For much of medical history, the cause of myocardial infarction remained unknown.
Chest pain had been recognized since antiquity, but its origin was unclear. It was referred to as “angina pectoris,” without a true understanding of what was happening within the heart’s arteries.
The turning point of the 19th century
In the 19th century, the first anatomical observations helped establish a link between the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that and certain sudden deaths.
Autopsies revealed the presence of lesions and obstructions in patients who had experienced chest pain. Gradually, the idea emerged that the heart could suffer from a reduced bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood supply.
Early 20th century: an incomplete understanding
At the beginning of the 20th century, myocardial infarction became better defined. It was recognized that an obstruction in a coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that could lead to the death of a portion of the heart muscle.
However, the cause of this obstruction remained uncertain. Until the 1970s, the prevailing explanation was based on the slow progression of an atherosclerotic plaque, eventually leading to complete blockage of the artery.
A feared condition… without effective treatment
At that time, a heart attack was a particularly feared condition.
Certain expressions reflected this reality: a major artery was nicknamed the “widow-maker,” and some electrocardiographic tracings were described as resembling a “tombstone.”
Therapeutic options were extremely limited. There was no specific treatment capable of addressing the underlying cause of a heart attack.
Management was mainly focused on relieving pain — particularly with morphine — strict bed rest, and careful monitoring for complications, especially heart rhythm disturbances.
Everything was done to avoid even the slightest effort, including the use of stool softeners to prevent straining.
Bed rest was enforced for several weeks, often around three weeks, followed by a very gradual return to activities.
After discharge, patients were advised to avoid physical exertion, emotional stress, and strain.
Despite these precautions, mortality remained high, reaching approximately 30%, or nearly one in three patients.
The first challenges to established thinking
In the 1950s, a different hypothesis began to emerge.
Sol Sherry proposed a new perspective: rather than a gradual obstruction, he suggested that a bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood clot plays a central role in the acute event.
His work showed that a treatment capable of dissolving this clot could improve outcomes, provided it was administered early—ideally intravenously within the first hours after symptom onset.
Despite its potential, this approach remained on the margins for many years. It challenged prevailing beliefs and originated from a field—hematology—that was not yet well integrated into cardiology at the time.
The revolution of the 1970s
At the end of the 1970s, a major shift took place.
Marcus Wood, a cardiac surgeon in the Philadelphia area, demonstrated—based on direct observations in patients operated on very early after symptom onset—that nearly 90% of myocardial infarctions were associated with a bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood clot abruptly blocking the artery.
These findings, supported by striking images, created a true shock within the medical community. They challenged the long-held belief of a slow, progressive obstruction and clearly established the central role of the clot.
Myocardial infarction was now understood as an acute, often sudden event.
This discovery marked a decisive turning point and profoundly changed the understanding of myocardial infarction.
The emergence of a modern concept: “time is muscle”
This led to the development of treatments aimed at rapidly restoring bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow.
The body has a natural system capable of dissolving clots, known as thrombolysis. This principle inspired the development of therapies designed to quickly eliminate the obstruction.
Early approaches used streptokinase, initially administered directly into the coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that.
A key question then arose: could the heart muscle recover if bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow was restored quickly?
Willie Ganz demonstrated that early reopening of the artery helps preserve cardiac function and limits long-term damage.
It was in this context that a fundamental principle emerged: the faster the artery is reopened, the more heart muscle is preserved.
Intravenous administration of thrombolytic therapy soon became the preferred approach, as it allowed for faster and more accessible treatment.
In the early 1980s, the GISSI group confirmed that early administration significantly improves survival.
Although this approach carries a risk of bleeding, it marked a major breakthrough: for the first time, it became possible to directly target the underlying cause of myocardial infarction.
A major transformation in cardiology
Within just a few years, the management of myocardial infarction underwent a dramatic transformation.
Coronary care units improved patient monitoring and reduced mortality by approximately 50%. At the same time, treatments aimed at dissolving the clot also led to a significant reduction in deaths.
As a result, mortality, which was around 30% in the 1970s, gradually declined to approximately 8%.
This progress is based on a now well-established understanding of the mechanism of myocardial infarction: the formation of a clot on a cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> plaque.
This discovery profoundly transformed cardiology and remains the foundation of modern treatment and prevention strategies.
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