see also:

• historic perspectives of medicine
• a brief history of medicine in Melbourne and Victoria
• timeline of events in the history of medicine
• History of use of anti-arrhythmic agents

• AI enabled research based on genome analysis, microbiomes, transciptomes, etc
• ED bedside ultrasound becomes common place for POCUS echocardiography
• mechanical circulatory support: continuous‑flow left‑ventricular assist devices (LVADs) / impellers and refinements in selection and management improved survival and quality of life in advanced heart‑failure patients as bridge‑to‑transplant or destination therapy.
• for VF/pVT, 2023 in-hospital arrest analysis reinforced lignocaine's edge in ROSC, 24-hour survival, and even discharge rates in certain settings, prompting its explicit addition to the ACLS algorithm alongside amiodarone (300 mg IV preferred first, lidocaine 1-1.5 mg/kg as alternative)
• angiotensin receptor–neprilysin inhibitors (ARNIs) became a foundational therapy for HFrEF with mortality and hospitalisation benefits
• hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers for heart failure
• pulsed‑field ablation (PFA) for atrial fibrillation: Approved in 2023 in some regions, PFA emerged as a promising energy source that may reduce collateral tissue injury and streamline AF ablation
• transcatheter mitral and tricuspid valve repair/replacement matured, expanding catheter‑based options for complex valve disease
• wearables, remote monitoring, and AI
  • consumer wearables with ECG capability and implantable/wearable sensors enabled earlier detection of arrhythmias and heart‑failure decompensation
  • emerging AI applications in ECG interpretation, imaging analysis, and risk prediction began to influence diagnostic workflows and research
• Covid-19 pandemic

• deep learning AI developed
• lignocaine re-introduced as 1st line alternative to amiodarone for VF/pVT in ACLS
  • ROC-ALPS (2016) failed to show amiodarone improved long-term survival or neurologic outcomes over placebo, though both drugs boosted ROSC and short-term survival vs placebo; lidocaine showed similar ROSC rates to amiodarone in some analyses.
  • lignocaine offered practical advantages: easier dosing, faster onset, fewer hypotensive effects, no need for central access, and widespread availability, making it a viable backup when amiodarone fails or is unavailable
• transcatheter aortic valve implantation (TAVI/TAVR): TAVI moved from high‑risk/inoperable patients into intermediate‑ and low‑risk populations, establishing catheter‑based valve replacement as mainstream therapy for severe aortic stenosis.
• new oral anticoagulants (DOACs): direct oral anticoagulants (e.g., dabigatran, rivaroxaban, apixaban, edoxaban) replaced or supplemented warfarin for many patients with atrial fibrillation and venous thromboembolism, simplifying anticoagulation.
• potent P2Y12 (prasugrel/ticagrelor) became first-line with aspirin in DAPT for 12 months post-ACS/PCI
• SGLT2 inhibitors in cardiology: originally diabetes drugs, SGLT2 inhibitors showed robust benefits in heart‑failure and kidney‑disease outcomes, changing standard of care for HFrEF and later HFpEF.
• PCSK9 inhibitors: monoclonal antibodies targeting PCSK9 provided major additional LDL‑cholesterol lowering beyond statins and reduced cardiovascular events in high‑risk patients.
• leadless pacemakers and subcutaneous ICDs: novel device platforms reduced lead‑related complications and broadened options for bradyarrhythmia and sudden‑death prevention.
• wider use of cardiac CT (especially coronary CT angiography), cardiac MRI, and hybrid imaging improved non‑invasive assessment of coronary disease, cardiomyopathies, and viability.

• angioplasty and stenting for AMI in preference to thrombolysis, BiPaP/CPAP for APO and other respiratory conditions, ED bedside ultrasound, formation of ED observation units and fast track streaming
• troponin replaces CK-MB as the biomarker for AMI / ACS
• ED bedside ultrasound becomes common place for trauma and early pregnancy patients in particular
• drug‑eluting stents (first‑generation and second-generation): DES were introduced and rapidly adopted, dramatically lowering restenosis and repeat revascularisation compared with bare‑metal stents
• statins
  • evidence‑based statin era: large statin trials consolidated LDL‑lowering as cornerstone therapy for secondary prevention, reducing recurrent myocardial infarction and stroke.
• cardiac resynchronisation therapy (CRT): Around 2000, CRT was shown to improve symptoms, reduce hospitalisations, and in many cases improve survival in selected heart‑failure patients with reduced ejection fraction and wide QRS complexes.
• evolution of heart‑failure programs: structured heart‑failure clinics and guideline‑directed therapy (ACE inhibitors/ARBs, beta‑blockers, mineralocorticoid antagonists) became systematically implemented
• routine high‑flow oxygen for all heart‑attack patients started being dropped from guidelines in the 2008-2010, with normoxic patients no longer advised to receive oxygen as studies in 2007 suggested high oxygen levels may do more oxidative harm than good
• morphine falls out of favour for APO and ACS and formally “not recommended” for APO by 2015-2017
• amiodarone becomes 1st line for ACLS for VF and pulseless VT - bretylium no longer recommended as part of Rx algorithm for VT/VF while lignocaine was relegated to alternative agent - ARREST trial (published 1999)
• 2002 guidelines adding clopidogrel to aspirin for NSTEMI/UA

• MRI scanners gradually introduced, CT scanners and ultrasound machines much improved and more readily available, personal computers and the internet
• CK-MB becomes the main biomarker for Dx of AMI
• stat 300mg aspirin for suspected heart attacks introduced in early 1990s
• AHA/ACC guidelines (1990–1996) recommended UFH IV bolus + infusion alongside aspirin/thrombolysis for STEMI
• GP IIb/IIIa inhibitors emerged late 1990s
• bare‑metal stents standardised: intracoronary stents moved from innovation to routine practice, markedly reducing acute vessel closure and improving PCI outcomes vs balloon angioplasty alone
• CPAP NIV becomes 1st line Rx for APO along with nitrates and diuretics - many hospitals initially had DIY devices
• BiPap devices are marketed and become more widespread after Respironics obtained a patent for bi‑level technology in 1992 after using similar devices from 1988 onwards
• early implantable cardioverter‑defibrillator (ICD) expansion: use of ICDs for primary and secondary prevention of sudden cardiac death grew, based on landmark trials in high‑risk patients with low ejection fraction or prior ventricular arrhythmias.
• 1995: meta-analysis suggested that primary angioplasty had better outcomes than iv thrombolysis for AMI leading to a push for emergent 24×7 “hot” angio facilities
• 1992-95: several studies confirmed that ACEI's reduced mortality and morbidity when started after AMI, joining the roles of aspirin, betablockers and statins, however, long term antiarrhythmic agents increased mortality in general.
• 1993: GUSTO trial of thrombolytics in AMI showed that accelerated dose tPA PLUS heparin improved survival compared with streptokinase, and the LATE study showed there was benefit even if given after 6-12hrs after onset
• 1991: Australian court ruling on involuntary passive smoking starts the process of banning smoking indoors at work, public buildings and then in cars
• 1990: Goto: disc. of endogenous digitalis-like factor

• decade of the introduction of CT scanners and diagnostic ultrasound machines, thrombolysis for AMI
• diagnosis of myocardial infarct based mainly upon ECG STEMI combined with biomarkers CK, AST, and LD
• transoesophageal echo (TOE) arrived in mid-80s
• 2D transthoracic echocardiography gained interest in ICUs
• 1989: biosynthetic pathway of nitric oxide discovered
• 1988: ISIS-2 trial of streptokinase and/or aspirin for AMI
• 1988: Yanagisawa et al: endothelins disc.
• 1987: Palmer: nitric oxide release accounts for activity of endothelin relaxing factor
• 1986: GISSI trial of iv thrombolytic Rx (streptokinase) for AMI results in push for early iv thrombolysis in STEMI
• 1985: TIMI trial of streptokinase vs tPA for AMI
• 1985: Baum and Benzer 1st describe bilevel ventilation mode (now called BiPAP)
• 1985: Campbell: suggested angiotensin II could be produced in tissues rather than in circulation and following year showed presence of m-RNA for angiotensinogen in tissues
• 1984: r-tPA (Alteplase) 1st iv tpa thrombolytic to be used for AMI
• 1982: Smith: anti-digoxin Fab antibody fragments used to Rx digoxin toxicity
• 1981: verapamil approved in USA for use in angina and SVT
• 1980: Furchgott: showed obligatory role of endothelium in arterial smooth muscle relaxation

• cardiac arrest protocols developed
• pacemakers
• 1978: bretylium approved in USA as antiarrhythmic and was included in the cardiac arrest protocol for some years
• 1978: disopyramide approved in USA for RX of some ventricular arrhythmias
• 1978: Ganong: theory of conversion of angiotensin I to angiotensin II by ACE in the pulmonary circulation
• 1977: 1st successful intubation techniques by paramedics
• 1975: Shaul: teratogenic effects of warfarin
• 1974: sodium nitroprusside approved in USA
• 1972: 1st widely available pulse oximeter (weighed 17kg)
• 1972: CT scanner invented
• 1972: Hill: ECMO 1st used for ARDS
• 1970: nuclear powered cardiac pacemaker
• 1970: Swan/Ganz: 1st easy to use balloon catheter to measure pulmonary artery and left atrium pressures

• 1969: 1st coronary artery bypass graft surgery
• 1967: Barnard: 1st heart transplants on humans
• 1967: Fleckenstein: suggested that verapamil acts via calcium antagonism which he coined
• 1966: Pantridge: 1st mobile intensive care unit ambulances (MICA) with defibrillators, pacing and anti-arrythmic capabilities
• 1965: Van Itallie: cholestyramine, initially used for pruritis in cholestasis, was shown to lower lipids
• 1963: Carson: 1st desc of homocystinuria
• 1962: Hass: verapamil reported to have negative inotropic and chronotropic effects
• 1962: Waring: clofibrate synthesized and found to lower total lipids and cholesterol

• 1959: Link: clinical safety of warfarin shown in trials
• 1958: Powell: 1st beta blocker discovered - dichloroisoproterenol (DCI)
• 1957: Bumpus: angiotensin II synthesized
• 1957: Kirklin: use of cardiopulmonary bypass in cardiac surgery
• 1956: anaesthesia revolutionised with introduction of halothane
• 1956: Bertler: reserpine found to deplete tissues of noradrenaline
• 1955: Sarnoff: concepts of ventricular function curves established
• 1955: Altschul: nicotinic acid discovered to lower blood lipids
• c1955: Peart: recognition of 2 angiotensins and angiotensinogen converting ezyme (ACE)
• c1955: bretylium introduced as antihypertensive
• 1954: Simpson et al: coined aldosterone for the substance from urine in patients with oedema
• 1953: Gibbon: use of heart-lung machine in cardiac surgery
• 1953: Rahn: 1st use of a pulmonary artery balloon pump (in animals)
• 1952: Vorhees: 1st use of vascular prosthetic grafts
• 1951: Mark: procainamide discovered
• 1951: De Bakey: 1st use of vascular homografts
• 1950: Harris: phenytoin reported to be effective in VT

• 1949: curariform action of succinylcholine discovered
• 1949: Gross: 1st surgery of the aorta
• 1949: Hench: cortisone (compound E) discovered and uses adrenal steroids to Rx rheumatoid arthritis
• 1948: lidocaine / lignocaine introduced
• c1948: lithium chloride used as a salt substitute in CCF but found to have toxicity
• 1946: Euler: definitive evidence that noradrenaline was the sympathetic neurotransmitter
• 1944: Ikawa et al(Wisconsin Alumni Research Foundation): 1st prepares racemic Warfarin - an acronym
• 1943: quinine synthesized
• 1942: curare 1st used as a muscle relaxant in anaesthesia
• 1941: 1st oximeters and capnometers
• 1940: research on curare accelerates
• 1940: emergence of theory of 2 types of adrenal steroids - mineralocorticosteroids and glucocorticosteroids
• 1940: Braun-Menendez: reported renin was enzyme that produced angiotensin
• 1940: Florey: penicillin developed as an antibiotic

• 1939: Link: haemorrhagic agent in sweet clover identified as dicoumarol
• 1939: Gross: cardiac surgery to repair congenital defects
• 1937: 1st artificial heart invented
• 1937: electroconvulsive therapy (ECT) introduced in psychiatry
• 1936: Mautz: procaine elevates electrical threshold of cardiac muscle
• 1935: thiopentone / thiopental used as iv anaesthetic; structure of d-tubocurarine established;
• 1931: Bose: Rauwolfia alkaloids used in India for hypertension and insanity

• 1929: Moore: purified carotene found to be a potent source of vitamin A
• 1929: sodium nitroprusside shown to lower BP
• 1927: Moniz: X-rays used to visualise blood vessels (angiography)
• 1926: Navratil: proved that the vagus nerve neurotransmitter is acetylcholine
• 1924: ephedrine introduced to Western medicine
• 1923: acid-base theory
• 1923: Cutler: cardiac valvotomy
• 1922: water-soluble mucopolysaccharide discovered and named heparin
• 1922: Laterjet: vagotomy proposed for relief of abdominal pain in tabetic crises
• 1921: Loewi: 1st proof of chemical mediation of nerve impulses (neurotransmitters)
• 1920: Murray: 1st to successfully Rx myxoedema with thyroid extract

• 1918: Frey: quinidine found to be most effective agent for AF
• 1916: sympathectomy used to Rx angina
• 1916: blood for blood transfusions refrigerated during transport
• 1915: Starling: Starling's law of cardiac contractility and cardiac fibre length
• 1914: Wenckebach: reports of quinine alkaloids on certain arrhythmias
• 1914: Dale: proposed existence of an acetylcholinesterase and coined term parasympathomimetic to characterise effects of acetylcholine
• 1914: successful heart surgery on a dog
• 1913: Dale: 1st description of the nicotine paralyzing action of tetraethylammonium (TEA) on ganglia
• 1912: Herrick: studies helped clarify the syndrome of coronary occlusion
• 1911: Taveau: methacholine 1st studied
• 1910: Moritz: 1st clinical measurement of CVP
• 1910: Barger: pharmacologic studies of a large number of sympathomimetic amines

• 1907: Dixon: postulated that vagus nerve liberates a muscarine-like substance as transmitter
• 1906: Dale: discovered ergot alkaoids and 1st adrenergic blockers
• 1905: Elliott: postulated that sympathetic nerve impulses releases adrenaline-like substances
• 1903: Einthoven: ECG invented
• 1903: barbitol (barbiturate) introduced
• 1902: veronal synthesized and used as a safer iv anaesthetic; routine BP measurements during anaesthesia
• 1901: adrenaline isolated
• 1901: Ehlers: clarification of Ehlers-Danlos syndrome
• 1901: Landsteiner: disc. of A,B, O blood groups
• 1900: Carrell: 1st arterial anastomosis surgery

• 1899: Dresser: aspirin 1st marketed - named derived from the plant spiraea
• 1899: Abel: pressor agent in suprarenal extract named epinephrine (adrenaline)
• 1898: Langley: similarity of effects between adrenal gland extracts and sympathetic nerve stimulation
• 1898: Tiegerstedt: discovery of pressor agent in kidney extract coined renin
• 1896: Dock: case of coronary occlusion discovered during life and confirmed at PM
• 1896: cathode rays and radioactivity disc.
• 1896: Mikulicz: surgical masks in surgery to reduce infection
• 1895: Rontgen: 1st use of x-rays for diagnostic purposes
• 1891: Bergman: aseptic technique in surgery

• 1889: use of rubber gloves in surgery
• 1889: Dickinson: nicotine's actions shown to be at ganglions
• 1885: orotracheal intubation using an introducer
• 1885: steam sterilisation invented
• c1885: Hoffman: acetylsalicylic acid (aspirin) 1st prepared
• 1883: Bizzozeri: disc. platelets
• 1880: 1st successful anaesthetic use of chloroform via oral tracheal tube
• 1880: electrical stimulation of vagal nerve in the neck used to Rx asthma

• 1879: Murrell: used sublingual nitroglycerin (GTN) to relieve angina and prevent exertional angina
• 1878: Hammer: disc. thrombotic occlusion of a coronary artery
• 1877: Lichtheim: noted that CVP changed with blood volume
• 1877: oxygen liquefied
• 1877: Eck: 1st surgery on AV fistulae
• 1874: 1st use of iv anaesthetics

• 1867: 1st use of amyl nitrite for angina
• 1867: Lister: encouraged use of phenol as antiseptic in surgery
• 1867: Baeyer: acetylcholine 1st syntheseized
• 1867: Bezold: demonstrated that atropine blocks cardiac effects of vagal stimulation
• 1860: Kolbe: synthetic manufacture of salicylic acid from phenol
• c1860: use of electrical impulses for neurologic conditions
• c1860: s/c use of morphine as analgesic

• 1857: Brunton: inhaled amyl nitrate used to relieve angina
• c1855: Brunton: phlebotomy found to help relieve severe anginal pain
• 1853: quinidine 1st prepared
• 1852: hypodermic syringe invented for subcutaneous injections
• 1850: speed of nerve impulse estimated
• c1850: new technology cigarettes produced milder smoke and enabled greater inhalation
• c1850: beri beri becomes widespread in east Asia due to rice mills removing husks
• c1850: Henle: discovered endothelium, vascular smooth muscle

• 1848: Van-Heyningen: quinidine 1st described
• 1847: Virchow: associated emboli with endocarditis
• 1847: Hering: sublingual dosage of nitroglycerin (GTN)
• 1846: Sobrero: nitroglycerine manufactured and found to cause headache when placed on tongue
• 1843: Orfila: 1st pharmacologic studies of nicotine
• 1841: Bouillard: coined terms endocardium and endocarditis
• c1840: Purkinje: 1st to use the microtome, and disc. Purkinje cells of cerebellum and Purkinje fibres in the heart

• 1839: Hope: associated aortic incompetence with diastolic murmur in aortic area
• 1832: Corrigan: associated aortic incompetence with characteristic Corrigan's pulse
• 1831: Mein: purified atropine isolated

• 1829: Leroux: salicin isolated from willow bark (1st step in development of aspirin)
• 1828: Posselt: nicotine isolated from tobacco leaves
• 1827: Hodgkin: associated aortic incompetence with dilated ventricles, hepatised lung, ascites and pericardial effusion
• 1827: Ohm: electrical current discovered
• 1820: Pelletier: colchicine isolated from colchicum

• 1816: Laennec: invented stethoscope

• 1799: Ferriar: 1st description of cardiac actions of digitalis
• 1794: Beddoes, Wat, Davy: inhalational oxygen Rx

• 1776: Hunter: noted PM changes in myocardium associated with angina
• 1775: Withering: use of digitalis as diuretic for dropsy (CCF)
• 1771: Galvani: electrical nature of the nervous system

• 1769: Morgagni: associated aortic incompetence with SOB, pleural effusions and palpitations, and noted association between endocarditis and gonorrhoea
• 1768: Heberden: this account of angina pectoris led to it being accepted as a distinct disease entity

• 1749: De-senac: cinchona used to Rx AF

• 1726: Hales: 1st to measure human BP
• 1723: Riverius: 1st desc. in literature of clinical picture of bacterial endocarditis
• 1720: Hales: 1st to measure CVP and BP (in dog and horse)

• 1715: Vieussens: clinical features of pulmonary valve incompetence

• 1708: Boerhaave: theory of inflammation put forth
• 1707: Floyer: introduced counting pulse beats
• 1706: Cowper: ossifications of aortic valves and noted aortic incompetence

• 1695: Grew: magnesium sulphate isolated

• 1685: De Vieussens: 1st adequate description of left ventricle and coronary vessels
• 1682: Van Meekeren: 1st desc. of Ehlers-Danlos syndrome

• 1668: Leibniz: 1st desc. of RBCs
• 1660: Earl of Clarendon: one of the earliest accounts of angina pectoris

• c1650: potato, tea, coffee, cocoa, digitalis leaves introduced to Europe

• 1628: Harvey: proved beyond doubt the physics of the general circulation of blood using mathematical proofs
• 1627: Aselli Gaspare: disc. of lymphatics

• c1590: tobacco smoking 1st observed in Europeans

• 1580: Raleigh: native curare preparations brought to Europe and studied

• c1560: Aranzio: anatomy of the fetus; discovered ductus arteriosis & ductus venosus;
• c1560: D'Acquapendante Gerolama Fabrizio: venous valves
• c1560: Carcano Giambattista: 1st desc. foramen ovale & ductus arteriosis
• 1560: Cesalpino: 1st to use the term circulation and discover the general circulation
• 1560: Pare: abolished cautery and boiling oil onto wounds; ligated arteries at haemorrhaging wounds

• 1550: Vesalius:
  • 1st description of corpus luteum and corrected Galen's errors on the uterus; course of the veins; careful description of the heart anatomy;
  • 1st to show atificial respiration could keep an animal alive even after it's thorax is opened
• 1550: Colombo: 1st to state that the arteria venosa carried blood not air from lungs to heart
• 1550: Cannano: 1st description of valves within the veins

• 1535: Brunfels: 1st adequate pharmacopoeia

• 1520: Paracelsus:
  • re-popularised use of opium as therapeutic in Europe
  • “All things are poison, and nothing is without poison; only the dose permits something not to be poisonous.”
  • discarded the 4 humours doctrine of that illness was caused by imbalance of the Hippocratic 4 humours - blood, phlegm, black bile and yellow bile, and believed that illness was caused by external factors and that sickness and health relied on harmony between man and nature, and thus astrology was a significant part of his medicine.

• 1500: Da Carpi: 1st careful examination of tympanic membrane, pineal gland, lateral ventricle of the brain and valves of the heart
• c1500: Chinese used dried skin of toads (contains glycosides)

• 1463: printing invented

• c1300: Arabian traders introduce opium to the orient

• 1250: Welsh physicians use foxglove (digitalis)

• 1010: Avicenna: attempted to codify all medical knowledge

• c100BC: ephedrine containing plants used

• c200AD: Aretaeus:
  • diabetes is the melting down of flesh into urine, Rx by quenching thirst
• c100AD: “squill” used as diuretic, heart tonic, emetic, and rat poison

• c400BC: Hippocrates (c460-370BC):
  • founder of the Hippocratic School of Medicine and regarded as the father of western medicine
  • made careful, regular note of many symptoms including complexion, pulse, fever, pains, movement, and excretions
  • noted that the obese die earlier
  • importance of diet, massage, exercise, gymnastics, sea bathing
• c450BC:
  • usage of animal cadavers to learn anatomy as Greece banned human dissection

• 1000BC: squill containing cardiac glycosides used