President Eisenhower Changed the Way Doctors Treat Heart Attacks


president eisenhowerOn Sept 23, 1955, the President of the United States, Dwight D. Eisenhower, was staying at his in-laws’ house in Denver and went to play golf at the Cherry Hills Country Club.  There he suddenly developed pain in his chest and belly.  That evening, he had dinner with his physician, Major General Howard Scrum Snyder, and went to bed early, still complaining of pain. At 2 AM, the pain became so severe that the president’s wife, Mamie, called Dr. Snyder.  At 3 AM, a major general in the United States Army made a medical house call  for the only time ever.  However, Dr. Snyder misdiagnosed Eisenhower's chest pain for another episode of intestinal cramping because the president had a long history of recurrent ulcers in his intestines, called Crohn's disease.
It wasn’t until the next afternoon that an electrocardiogram showed that the president had had a left anterior heart attack.  He was transported by car to Fitzsimmons Veterans Hospital and placed in an oxygen tent.

Complete Bed Rest Is Wrong
His doctors listened to his heart and heard a grating sound called a friction rub. They interpreted this sound as a sign that the president might have an aneurysm, a ballooning of an artery carrying blood from his heart, that could rupture and kill him instantly.
They put him on absolute bed rest and did not allow him to move for several days.  Doctors don't do that today because inactivity increases the likelihood of forming clots that can block arteries leading to his brain, heart and lungs to cause strokes, heart attacks, and lung clots.  
Paul Dudley White Saved His Life
After a few days of prescribing absolute bed rest, the doctors finally requested a consultation from Paul Dudley White, a Harvard physician and the father of cardiology in the United States.  White came to the president’s bedside, examined the president and immediately told the attending doctors that Eisenhower did not have an aneurysm of his heart. He immediately got him up from his prone position in bed and sat him up in a chair. The president’s chest pain became so severe that they had to put him back in bed. The next day, Dr. White got Eisenhower out of bed again and encouraged him to exercise, which at that time was revolutionary.  Doctors now recommend exercise for all heart attack patients as soon as they dare.
Like Me, Paul Dudley White Rode a Bike
In 1913, Dr. White took his residency at the Massachusetts General Hospital and eventually became chief of Cardiology there.  In 1962, I was a resident at the Mass General Hospital and I remember seeing the 77-year old White come to work on his bicycle. He continued to ride his bike to work into his eighties. I am now 82 and still do interval training and ride more than 150 miles a week on my bike.  The difference between Dr. White and me, at the same age, is that I am retired, while he was still working. Retirement is too rewarding to ruin with the stress of having to go to work.

Smoking Causes Heart Attacks
In March 1949, six years before Eisenhower's first heart attack, Dr. Snyder had told him to reduce his smoking from four packs of cigarettes per day to one pack. However, Eisenhower quickly learned that counting cigarettes is more difficult than not smoking at all, so he gave up smoking altogether.
Lifestyle Changes to Avoid Heart Attacks
Dr. Snyder told Eisenhower that if he wanted to live, he had to change his lifestyle dramatically.  Snyder told Ike to exercise, cut back on eating meat, take an anti-clotting agent called Coumadin, eat a low-fat diet and maintain his weight at 175 pounds.  Ike went on for six more years as president and retired to an active life of almost daily golf until he died 14 years later.
Low-fat Diet Recommended at That Time
This was the first time that the press extensively reported that heart attacks might be caused by cholesterol and saturated fat. Researcher Ansel Keys of the University of Minnesota claimed that a low-fat, high-carbohydrate diet could prevent heart attacks. He was wrong because most people replaced saturated fats in animal food (meat, chicken, eggs, dairy) with refined carbohydrates made from flour and sugar and that bad advice increased the rate of heart attacks rather than reducing it, as Keys expected (Clinical Pharmacist, Jul 14, 2017;9(8)).  Now we know that dietary cholesterol (from foods such as eggs) does not cause heart attacks (Am J Clin Nutr, August 2015;102(2):276-294), and saturated fats in meat are not the factors that cause heart attacks (Ann Intern Med, March 18, 2014;160;398-406).  Meat is certainly associated with increased risk for heart attacks (Archives of Internal Medicine, November 12, 2012), but it does so probably because of other factors such as a sugar-protein called Neu5Gc or the components in meat that are converted to TMAO by bacteria in your colon. 
Preventing heart attacks requires more than reducing your intake of red meat, stopping smoking, losing weight and exercising regularly (Br J Sports Med, 2017 Aug;51(15):1111-1112). You should also limit fried foods and all refined carbohydrates, including sugared drinks, sugar-added foods and those made from flour such as bakery products, pastas and most dry breakfast cereals. The people who are particularly susceptible to heart attacks from eating refined carbohydrates are those who are overweight, diabetic, have high blood cholesterol levels and high blood pressure, and store their excess fat primarily in their belly (Journal of Clinical Investigation, September 26, 2016).

Ike Didn’t Change Enough
From April through August 1968, Eisenhower had four heart attacks and his heart stopped beating 14 times. At 12:25 PM on March 28, 1969, President Eisenhower died of heart failure at the too young age of 79.
October 14, 1890 – March 28, 1969