HISTORY
“Sushruta Sanhita”, a great classic on the science of surgery, was introduced around 600 BC. Sushruta scientifically depicted the various aspects of human biology, anatomy and surgery with instrumentations in his book which earned him the title of “Father of Surgery” internationally.1 Similarly another stalwart physician Charaka possibly in the same era scripted the pharmacotherapy of various diseases in “Charaka Sanhita”.2
Indian documentation of description of heart dates back to the Charaka Sanhita and Sushruta Sanhita. Here, heart was described as the seat of consciousness and as a prime mover of “prana” or impervious energy. Heart being the center of the system, transmits energy through different “nadis” or channels, which were later on described as “siras” or veins, “dhamanis” or arteries and “srotas” or flow.2
Modern Cardiology became a reality as a superspeciality after the World War II. The advanced outlook and vision of a group of topmost Indian physicians under the leadership of Bharat Ratna Dr. Bidhan Chandra Roy led to official formation of the Cardiological Society of India (CSI) on April 4, 1948, even before the formation of the American College of Cardiology in 1949 and many others.3 The Official Journal of CSI, Indian Heart Journal, started with a modest beginning at Kolkata in 1949. Today the journal is very well accepted worldwide and is electronically uploaded.
CLINICAL CARDIOLOGY
The first full-fledged Cardiology Department came into existence at Vellore, Tamil Nadu, in the early 1950s. Near about the same time at Mumbai, Dr. Rustom Jal Vakil, a doyen in Modern Cardiology, while serving in Government institution of King Edward Memorial (KEM) Hospital, Bombay was able to identify a group of patients who were at high risk of developing acute myocardial infarction (MI) at a time when the concept of acute coronary syndrome was at its infancy.4 The mobile coronary care units were started in the early 1960s at Bombay.
There were noted teachers in all the corners of India, who contributed a lot to the understanding and conceptualization of clinical cardiology as a subject. Over the years, clinical cardiology has evolved in India and as in all the branches of medicine, more and more emphasis is being laid upon investigative cardiology. The stethoscope is slowly turning extinct. However, a sound clinical base is without doubt a necessity for a good practice and therefore more efforts need to be made to revive this dying art which we Indians were once recognized for.
INDIA AS AN INNOVATOR
For a large country as India, the list is small:
- Rauvolfia serpentina (Reserpine), an alkaloid from the extract of Rauvolfia was the first antihypertensive drug from India
- Sree Chitra Valves for valve replacement
- Indigenous Khalilullah-Mendez temporary pacemaker
- Kalam-Raju Stent for percutaneous coronary intervention
- Chiral Molecules with less side effects
- Redefining Yoga and Meditation in modern cardiology, as a therapeutic option for atherosclerotic coronary artery disease.
We as a country should start laying more emphasis on research and development, as the cardiac disease and the social factors, which our population faces, is so very unique in itself.
INVASIVE CARDIOLOGY
The first-ever cardiac catheterization laboratory for clinical studies was established in All India Institute of Medical Sciences (AIIMS), New Delhi, India. First coronary artery 4bypass graft (CABG) surgery was carried out by Dr K M Cherian in 1975 at Chennai. The history of first percutaneous transluminal coronary angioplasty (PTCA) is interesting. As per the record, the first ever PTCA was done in 1984 on right coronary artery (RCA) of a post-MI patient with DJ balloon with J-tipped wire at AIIMS, New Delhi. It started a revolution and no other field of medicine has grown at such a rapid pace as interventional cardiology. India has kept up with the rapid pace and Indian interventionists are today recognized as one of the finest in the world.
India has been in the forefront in the application of all the techniques, innovations and modalities in interventional cardiology. Right from the latest stents, diagnostic applications, like intravascular ultrasound (IVUS), optical-coherence tomography (OCT), fractional flow reserve (FFR), implantable cardiac-defibrillators (ICDs), cardiac resynchronization therapy (CRT) pediatric interventions; all have found day-to-day applications in regular practice.
Cardiac surgery has also made huge strides and more and more complex surgeries, adult and pediatric are routinely done all over the country. It is a matter of pride for India that the tide has turned and today patients from other countries routinely travel to India for complex cardiac interventions and surgeries.
NONINTERVENTIONAL CARDIOLOGY
Echocardiography, the real stethoscope for cardiologists came to India for the first time in KEM Hospital and Port Trust Hospital, Mumbai in 1974–75, when only M-mode echocardiography was performed. In mid-to-late 1980s, the two-dimensional (2D) echocardiography facility reached the rest of India on a regular basis. Today we have evolved tremendously and Echo laboratories are seen at the smallest of centers. Nuclear medicine, cardiac computed tomography (CT) and cardiac magnetic resonance (MR) are as of now still restricted to the major cities, though.
CARDIOLOGY AND THE FUTURE
Cardiology is a very dynamic branch, and at the same time is also very demanding. It is one of the most satisfying fields from the physician's point of view. More and more innovations are bound to be seen in the future, given the prevalence of the disease. The onus lies on us to not only keep ourselves abreast of the latest developments which the West offers us, but to develop a keen interest in the innovation, research and development of newer unique techniques in treating our people.
REFERENCES
- Hati AK. Ayurveda: fundamental concept. In: History of Science in India: Medicine and Pharmacology. Volume II. The National Academy of Sciences India (NASI) and The Ramakrishna Mission Institute of Culture; Kolkata, India: 2014. pp. 41–2.
- Hati AK. Ayurveda: history of ayurveda. In: History of Science in India: Medicine and Pharmacology. Volume II. The National Academy of Sciences India (NASI) and The Ramakrishna Mission Institute of Culture; Kolkata, India: 2014. pp. 83–8.
- Padmavati S. Development of cardiology in India: are we on the right track. In: Chopra HK, Nanda NC (Eds). Textbook of Cardiology: A Clinical and Historical Perspective, 1st edition. Jaypee Brothers Medical Publishers; New Delhi, India: 2013. pp. 3–4.
- Das MK, Kumar S, Deb PK, et al. History of cardiology in India. Indian Heart J. 2015;67(2):163–9.