Eugene Braunwald: Maestro Of American Cardiology
Perhaps more than any other academic physician, Eugene Braunwald, M.D., has guided the movement of cardiovascular research—recognizing the significance of disparate results and pushing the field forward from bench to bedside. Like a conductor who understands the importance of each note in a symphony, Braunwald is viewed by many as the “grand maestro” of American cardiology.
“He led a series of studies that transformed the face of cardiovascular medicine,” says Douglas Vaughan, M.D., former chief of Cardiovascular Medicine at Vanderbilt University Medical Center. During the past 25 years, in part because of research led by Braunwald, the percentage of people who die within a month of being hospitalized for a heart attack has plunged five-fold, from 20 percent to about 4 percent.
“That is an enormous difference,” says Vaughan, who was part of Braunwald’s research team in the late 1980s. “Every practicing cardiologist has to appreciate the impact of Dr. Braunwald’s insights and research in the mechanisms and treatment of acute myocardial infarction (AMI).”
Braunwald struck his first international chord as the lead author of a 1971 landmark study showing, in an experimental model, that the damage caused by AMI, a heart attack, could be limited by favorably altering the balance between the supply of and demand for oxygen in the heart.
Until that discovery, physicians had believed that once a patient exhibited symptoms of crushing chest pain, little could be done to affect the outcome. When patients with AMIs were rushed to the hospital, they were sedated, put on strict bed-rest and, if necessary, defibrillated. If they survived, they were sent home on various medications. During the next year, a quarter of the survivors died, usually of heart failure.
Braunwald was the first to challenge this laissez-faire approach to AMI. In 1967, while visiting the laboratory of Seymour Schwartz, M.D., a surgeon at the University of Rochester, he was shown dogs with experimentally-induced hypertension. Implanted stimulators of the animals’ carotid sinus nerves restored their blood pressures to normal.
At the time, Braunwald, at the ripe old age of 38, had already been chief of cardiology at the National Heart, Lung and Blood Institute, part of the National Institutes of Health (NIH), for eight years. Immediately, he and his colleagues began implanting stimulators of the carotid sinus nerves in patients, but for a totally different reason—to relieve angina pectoris (chest pain). Although this treatment worked, it was short-lived because of the near simultaneous introduction of coronary bypass surgery, which was a preferable way to correct the imbalance between the heart’s supply and consumption of oxygen.
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