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Coronary heart disease: historical perspective


U. Ralapanawa

University of Peradeniya, LK
About U.
Department of Medicine
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Cardiovascular disease is the leading cause of mortality and morbidity worldwide. The 2011 annual report from the World Health Organization mentioned that, coronary heart disease and cerebro-vascular disease which were reported as the top two causes of mortality in 2004, are predicted to remain the major cause of death in the next 20 years. Coronary heart disease(CHD) and atherosclerosis were once thought to be a disease of modern humankind linked to modern lifestyle. However, researchers dispute this and has confirmed that atherosclerosis was common in preindustrial inhabitants too. Further, vascular system studies of mummies give substantial evidence of atherosclerosis as ancient human disease and clinical syndrome of angina pectoris existed in ancient Egypt. In 1768 the paper presented at the Royal College of Physicians in London on “Some account of a disorder of the breast” was an eye opener to medical professionals and later this excruciating “disorder of breast” was linked to the “hardening of the arteries’’. In the past it was generally believed that MI virtually always resulted in death and identified in postmortem. In1878, the first case of coronary occlusion diagnosed during life was described. ECG was used to diagnose the condition in 1912 and the use of current 12-leads ECG became accepted practice since the 1950s. In addition to clinical evaluation and ECG, cardiac biomarkers play a pivotal role in diagnosis and management of acute coronary syndrome. Aspartate aminotransferase became the first biomarker used to diagnose and subsequently CK-MB isoenzyme, lactate dehydrogenase and myoglobin played very significant roles. Troponin is now considered the ‘gold standard’ biochemical test for the diagnosis. The definition, diagnosis, management and prognosis of coronary heart disease have changed over the decades with the development of medical science and knowledge. It is therefore interesting to appraise the historical aspect of evolution of CHD definitions and diagnosis. Moreover, clinicians should have updated knowledge on the evolution of definition, diagnosis, management and prognosis of this condition.
How to Cite: Ralapanawa, U., 2021. Coronary heart disease: historical perspective. Sri Lanka Journal of Medicine, 30(2), pp.22–29. DOI:
Published on 30 Dec 2021.


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