The failing myocardium. Historical notes

The management of the failing myocardium was primarily empirical for centuries, until Withering introduced foxglove (digitalis) in 1785 as an effective medication. Gradually, the medical treatment included, besides digitalis preparations, the use of diuretics to reduce excessive sodium and water retention; limiting salt and water intake; and the administration of drugs to combat vasoconstriction, irregular rhythms, and hypertension. Cardiac surgery emerged for the correction of mechanical lesions while relieving the strain on the myocardium, first in patients with congenital heart diseases and then in those with acquired disease, by closed and then open techniques. In arresting the heart for more precise surgery, the combination of hypothermic and potassium-induced arrest proved to be minimally damaging to the myocardium. However, the search goes on. Mechanical cardiac assist apparatus have been successful in buying time for salvage of patients with failing myocardia refractory to conventional methods. Heart and, more recently, heart-lung transplantations are now having long-term survival. The opportunity for me to present these historical notes is a great privilege , since I have been involved in the problems of heart surgery for more than four decades.