President Dwight D. Eisenhower used a stethoscope to listen to the heartbeat of Paul Dudley White, the doctor who treated him for a heart attack. (American Heart Association)

Michael Marshel, American Heart Association News

Heart disease is not new to the White House.

But in a century of presidential heart crises, none affected America more than Dwight Eisenhower’s heart attack in 1955. The incident first shocked and then enlightened the public. And it highlights just how much researchers have learned about heart health just before an era of rapid scientific advancement.

The list of presidents who have suffered from cardiovascular disease over the past 100 years is almost as long as the list of presidents. President Franklin D. Roosevelt died of a stroke at the age of 63 while in office. Four years after leaving the Oval Office, Calvin Coolidge died of a heart attack at age 60. Lyndon Johnson suffered a heart attack before ascending to the White House and died of a heart attack at the age of 64 after he left office.

George H.W. Bush, 66, was treated for atrial fibrillation, a type of arrhythmia, while in office. After he left office, Bill Clinton required quadruple coronary artery bypass surgery in 2004 at age 58 and stent surgery in 2010.

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It’s just a sampling. Eisenhower’s heart attack stands out because it occurred at a time when people were paying more attention to cardiovascular disease, but even doctors knew surprisingly little about it.

“The term ‘risk factor’ just didn’t exist,” says Dr. Thomas H. Lee, chief medical officer at consulting firm Press Gainey. “So the idea that you could predict who was at risk didn’t exist.”

Lee, who wrote an article about Eisenhower’s case in the New England Journal of Medicine in 2020, said the heart attack at the time “came out of nowhere and was bad.” Even among those taken to the hospital, the mortality rate was as high as 40%.

Mr. Eisenhower’s case began on the afternoon of Friday, September 23, 1955, at a golf course in Denver. The World War II hero elected in 1952 complained of indigestion. He blamed his discomfort on his lunch, a hamburger with Bermuda onions.

But shortly after midnight, he woke up with severe chest pains. His wife, Mamie, called his doctor, who arrived at 3 a.m. What treatment the president received next is up for debate, but it is likely that the main treatment attempt at that point was simply administering morphine for the pain. It wasn’t until the next afternoon that an electrocardiograph was brought in to measure the heart’s electrical activity.

It was after Mr. Eisenhower woke up at 1 p.m. that the device was used to confirm that Mr. Eisenhower had suffered a severe heart attack.

“When you look back at his care back then, it’s really remarkable how different it was today,” said Dr. Adrian Messerli, section chief of interventional cardiology at the University of Kentucky in Lexington. Ta. Messerli co-authored an article about Eisenhower’s heart attack for NEJM’s 50th anniversary.

Messari said the slow pace of care for the president stands in contrast to what is done today. We now know that every second counts, which is why you should call 911 immediately if you experience symptoms of a heart attack. The patient is rushed to the hospital, immediately given an electrocardiogram and sent to a catheterization lab for a procedure to remove the clogged artery.

In 1955 that was almost impossible.

There was no coronary artery disease treatment unit. CPR and portable defibrillators were not provided for those who went into cardiac arrest. All of that happened a few years later, said Lee, who is also a senior physician at Brigham and Women’s Hospital in Boston.

“It was a great consideration to put people to bed and hope for the best,” he said.

News of the president’s heart attack was frightening because there was no effective treatment. Then-U.S. Surgeon General Dr. Leonard Scheer equated his shock to what he felt after the attack on Pearl Harbor. On Monday after the news broke, the Dow Jones Industrial Average fell 6%, with a $14 billion loss, the largest since the 1929 crash.

Dr. Paul Dudley White of Massachusetts General Hospital in Boston stepped into this terrifying atmosphere. He was summoned by a military doctor and flown to Denver on Sunday.

White helped found the American Heart Association in 1924, treated people like Andrew Carnegie and William Randolph Hearst, and was “perhaps the most respected physician in this country,” Lee wrote. There is.

President Eisenhower ordered his press secretary to “tell everything,” paving the way for an unprecedented public discussion of his health. White reviewed the president’s records, consulted with his doctor and examined the man.

And before a packed news conference Monday morning, White seized the opportunity to not just discuss the president’s prognosis, but to teach.

“On that day, for millions of Americans, heart attacks became less mysterious and less scary,” Lee wrote. “And Mr. White gave them the message that they can take steps to reduce the risk.”

White explained that the president’s problems have nothing to do with golf or Denver’s highlands, as some have suspected. He detailed a disease process he called “coronary thrombosis,” in which blood clots block the flow of blood to the heart.

From the forefront of understanding, White said heart attacks can be related to factors such as diet, alcohol, tobacco, exercise and family history.

Importantly, Lee said, White also expressed honest hope about the president’s chances of recovery. Importantly, White also said that a heart attack does not mean the end of a productive life, as many people thought at the time.

The people listened. As Clarence G. Rusby wrote in his 1997 book, “Eisenhower’s Heart Attack: How Ike Overcame Heart Disease and Stayed in the Presidency,” White went to Denver as a consultant. Ta. After a few weeks, he became a national celebrity.

White’s thoughts on heart health became front-page news. “I spoke with the state over the next few weeks, just as I have spoken with the families of many civilian patients,” Rusby is quoted as saying.

The immediate effect was to dispel the notion that heart attack survivors are doomed to do nothing. Messerli also said that over time, White’s message “may have improved the public’s tolerance for funding cardiovascular research and medical research in general.”

White’s accomplishments did not necessarily include curing the president.

“I think he survived despite all the precautions,” Messerli said. “So it’s highly unlikely that the medical therapy he received at the time had a significant impact on the outcome of his heart attack.”

However, Eisenhower recovered and won reelection in the 1956 election. And he took for himself some steps to help heart health that doctors recommend today.

Rusby wrote that Eisenhower was “far ahead of the field” in following White’s advice on the importance of exercise and a low-fat, low-cholesterol diet. A former four-pack-a-day smoker, he quit cold turkey in 1949. He was watching his weight carefully. And after reading about the president’s cholesterol-lowering diet in 1959, one doctor joked that he became more concerned about his cholesterol levels than his golf scores.

But his cardiovascular problems weren’t over. Eisenhower suffered a stroke in 1957, which affected his language abilities. Another heart attack in 1965 ended his participation in public life. He died in 1969 at the age of 78 from congestive heart failure.

Eisenhower lived long enough to benefit from a series of treatments developed in his later years, Messerli said. Eisenhower was one of the first to benefit from the defibrillator, introduced in 1962, which can shock the heart back into its proper rhythm. During one hospitalization in 1968, Eisenhower received multiple shocks. “Every time it’s administered, you can claim it saved his life,” Messerli said.

Late in life, he was considered for then-new treatments, including coronary artery bypass surgery.

Heart attack treatment entered a new era in 1977 with the successful pioneering of balloon angioplasty, which involves inserting a balloon through a catheter to open a blocked artery. Thanks to these treatments, and the introduction of blood clot-dissolving drugs in the 1980s, today the 30-day survival rate for severe heart attacks is about 90%.

Messerli said looking back at these advances makes him excited about today’s new technologies. “With the right research and funding, he is humbled to think where we could be in 80 years.”

Although Mr. White is known today for educating people about heart health with kindness and compassion, Mr. Eisenhower’s feelings toward Mr. White cooled because he perceived Mr. White to be a “propaganda guy.” Rusby wrote. But the author credits the president and the doctor with helping unleash “an unparalleled flood of knowledge that constitutes this country’s first full-scale study of our most devastating disease.”

In 1955, the editors of U.S. News and World Report, in a letter to the president, noted numerous requests for reprints of interviews with heart experts and wrote, “Because of your illness, America… “The public is better educated than ever before about the heart and its diseases.” It happened before. ”

Army physician Thomas Mattingly, who oversaw most of the president’s care, said of White, who died in 1973 at the age of 87, that “all the victims of coronary artery disease who survive today are grateful for his help.” I am doing it,” he wrote.