Tuesday, October 29, 2013

Cardiology History 101: Lessons Learned from the Civil War

By Dr. Stephen Sinatra

I've had a longtime interest in the Civil War. In fact, some of my patients in Connecticut may recall how my waiting room was decorated with my collection of Civil War generals and battle scenes. So, this summer I was delighted to take in the annual Deep River Ancient Muster, a two hour event with fife and drum corps.

My wife feels strong ties to this town because it was her paternal grandfather's hometown, and he often brought her there to visit his family. Little did either of us realize that this sleepy little village hosts the largest fife and drum corps muster in the world! Its impact on me was palpable.

Decades ago my Civil War curiosity involved taking my kids to visit Civil War battlefields between New England and Atlanta, Georgia. But it took this summer's muster—and hearing the marching band music that originated as far back as the American Revolution—to help me envision the sounds on the battleground. I listened to the antique musket-fire, the fifes, the drums, and the cadence of the feet and imagined the call to arms, battle cries, the thunder of cannons, and cries of agony.  

That experience reminded me cardiology has some pretty impressive historical roots that date back to that sad time. What was then referred to as "soldier’s heart" was a set of symptoms very similar to what we know of as heart disease now. Some of those poor soldiers—many of whom were very young men, and even boys—had complaints that were at first written off as lack of sleep, or "bad food." They would report shortness of breath, fatigue with exertion, inability to keep up with comrades, palpitations of the heart, sweating, dizziness, and even chest pain.

This condition was eventually referred to as "Da Costa's Syndrome," named for Jacob Mendes Da Costa—the physician and surgeon who investigated and described the disorder back then. He worked in Union hospitals and observed patients with what he called an "irritable heart." Yet, they didn’t exhibit any of the physical abnormalities he expected to find with an irritable heart, such as an enlarged or dilated heart. In his 1871 report of 300 soldiers, he also described GI ailments, diarrhea, and high fevers in those with more advanced cases.

Moreover, Da Costa identified rapid heart rates that were extremely influenced by body position. This kind of "orthostatic intolerance" is also seen today in medical conditions such as mitral valve prolapse, postural orthostatic tachycardia syndrome (POTS), and chronic fatigue. He also observed symptom relief in more severe cases when the soldier was removed from the stress. Da Costa’s Syndrome has been described as both an anxiety disorder and a neurological condition—known also as battle fatigue. It laid the foundation for what we call post traumatic stress disorder (PTSD), which is a condition that affects many people today.

Yes, you may not know it, but the Civil War taught us a lot about the effects that chronic, unrelenting stress has on the heart. As I've mentioned before, the many forms of human heartbreak can also impact the heart catastrophically. Today, our soldiers continue to serve and remind us of the huge impact unrelenting stress can have on the body.

So, what’s the takeaway here? If you’re having any cardiac symptoms, and think stress has any role to play, take action. Do NOT underestimate the fact that stress can kill. Maybe you are at war with yourself. Maybe your battlefield is the office, or your home situation, finances, or a family member's illness. Remember, you don't have to be under as much stress as our veterans have experienced for your own heart to be affected. The first step is recognizing that it's a problem, just like Dr. Da Costa did, and see your doctor for a thorough evaluation.

Excerpted from: drsinatra.com

IMAGE: Jacob Mendes Da Costa


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