History of Medicine

                                    EISENHOWER’S HEART 

      At about two AM on the morning of September 24, 1955, a severe chest pain awakened President Eisenhower. Thinking it related to a giant hamburger with onions eaten the day before, he got up to find some milk of magnesia. Mamie, hearing the noise, came in and, alarmed at her husband’s appearance, called their family physician, Dr. Howard Snyder. Dr. Snyder, residing nearby, arrived at about 3 AM at the home of Mamie’s mother, outside Denver, where the couple were staying. Eisenhower had suffered from abdominal

General Snyder, Eisenhower's personal
physician (Wikipedia)

pains for years, all through WWII in fact (with no clear diagnosis), and Dr. Snyder apparently thought this might be a manifestation of his usual disorder. He administered morphine which helped the pain. Events thereafter are confused due to differing reports, but it is safe to say that sometime in the late morning Snyder suspected a cardiac origin of the pain and called nearby Fitzsimons Army Hospital, requesting an EKG machine. The commander of the hospital and the chief cardiologist, Dr. Byron Pollock, came and quickly diagnosed an anterior myocardial infarction. 

         Ike was helped down the front stairs into the presidential limousine, driven by a circuitous route to avoid the press, and delivered to the back door of Fitzsimons Army Hospital. Once in bed, covered by an oxygen tent, he received more morphine, along with papaverine (thought to open up the coronary arteries), atropine (thought to help prevent arrythmias), and heparin, followed by Coumadin (for anticoagulation). Dr. Thomas Mattingly, chief of cardiology at Walter Reed Hospital and Dr. Paul Dudley White, who had been a mentor of Mattingly and was at the time probably the best-known cardiologist in the country, were called in for

Paul Dudley White, seated, next to Ancel Keys,
early advocate of Mediterranean diet, standing.
(National Library of Medicine)

consultation. They all concurred on the prescribed regimen. Eisenhower, unhappy about the previous cover-ups of the illnesses of FDR and Woodrow Wilson, ordered that the public be informed of events.

         Interestingly, during the previous few days Eisenhower had been fishing near the continental divide, at about 8900 feet, without any chest complaints. His blood pressure was known to be mildly elevated at times, especially when angry. His cholesterol was about 200, he was not overweight, he exercised regularly and, though previously a heavy smoker, he had given it up abruptly in 1949.

         The choice of Paul Dudley White (“P. D.” to friends) as the civilian consultant was a fortunate one. White was a founder of the American Heart Association, author of numerous books, including a standard textbook on cardiology, and a physician consultant to a number of celebrities. He had transported to the Massachusetts General Hospital their first EKG machine from the laboratory of Dr. Thomas Lewis, in London, in 1914. Equally important, White was smooth and tactful with the press.

         Eisenhower was not treated in a cardiac care unit at Fitzsimons. In fact, treating heart attacks at home was still a common and recommended practice. The first CCU in the world opened seven years later, in Kansas City in 1962. The essential components of a CCU, such as external pacemaking, electroshock for ventricular fibrillation, and closed chest massage for cardiac resuscitation were not worked out until 1960. Monitoring with oscilloscopes was possible, and drugs such as quinidine, procainamide, and digitalis were available, as was anticoagulation. CCUs proliferated worldwide once the necessary elements were in place. 

         Eisenhower’s clinical course was fairly smooth, though the infarct was a large one. Six weeks of bed and chair existence was the favored regimen at the time, followed by a gradual increase in exercise. Eisenhower left the hospital after seven weeks. About nine months later, he developed an intestinal obstruction, relieved by surgery, at which time the diagnosis of regional ileitis, or Crohn’s

Dwight Eisenhower during his second term
(Wikipedia)

disease, became apparent. It was certainly the reason he had had so much intestinal distress over the years. After a somewhat slow but steady recovery, Eisenhower ran for a second term as president and completed his time in office without major medical problems.

         In November 1965, now retired and in Georgia, Ike had another, milder, attack. After stabilization, he was transferred this time to a modern CCU in Walter Reed Hospital, where he stayed five weeks, still on the bed and chair regimen. Two and one-half years later, in California, recurrent chest pains landed him in the hospital at March Air Force Base from where he was flown back to Walter Reed. This infarction was complicated by multiple episodes of ventricular fibrillation, uncontrolled by drugs. It required a total of fourteen external shocks to Eisenhower’s chest before the rhythm settled down. “He died fourteen times,” it was said. Amazingly, he remained alert and calm through most of the ordeal. 

Walter Reed Hospital (Wikipedia)

But the old soldier’s time was running out. Before he could be discharged, another intestinal obstruction prompted a second operation that he endured successfully, though it weakened him. His heart failed to rally after the surgery, and he expired quietly on March 28, 1969. An autopsy confirmed extensive three-vessel coronary disease and scarring of the heart muscle. His final stay in Walter Reed Hospital had lasted for approximately ten months.

         Dwight Eisenhower’s staff generally reported his medical problems correctly, as he had asked, though sometimes minimizing their severity. And, importantly, Ike’s cardiac illness helped promote awareness and knowledge of heart disease among the general public.

P.S. Please visit the informative History of Medicine Museum of the Sierra Sacramento Valley Medical Society at: http://www.ssvms.org/museum.aspx

The exhibits and essays are well worth it.

 

SOURCES:

Lasby, Clarence G., Eisenhower’s Heart Attack: How Ike Beat Heart Disease and Held on to the Presidency. Univ of Kansas Press, 1997.

 

Diamond, E. Grey, ed., Paul Dudley White: A Portrait. Reprinted from Amer J Cardiology, 1965.

 

Fye, W. B., “Resuscitating a Circulation Abstract to Celebrate the 50^th Anniversary of the Coronary Care Unit Concept.” 2011; Circulation, 124: 1886-93.

 

Caswell, J.E., “A Brief History of Coronary Care Units.” 1967; Pub Health Reports 82 (12): 1105-7.

 

Herrick, J.B., “Concerning Thrombosis of the Coronary Arteries.” 1918; Trans Assoc Amer Physicians 33: 408-18.