What We Counted

Published:January 25, 2013DOI:
      We measured and counted a lot of things when I was a medical student and resident that no longer seem to matter. What we measured and counted with the tools that were available seemed vitally important then and reflected our contemporary understanding of cardiac pathophysiology. Just 30 years later, the tools and the concepts seem very primitive. The story of the evolution of scientific paradigms has been written many times, as have the follies of overenthusiastically embracing unproved observations. I would like to arrive at a similar destination, but by a different and less chronicled route, focusing primarily on measurement tools and the beliefs they reinforced, with a few humble examples.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Forrester J.S.
        • Diamond G.
        • Chatterjee K.
        • Swan H.J.
        Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts).
        N Engl J Med. 1976; 295: 1356-1362
        • Battler A.
        • Karliner J.S.
        • Higgins C.B.
        • Slutsky R.
        • Gilpin E.A.
        • Froelicher V.F.
        • Ross J.
        The initial chest x-ray in acute myocardial infarction. Prediction of early and late mortality and survival.
        Circulation. 1980; 61: 1004-1009
        • Clark A.L.
        • Coats A.J.S.
        Unreliability of cardiothoracic ratio as a marker of left ventricular impairment: comparison with radionuclide ventriculography and echocardiography.
        Postgrad Med J. 2000; 76: 289-291
        • Lown B.
        • Fakhro A.M.
        • Hood W.B.
        • Thorn G.W.
        The coronary care unit: new perspectives and directions.
        JAMA. 1967; 199: 188-198
        • Lown B.
        Sudden cardiac death—1978.
        Circulation. 1979; 60: 1593-1599
        • The Cardiac Arrhythmia Suppression Trial (CAST) Investigators
        Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction.
        N Engl J Med. 1989; 321: 406-412
        • Baman T.S.
        • Lange D.C.
        • Ilg K.J.
        • Gupta S.K.
        • Liu T.-Y.
        • Alguire C.
        • Armstrong W.
        • Good E.
        • Chugh A.
        • Jongnarangsin K.
        • Pelosi F.
        • Crawford T.
        • Ebinger M.
        • Oral H.
        • Morady F.
        • Bogun F.
        Relationship between burden of premature ventricular complexes and left ventricular function.
        Heart Rhythm. 2010; 7: 865-869
        • Killip T.
        • Kimball J.
        Treatment of myocardial infarction in a coronary care unit: a two year experience with 250 patients.
        Am J Cardio. 1967; 20: 457-465
        • Antman E.M.
        • Berlin J.A.
        Declining incidence of ventricular fibrillation in myocardial infarction. Implications for the prophylactic use of lidocaine.
        Circulation. 1992; 86: 764-773
        • Grayburn P.A.
        • Hillis L.D.
        Cardiac events in patients undergoing noncardiac surgery: shifting the paradigm from noninvasive risk stratification to therapy.
        Ann Intern Med. 2003; 138: 506-511