reduced output, etc.

In the olden days, treatment was rest. You’d get a heart attack and you’d get stuck in the hospital for a couple of weeks until you didn’t croak. Then you went home. With the advent of cardiac surgery starting back in the 60s, a long line of improvements has led to today’s very aggressive intervention for acute ischemia with the goal of rapid re-perfusion. Interestingly (and back when I first started my own training) there was a period of time when CV surgeons were nervous about re-perfusing acute heart attacks because they thought the newly injured muscle might be soft and become hemorrhagic. No more. It’s all about door to re-perfusion time in any good ED and cardiac facility. Generally the approach now is to rapidly diagnose with a cardiac cath, try opening the occluded vessel with balloon angioplasty, and off to bypass if all that craps out. Unless you are in Canada and have to queue up. Just kidding.

13

I can testify what they did 46 years from personal experience. I spent about two weeks in the hospital and then some amount of time confined to quarters (we lived in a 4th floor walkup and several friends carried me up in a chair, believe it or not). They certainly did know about smoking and I have not smoked a single cigarette from that day to this.

They did have diuretics in those days and I also took a blood thinner (coumadin) for about a year. Eight years later (1973), they put me on a beta blocker which had the effect of lowering my resting pulse rate to around 48. It blocks the body’s response to adrenalin and is sometimes used to overcome stage fright in actors or the yips in athletes. It also lowers the blood pressure somewhat. Interestingly, my uncle, who was a biochemist teaching in a med school, discussed me in 1973 with a cardiologist colleague who was surprised that I didn’t have a bypass. Well, I have seen some very bad outcomes among people with bypasses (as well as excellent outcomes, to be sure) and I am just as happy I have never had one.

About ten years I had a cardiac ultrasound examination and they could find no evidence of scar tissue. I guess the fact that I was 28 at the time of the attack meant that my heart could heal. I am convinced, without evidence, that it was the smoking that did me in. Perhaps I had a variant form of hemoglobin that was ultra-sensitive to CO. My wife says my complexion changed from yellow to pink when I stopped smoking.

14

Many people died if they had a heart attack. Many of my relatives and friends. One boy (in my high school) died of a sudden heart attack in his sleep. Life span was much shorter than now. My brothers (all 5) had open heart surgery,one had many operations and is still living at age 82 he will be 83 in June. Had my father or father in-law had the same surgeries they may have well lived for many more years!

15

I think I read death rates from heart attacks and strokes declined about 60% from 1950 to about 2000, and I think death rates declined about 30% from 2000-2010. So there have been tons of advances in averting/delaying death.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4830a1.htm

But my grandfather had his first heart attack in the 1960s when he was in his 40s. He survived, had 2 more (one when he was in his 60s, another in his 70s) and lived to be 81. People like LBJ had heart attacks and lived productive lives for years afterwards. An older coworker had her father have his first in this 30s, and he lived until his 70s and died of cancer, not heart disease.

My dad took the hint and tried to be proactive about his heart health since he knew it ran in the family. He was on several meds for hypertension, cholesterol, triglycerides, etc. He had a triple bypass when he was almost 60 anyway.

I guess I feel sort of despondent. If my dad took the hint and tried to be proactive (he was on at least 10 different medicines and supplements to help his cardiovascular system. Maybe 3 anti-hypertensives, 3 or 4 anti-cholesterol meds, blood thinners, various supplements, etc for years before his event. My dad works in medicine so he has good health insurance) and has 3 blockages before he is 60 anyway, then what is the use? But if people could survive even before all these meds, then maybe my dad, myself and my brothers all have hope. My grandfather survived a long time. Maybe all my dad did was delay his first heart attack with all those meds, but he still survived it.

I asked him why a stress test never detected the blockages and he said ‘I never got a stress test’. WTF. Why would you take all those medicines to overcome your genetic predisposition and never get a stress test to make sure they are working? He didn’t find out he had all those blockages until he had a heart attack at 2 in the morning one day.

16

I knew someone who had a heart attack at age 18. He died in his 60’s back in 1995-ish.

17

My father had one in 1962, when we were in the Congo. He was in the hospital for about two months before he stabilized enough so that we could go home. I’m pretty sure he was put on warfarin, but it was mostly bed rest.
He is still alive. He had another heart attack about four years ago - stents were put in, and he was out of the hospital, at 89, in 2 days.