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Acute Coronary Syndromes

In the 1920s and 1930s, it was believed that people suffering acute coronary thrombosis could not survive.  Admissions to hospital were rare, and such a diagnosis was generally made at autopsy.

Clinical diagnoses of acute myocardial infarction / coronary occlusion began to be made in the 1940s and especially in the 1950s.    Realising that some of these patients could survive, measures were taken to improve outcomes, but which in some cases had the opposite effect.
It became commonplace to insist that such patients be kept in bed for several weeks.
In 1952, there were 174 admissions with a primary diagnosis of acute myocardial infarction.   There were 52 hospital deaths (30%) after a median 6 days in hospital.  The 122 patients who were discharged alive had a median length of stay of 40 days.

These patients were admitted under the care of general physicians and there was no continuous ECG monitoring.   Eventual ambulation was taken very slowly, and even after discharge from hospital, activities were significantly limited.
In hospital, morphine was used for pain relief together with nitroglycerine for interval angina.  It was not uncommon for complications of prolonged inactivity in bed to occur, notably venous thrombosis and pulmonary embolism.  It became fashionable in the 1950s to place all AMI patients on coumadin or dindevan, not just for venous thromboembolism prevention but also in the belief that there might be benefit at a coronary artery level.
The practice described above was still in place in the early 1960s - I well remember such patients when I was a house physician in 1961-62.