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February 27, 2017
Ischemic Cardiomyopathy Henri Huchard

Henri Huchard (1844-1910)

Maladies du coeur et des vaisseaux. Paris, O. Doin, 1889

Traite clinique des maladies du coeur et de l'aorte. 3 vols. Paris, O. Doin, 1899-1903



Henri Huchard was a French physician and published his important monograph, "Traite clinique des maladies du coeur et des vaisseaux", in 1889. A second edition of this book completely reorganized and reedited by Huchard appeared in 1893. Huchard is remembered for his clinical and investigational work in arteriosclerosis.

An extensive section of Huchard's monograph is devoted to the diseases of the myocardium . Huchard distinguished four types of acute, subacute and chronic myocarditis:

1) Acute and chronic parenchymal myocarditis

2) Suppurative myocarditis

3) Non-suppurative interstitial myocarditis

4) Arteriosclerosis of the heart characterised by myocardial degeneration and dystrophy. He specified that there were no inflammatory lesions of myocardium in the arteriosclerosis. He identified hypertension as the principle cause of arteriosclerosis.

Huchard stressed the fact that arteriosclerosis of the heart was primarily a vascular disease with sclerosis and obstruction of coronary arteries. He also believed that in most instances that was a generalized disease affecting the entire arterial system. He also emphasized that there were seconadry myocardial degeneration and dystrophy without any inflammatory process involved.

He then mentionned that the effect of this type of cardiopathy can stay either localized to the myocardium or extend and lead to valvular dysfunctions. . He named this entity "cardiopathies arterielles a type valvulaire" or myo-valvular cardiopathy.

He described three evolutive phase in the progression of this disease: 1) arterial phase with hypertension and arterial sclerosis 2) cardio-arterial phase with cardiac sclerosis and 3) mitro-arterial phase.

The mitro-arterial phase was characterised by dilatation of cardiac chambers, myocardial dysfunction , dilatation of atrioventricular orifices leading to mitral regurgitation, and particularly a decrease in the blood pressure. He viewed this stepwise evolution as an arterial disease which was progressively transformed into a cardiac disease. In addition to annular dilatation, he described several mechanisms of mitral regurgitation in patients with myo-valvular cardiopathy.  Huchard postulated that abnormality in the contraction of the papillary muscles could  lead to functional mitral regurgitation. Finally, he described that sclerosis with retraction of papillary muscles could be at the origin of an organic mitral regurgitation in these patients.

Huchard described the case of a 57 year-old patient who presented with right and left-sided congestive heart failure and apical systolic murmur of mitral regurgitation. Her arteries were hard at palpation. He suspected advanced arteriosclersis of the heart with mitral regurgitation. This patient expired rapidly. At postmortem examination, Huchard noted: "...generalized arteriosclerosis of the arterial system and the heart, dilatation of the right and left cardiac chambers, functional mitral regurgitation and slight dilatation of the aorta."

He then elaborated on the clinical symptoms of this disease including dyspnea, angina,palpitation, and irregularity of the pulse. He correctly recognized that episodes of combined dyspnea and angina( "dyspnee douloureuse") were from cardiac origin and related to coronary lesions that he called "endarterite coronaire".

In the phase mitro-arterial, he described the dyspnea, most often, as permanent and secondary to congestive heart failure.

Huchard showed the radial artery pulse tracing of several patients with arteriosclerosis of the heart and mitral regurgitation. Most these tracings were compatible with atrial fibrillation, althought this arrhythmia was not yet described in 1893.

In the conclusion of his chapter, Huchard discussed the complexity of the diagnosis of this condition as most patients with arteriosclerosis presented with a variety of symptoms involving multiple organs. Regarding the arteriosclerosis of the heart, he commented: "...future research should be directed toward the vessels of the heart. One should not forget that the principal factor of the sclerotic lesions of the myocardium is the sclerotic lesions of the coronary arteries with or without stenosis...after experimental obstruction of these[coronary]vessels, one provoke arrhythmia, palpitations, maybe pain episodes, and surely rapid and definite myocardial lesions."

In this outstanding work, Huchard provided one of the early accounts of mitral regurgitation due to ischemic cardiomyopathy as we recognize it today. Although historians have acknowledged Huchard's major contributions to the field of arteriosclerosis, his description of secondary mitral valve dysfunction resulting from arteriosclerosis has attracted less attention .

The entire chapter on arteriosclersis of the heart  and the section on "myo-valvular cardiopathy" are reproduced here.

 

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A Le Piez George Burch


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