The state of medicine in the US in the late 1970s?

[SunnyOne]

I know the late 70s was a long time ago, but I am wondering if anyone here might have knowledge of the medical care available in that era.
The reason I ask is that I've recently come across some things that belonged to my father who passed away in the late 70s, very suddenly and
unexpectedly. He was only 42 years old. I was just a kid.
There are a lot of questions and I guess I'm only wondering out of pure curiosity.
What I know is that he suffered an unexpected nosebleed and felt unwell, so he went to a local doctor
who determined he had high blood pressure. He was given medicine and sent home.
The next day he suffered - what we were told - was a "massive coronary".
He was in intensive care for several days, then sent home with medicine. He never felt well again.
He died at home, in front of us, two weeks later.
He had never been hospitalized before and wasn't being treated for heart disease - I guess in one's early 40s...it's totally unexpected.

Here are my questions:

The small town hospital never transferred him to a larger city hospital with a cardiology dept.
My own elderly mom in 2021, was transferred from the same small hospital to a large city hospital because of COVID, so I know they do transfers.
Were hospital transfers not as common years ago?
What kind of treatments were available for heart disease in the late 1970s?
obviously, no catherization? no stents? no bypass?
Were there any screening tools in the 1970s for heart disease?
I remember him talking about cholesterol, but only dietary cholesterol.

His parents lived into their 80s. His only sibling, a brother, is still alive at age 85.

There's just always been something freakish about it - the suddenness, his young age and the fact that the rest of his immediate family lived much longer than he did.
I know, I know, things happen....but we are entitled to wonder about them.

 

[gianmatt]

This will sound hard to believe, but the fact that almost all heart attacks are caused by blood clots in one of the coronary arteries was not discovered until 1976, and didn't gain widespread support until the 1980s.

There obviously wasn't any such thing as a CT Calcium scan which could show buildup in your arteries.

Stress tests were around, but maybe the doctors wouldn't have thought to use one on a 42-year-old... not for a nosebleed.

 

[SunnyOne]

thank you....it helps to get an understanding of the clinical environment at that time. It does make me wonder however what they thought was causing those symptoms.

 

[gianmatt]

We have come a very long way in 50 years. Anti-clotting drugs weren't even developed until the 1980s.

 

[RetMD21]

I agree that this is weird. I would be skeptical of the diagnosis. I wonder how high the BP was.

 

[Koolau]

I have a heart murmur which a cardiologist couldn't figure out ca 1977. He kinda figured it to be mitral valve prolapse but the testing at the time was fairly primitive. The doc ordered a echo-cardiogram. The unit was so new that it was housed in a (wait for it) storage room (along with extra hospital beds, chairs, piles of scrubs and sheets, etc.) The technician spent over an hour but could never visualize my mitral valve. She did see the others and no problem was found SO, the doc, once again concluded that it MUST be the mitral valve. He strongly pushed me to have an angiogram to find out "for certain" since mitral valve prolapse can be life threatening in some cases.

So I did the agngiogram and it didn't answer the question. Still, the assumption was that it had to be mitral valve prolapse.

FF to the late 90s. I had some symptoms (probably just A-fib coming and going.) My "new" cardiologist ordered a stress echo cardiogram. This time, the results were crystal clear (so clear I could see the doppler results in real time) I had a small irregularity in my aoritc valve leading to a small % of regurgitation. No mitral valve prolapse. Murmur "solved."

It's amazing how far we've come in diagnostics in 25 years. Late 70s were sort of the "stone age" by comparison to even 2000 - and especially to today. YMMV

 

[motley]

Yeah it seems they knew little about heart attacks then. Like it was something you had and "recovered" from like a concussion or something...not realizing the cause was still there lurking and ready to strike again. I think common understanding about the link to cholesterol wasn't there either.

 

[Lorenzo]

My dad had his first heart attack in the late '60s when I was just a few years old, and after that he got regular cardiac checkups--EKG with the technology of the day, etc.--and followed a diet recommended by the MD: low fat, substitute margarine for butter. Hoo boy, what we know today about trans-fats, right? I recall one day in the late '70s him musing to me about his own father (my grandfather, who died from a heart attack before I was born), saying, "I sometimes wonder if my father would still be alive today if back in the '50s they had had the kind of medical knowledge they do today." In the early '80s he had his second heart, which he didn't survive.

So I suppose when it comes to improvements in medicine it's all relative. Maybe in 20 years today's knowledge will seem primitive.

 

[JoeWras]

Progress seems to have come in bunches in the early 70s, mid 80s and then 90s. Before the late 60s, they didn't do a whole lot except support. My grandmother died of an MI in the hospital in the mid 60s. According to my mom, they didn't do much except watch her. Mom watched her die days after the initial incident. Her outcome would be much different today.

In the late 70s, just like your dad, my uncle (grandmother's son) had a huge MI outdoors in large metro area around Chicago. This is how my cousin tells it: Ambulance was called and it was a like a scene from "Emergency". He got good support on the way to the hospital and didn't go into v-fib until in the hospital, where they had to shock him. He got much better support in the hospital since they knew about the post-MI effects and knew how to manage them. There was no balloon angioplasty. Bypasses were around, but he was high risk so no bypass. He was managed with the usual stuff thereafter like nitro. He eventually had a bypass in the mid 90s and that kept him going another 20 years. Today, they would have done many more significant interventions for him right away.

My uncle said the hospital was great and they saved his life. His trip to this major regional hospital was a short drive. I'm going to suspect that the differences of care for your dad vs my uncle come down to major metro area versus rural. I can't answer why he didn't get a transfer. Things have changed a lot in that time, and the increased urgency of care is one reason society spends more on health care today than then. That's a good thing.

Here's a pictorial article of progress: Infographic: History of heart care
Here's a more technical discussion about advancements: Cardiology's 10 Greatest Discoveries of the 20th Century

 

[SunnyOne]

Thank you Joe...it really helps me to see the bigger picture. I do recall now that my dad brought home a bottle of nitroglycerin pills and kept those with him at all times...I am going to take a wild guess that maybe the nitro was intended to help give a patient more time to survive until they reached an ER and more help could be administered.?

Thanks again every one. This is an emotional issue for me and yet, I still wanted to dig a little deeper into what may have happened based on what was available at the time.
In spite of all the things I miss from the past decades that are no longer, I am still very grateful for medical advances.

 

[EarlyandLate]

I grew up around the medical community in the 1960's and '70's. Many doctors smoked. There were ashtrays in the office waiting rooms and doctors' lounges in the hospitals. It seems crazy now. There was far less knowledge of and appreciation for cardiovascular health.

 

[Koolau]

I grew up around the medical community in the 1960's and '70's. Many doctors smoked. There were ashtrays in the office waiting rooms and doctors' lounges in the hospitals. It seems crazy now. There was far less knowledge of and appreciation for cardiovascular health.

I still see a lot of hospital staff hanging out just behind the building - smoking! What's up with that? Should I trust these professionals with my life since they seem not to value their own?

 

[ncbill]

Dad's older brother was a bank examiner & while working in small town back in the late 1970s he had what the local hospital called indigestion...which was instead a major coronary.

Lots of heart damage...drugs worked for years but eventually he had to have a transplant, & nearly died while waiting.

Unlike my dad his brother always was athletic & ate healthy.

 

[Turbo29]

Thank you Joe...it really helps me to see the bigger picture. I do recall now that my dad brought home a bottle of nitroglycerin pills and kept those with him at all times...I am going to take a wild guess that maybe the nitro was intended to help give a patient more time to survive until they reached an ER and more help could be administered.?

Thanks again every one. This is an emotional issue for me and yet, I still wanted to dig a little deeper into what may have happened based on what was available at the time.
In spite of all the things I miss from the past decades that are no longer, I am still very grateful for medical advances.

Nitroglycerin was and is prescribed for angina pectoris (chest pain). I would guess that if your father carried the bottle with him at all times that he suffered from that. This would seem to indicate that the heart attack didn't come out of the blue and that perhaps he was being treated for cardiac symptoms. My father also carried a bottle with him at all times, suffered from chest pains, and died of a heart attack at 47yo.

 

[SunnyOne]

Nitroglycerin was and is prescribed for angina pectoris (chest pain). I would guess that if your father carried the bottle with him at all times that he suffered from that. This would seem to indicate that the heart attack didn't come out of the blue and that perhaps he was being treated for cardiac symptoms. My father also carried a bottle with him at all times, suffered from chest pains, and died of a heart attack at 47yo.

I guess my last post wasn't clear. He was only prescribed nitroglycerin after his first heart attack and hospital visit....so basically, he only had his prescription for a couple of weeks until he passed away.

 

[SunnyOne]

I guess my last post wasn't clear. He was only prescribed nitroglycerin after his first heart attack and hospital visit....so basically, he only had his prescription for a couple of weeks until he passed away.

Also, I am sorry for your own loss as well. if I may, what year did your father succumb?

 

[Turbo29]

Also, I am sorry for your own loss as well. if I may, what year did your father succumb?

He actually had his first heart attack in 1957 at the age of 35. I was two so I don't have memories of the treatment until later, in the late 1960's. Basically, it was rest and take it easy (definitely no advice to do any sort of exercise). I remember having the distinct feeling that one was supposed to just wait until another, probably fatal, heart attack hit. And hit it did, in 1970.

 

[SecondCor521]

Miscellaneous:

My Dad was a medical doctor who stopped smoking cigarettes in the mid- to late-60s. The story I was told was that he was persuaded by my sisters to give them up. @Koolau, I understand that nicotine is highly addictive. It's very easy to start smoking for bad reasons when young and then find it hard to kick the habit.

My Dad was not a heart doctor, but in his area of practice transfers to the next tier up of medical care were typical. The main trick is that it can be hard to determine - I don't think there are any hard and fast rules - whether a transfer is necessary or not. In borderline cases the doctors might consult among themselves. But back in the 1970s, the doctors were fewer and overworked, so some may have reasonably chosen to make a command decision. My guess is that the doctor caring for OP's Dad felt that s/he could handle his care.

OP, if you can make friends with a cardiologist and have a lot of your Dad's medical records, you could ask the cardiologist to take a look and give you their opinion. However, I'm 99% sure their opinion is going to be: "Well, it sounds like X, but it could also be Y, or Z." The original doctor probably took reasonable actions based on medical practice at the time.

If not - if there is any possible malpractice - you're probably not going to get satisfaction. Doctors are loathe to accuse each other or confirm suspected malpractice. There almost certainly won't be any damning notes or smoking guns in the records. And the original doctor has almost certainly passed away by now.

Bypasses were being done in the 1970's I'm pretty sure. The very first heart transplants were done in the late 1960s in Texas (my Dad worked with that doctor), but I think they were highly experimental at the time and not anywhere near as common.

Sorry for your loss, and I can see why you'd wonder about it.

 

[6miths]

Very sorry for your loss of a parent at such a young age and the angst of revisiting now.

The first human to human heart transplant was done in Capetown, South Africa. The first coronary bypass (CABG) was done in the USSR. The procedure was refined in many different countries with an Argentinian surgeon responsible for many refinements. Looking at the coronary arteries with radioopaque dye and X-ray came online in the mid-60s but there was really little in the way of treatment. CABG did not really get going until the mid-to-late 70s, only in a few centres and usually only for those who had survived an initial MI and recovered well from it. There would not have been many transfers in the 70s because, unlike today, there was no immediate intervention that required special care.

It is true that aspirin (an antiplatelet agent) was not used until the 80s but it had been recognized much earlier that most MIs (sorry myocardial infarctions - what most people call heart attacks) were associated with a blood clot found in a diseased and damaged coronary artery. The damage is largely caused by smoking, high blood pressure, diabetes, altered LDL and inflammation and the body’s attempts to heal the injuries. Much of the drop in cardiac mortality has been due to the drop in smoking which began after the Surgeon General’s report in 1964. Ultrasound and CT were brand new technologies in the late 70s and not then widely used by cardiology. Ultrasound has subsequently revolutionized the practice of cardiology. Physical exam, EKG and X-ray were the main diagnostic modalities and these were available even in small hospitals. Bed rest and nitroglycerin were the standard therapies to reduce stress on the heart as it tried to heal. Many individuals were lost in the days and weeks after their initial MI due to repeat blockages or rupture of the damaged heart wall. There were really no effective treatments.

 

[Koolau]

Very sorry for your loss of a parent at such a young age and the angst of revisiting now.

The first human to human heart transplant was done in Capetown, South Africa. The first coronary bypass (CABG) was done in the USSR. The procedure was refined in many different countries with an Argentinian surgeon responsible for many refinements. Looking at the coronary arteries with radioopaque dye and X-ray came online in the mid-60s but there was really little in the way of treatment. CABG did not really get going until the mid-to-late 70s, only in a few centres and usually only for those who had survived an initial MI and recovered well from it. There would not have been many transfers in the 70s because, unlike today, there was no immediate intervention that required special care.

It is true that aspirin (an antiplatelet agent) was not used until the 80s but it had been recognized much earlier that most MIs (sorry myocardial infarctions - what most people call heart attacks) were associated with a blood clot found in a diseased and damaged coronary artery. The damage is largely caused by smoking, high blood pressure, diabetes, altered LDL and inflammation and the body’s attempts to heal the injuries. Much of the drop in cardiac mortality has been due to the drop in smoking which began after the Surgeon General’s report in 1964. Ultrasound and CT were brand new technologies in the late 70s and not then widely used by cardiology. Ultrasound has subsequently revolutionized the practice of cardiology. Physical exam, EKG and X-ray were the main diagnostic modalities and these were available even in small hospitals. Bed rest and nitroglycerin were the standard therapies to reduce stress on the heart as it tried to heal. Many individuals were lost in the days and weeks after their initial MI due to repeat blockages or rupture of the damaged heart wall. There were really no effective treatments.

Thanks for the review. I feel lucky to have come of age such that when I had chest pains, there was something they could do for me. I'm still at greater risk going forward though I wasn't told of any major blockage other than the one region they placed stents. Of course, my calcium score was quite high, so...

 

[athena53]

Another anecdote: my Uncle, a gorgeous marathon runner with great abs, went to his doc for an annual checkup and the doc told him, “I wish I were in as good shape as you”. Less than a year later my Uncle dropped dead of a heart attack at age 42. This was 1978. Apparently he’d had some symptoms but like many fitness zealots, he tried to get rid of them by training harder.

No autopsy. I look at the imaging I’ve had, the very detailed research on cholesterol components, what we’ve learned about the impact of smoking, diabetes, BP, exercise, etc. on heart health and wonder what my Uncle might have learned that would have lengthened his life.