Claude Beck
Claude Schaeffer Beck (1894-1971) was an American Cardiac Surgeon.
Beck achieved worldwide recognition for his work in heart surgery and cardiopulmonary resuscitation. He assisted with the first mitral valve operations (1920s); performed the first surgical treatment of coronary artery disease (1935); performed the first successful defibrillation of the human heart (1947); and the first successful reversal of out of hospital cardiac arrest (1955).
Beck investigated numerous other problems relating to surgery of the heart making significant contributions to the advances in cardiac surgery including the study of penetrating and nonpenetrating cardiac trauma; techniques for suturing wounds of the heart; the use
of cardiac anaesthesia; and defibrillation of the ventricles.
Starting in 1950, Beck and his colleagues developed training courses for medical professionals in cardiopulmonary resuscitation techniques, training more than 3,000 doctors and nurses in less than 20 years. In 1963, a course in closed-chest cardiopulmonary resuscitation for lay persons was added.
Eponymously remembered for Beck’s triad I in acute cardiac tamponade [hypotension; distended jugular veins; and distant/muffled heart sounds on cardiac auscultation] and the Beck I and II operations for coronary artery occlusion.
Biography
- Born on November 8, 1894 in Shamokin, Pennsylvania
- 1916 – Graduated Franklin & Marshall College
- 1921 – MD, Johns Hopkins University
- 1922- General surgical training at Yale University’s New Haven Hospital
- 1923–1924 Resident training at Johns Hopkins; Arthur Tracy Cabot Fellow in Surgical Research at Harvard University under Harvey Williams Cushing (1869-1939)
- 1924 – Crile Research Fellow in Surgery, Western Reserve University School of Medicine; assisted Eliott Cutler (1888-1947) in the world’s first mitral valve operations. Cutler, with Beck’s assistance, attempted to relieve mitral valve stenosis using a new instrument, the cardiovalvulotome, developed in his surgical research laboratory
- 1935 – Performed the first surgical treatment of coronary artery disease
- 1940 – Professor of neurosurgery, Western Reserve University
- 1942-1945 Colonel with the Medical Corps; surgical consultant to the Army Fifth Service Command; Legion of Merit
- 1946 – 25th President of The American Association for Thoracic Surgery (AATS)
- 1947 – First successful defibrillation of the human heart
- 1952 – Nominated for Nobel Prize in Medicine
- 1952 – 1965 First American professor of cardiovascular surgery, Western Reserve University School of Medicine
- 1955 – First successful reversal of an otherwise fatal heart attack; first successful removal of a heart tumour
- 1965 -Professor emeritus, Western Reserve University.
- Died on October 14, 1971
Medical Eponyms
Between 1925 and 1935, Beck investigated Pick’s disease of the heart, exploring the the physiology and operative intervention of the acute and chronically compressed heart.
In 1935, Beck described two cardiac compression triads. His conclusions stemmed from his 1934 paper including 9 patients with a syndrome of chronic intrapericardial pressure with a ‘type of circulatory failure that frequently can be cured by operation‘.
The various anatomic disorders of the pericardium have a common physiologic relationship. Lesions of the pericardium produce the syndrome of either acute intrapericardial pressure or chronic intrapericardial pressure. We recommend the use of this conception of pericardial disorders
Beck, Cushing 1934
Beck’s triad (1) acute cardiac compression triad
In 1935, Beck described an acute cardiac compression triad which consisted of:
1) A falling arterial pressure, 2) a rising venous pressure and 3) a small, quiet heart. All other clinical manifestations of acute compression are secondary to this triad. The great venous gateway to the heart (the intrapericardial segments of the venae cavae and the right auricle) is partially or completely collapsed. The ventricles are also smaller than normal.
Beck 1935
Beck’s triad (2) chronic cardiac compression triad
In the same paper of 1935, Beck outlined the clinical picture of the chronic cardiac compression triad.
The chronic cardiac compression triad consists of 1) a high venous pressure, 2) ascites and 3) a small quiet heart. All other clinical manifestations of chronic compressions are secondary to this triad.
Beck 1935
For comparison, normal (fig. 1), acute (fig. 2) and chronic (fig. 3): The acute compression is produced by fluid in the pericardial cavity. Note collapse of venous gateway and distention of veins outside the pericardium. The ventricles are shrunken and the heart per se is smaller than normal. The parietal pericardium has not had time to dilate, nor has there been sufficient time for the liver to enlarge and for ascites to form. In the illustration for chronic compression of the heart the compression is produced by scar tissue. The heart is a small shrunken organ in contradistinction to cardiac dilatation. The veins dilate in response to the high venous pressure. The liver and spleen enlarge and ascites develops. [Beck 1935]
Subsequent studies have shown that these classic findings are observed in only a minority of patients with cardiac tamponade. However, Beck deserves credit for presenting a physiologic basis for the signs of cardiac compression.
Operations for coronary artery disease
Beck investigated methods to deliver additional blood to the heart muscle in the presence of coronary artery occlusion. Beck created two operations for coronary artery disease and diseases of the heart.
Beck I operation [cardiopericardiopexy]
The Beck I operation increased blood flow to the myocardium by causing granulomatous and vascular adhesions between the heart and pericardium. A collateral circulation through intercoronary and extracoronary communications provided a more homogeneous blood supply to the heart.
Beck I operation (A) Creation of partial coronary sinus occlusion (B) Abrasion of the parietal pericardium overlying the ventricles (C) Coarsely ground asbestos (0.2-0.4 g) sprinkled over the entire surface of the heart
Beck performed the first ‘cardiopericardiopexy’ on a human heart in 1935 after extensive canine laboratory experiments. Between 1935 and 1942, he performed 37 such operations on human hearts.
Beck II operation
The Beck II operation was developed in the 1940s and increased blood flow to the heart by placing a vein graft between the aorta and coronary sinus.
(B) Completed shunt with partial occlusion of the sinus.
Defibrillation and Cardiopulmonary resuscitation
1937 – Beck and his surgical colleague Frederick R. Mautz outlined a systematic approach to cardiac arrest in the operating room. The sequence ran:
- maintenance of pulmonary ventilation with 100% oxygen;
- immediate surgical exposure of the heart;
- manual cardiac massage to support the circulation;
- defibrillation by counter-shock; and
- topical and intracardiac application of procaine if the first shocks were ineffective.
The defibrillator applied a shock of 1-1.5 A, using 60-cycle alternating current at the standard potential difference of 110 V, for 0.5 to 2.0 seconds via two silver electrodes applied to the surface of the heart.
1941 – Beck publishes on the resuscitation of patients who ‘die in the operating room‘.
Fortunately, this type of death does not occur frequentIy…I can recall several instances in my own experience. The first one happened twenty years ago when I was a surgical intern in one of the hospitals in Baltimore. A pulmotor was brought to the operating room by the fire department. The patient could not be revived…My belief is that surgeons should not turn these emergencies over to the care of the fire department. We should take care of them ourselves.
Beck 1941
1947 – Beck performed the first successful (open) human defibrillation. A 14-year-old boy underwent surgery to repair a sternal deformity. During wound closure, his pulse stopped, the chest was reopened, and he was found to be in ventricular fibrillation. Open cardiac massage was performed for 70 minutes, and, after a series of electric shocks were delivered to the heart, a regular pulse was restored. No adverse neurological sequelae resulted.
By electric shock, applied directly to the exposed heart, ventricular fibrillation was abolished and supraventricular rhythm was restored. The patient made a complete recovery without detectable neurologic or cardiac damage
Beck 1947
1950 – Beck and Leighninger created the first course teaching the techniques of cardiac resuscitation in theatre. The course, was each month to 25 people, lasted a day and a half, and included open-chest demonstrations of resuscitation from standstill and fibrillation. Each student had to defibrillate a dog heart.
1953 – Reagan, Young, and Nicholson published on a patient who developed ventricular fibrillation while an ECG was being performed in the emergency ward. The patient was successfully resuscitated on April 13, 1953; the first case in which successful fibrillation has been performed outside of the operating room
1955 – On June 22, 1955 Beck, Weckesser and Barry performed the first successful reversal of out of hospital cardiac arrest
A physician dressed in his street clothes died from a heart attack while leaving the hospital. He was successfully resuscitated. This one experience indicates that resuscitation from fatal heart attack is not impossible and might be applied to those who die in the hospital and perhaps also to those who die outside the hospital.
Beck 1956
The veil of mystery is being lifted from heart conditions, and the dead are being brought back to life
Beck 1956
1956 – Beck advocates for systematic training in cardiopulmonary resuscitation following the first successful resuscitation in out of hospital cardiac arrest
When death occurs on the golf course, in the office, or in the home, resuscitation cannot be done unless equipment and trained personnel are immediately available. These problems are not insurmountable. Any intelligent man or woman can be taught to do resuscitation. A medical or nursing degree is not a prerequisite to learn resuscitation, nor is it impossible to provide resuscitation kits to be opened for the emergency.
Beck 1956
1960s – Open cardiac massage and defibrillation still being practised – but closed-chest cardiopulmonary resuscitation on the increase. Beck continued to agitate a groundswell of support for lay person and out of hospital CPR to ‘reverse death after a clean bill of health‘
The human heart has been made to beat again after it has stopped beating, which indicates that there is no obligate relationship between structural disease and death…The heart may be too good to die. The heart may only need a second chance to beat. The fatal heart attack is not necessarily the end of life.
Beck 1960
Cardiovalvulotome for mitral stenosis
Beck assisted Eliott Cutler in some of the world’s first mitral valve operations and pioneered this work in the United States. Cutler, with Beck’s assistance, attempted to relieve mitral valve stenosis using a new instrument, the cardiovalvulotome, developed in his surgical research laboratory.
A study of the fibrosed and often calcareous condition present in the mitral orifice in cases of chronic stenosing rheumatic disease demonstrated that a powerful instrument must be developed if we are to apply surgical relief in the treatment of the disease. An instrument (cardiovalvulotome) is described which actually excises a segment from the mitral orifice and removes this from the blood stream.
The efficacy of the instrument has been tested by its use on the stenotic valves of diseased hearts removed at autopsy. Its feasibility has been shown by operations both upon animals and in a single human case.
Beck, Cutler 1924
Major Publications
- Beck CS, Cutler EC. A Cardiovalvulotome. J Exp Med. 1924 Aug 31;40(3):375-9.
- Holman E, Beck CS. The physiological response of the circulatory system to experimental alterations: I. The effect of intracardiac fistulae. J Exp Med. 1925 Oct 31;42(5):661-79
- Beck CS, Holman E. The physiological response of the circulatory system to experimental alterations: II The effect of variations in total blood volume. J Exp Med. 1925 Oct 31;42(5):681-92
- Holman E, Beck CS. The physiological response of the circulatory system to experimental alterations: III. The Effect of Aortic and Pulmonic Stenoses. J Clin Invest. 1926 Dec;3(2):283-98
- Beck CS. Wounds of the heart. The technic of suture. Arch Surg. 1929; 18(4): 1659-1671
- Beck CS, Griswold RA. Pericardiectomy in the treatment of the Pick syndrome: experimental and clinical observations. Arch Surg. 1930; 21(6): 1064-1113
- Beck CS, Isaac L. Pneumocardiac tamponade a study of the effects of atmospheric pressure, negative pressure and positive pressure upon the heart. J Thorac Surg. 1931; 1(2): 124-148
- Beck CS, Bright EF. Changes in the heart and pericardium brought about by compression of the legs and abdomen. J Thorac Surg. 1933; 2(6): 616-628
- Beck CS, Cushing EH. Circulatory stasis of intrapericardial origin. The clinical and surgical aspects of the Pick syndrome. JAMA. 1934; 102(19): 1543-1548.
- Bright EF, Beck CS. Nonpenetrating wounds of the heart: A clinical and experimental study. American Heart Journal 1935; 10(3): 293-321
- Beck CS. Two cardiac compression triads. JAMA. 1935; 104(9): 714-716 [Beck’s triads]
- Beck CS, Mautz FR. The control of the heart beat by the surgeon: with special reference to ventricular fibrillation occurring during operation. Ann Surg. 1937 Oct;106(4):525-37.
- A resuscitation squad in our hospitals. Bulletin of the Academy of Medicine of Cleveland. 1939; 24: 12
- Beck CS. Resuscitation for cardiac standstill and ventricular fibrillation occurring during operation. The American Journal of Surgery 1941; 54(1): 273-279
- Beck CS, Pritchard WH, Feil HS. Ventricular fibrillation of long duration abolished by electric shock. J Am Med Assoc. 1947 Dec 13;135(15):985. [First successful (open) defibrillation]
- Beck CS, Leighninger DS. Operations for coronary artery disease. Ann Surg. 1955 Jan;141(1):24-37.
- Beck CS, Leighninger DS. The progress of coronary artery disease as affected by surgical revascularization. Trans Am Coll Cardiol. 1955 Apr;4:164-74
- Beck CS, Weckesser EC, Barry FM. Fatal heart attack and successful defibrillation; new concepts in coronary artery disease. J Am Med Assoc. 1956 Jun 2;161(5):434-6 [First successful defibrillation in OHCA]
- Beck CS. Surgical operations for coronary artery disease. In: Derra E, ed. Encyclopedia of Thoracic Surgery, vol II. Duesseldorf: SpringerVerlag; 1959: 779-833. [Beck II operation]
- Beck CS, Leighninger DS. Death after a clean bill of health. So-called “fatal” heart attacks and treatment with resuscitation techniques – PubMed (nih.gov). JAMA. 1960 Sep 10;174:133-5
References
Biography
- Leighninger DS. Contributions of Claude Beck. In: Safar P, Elam JO (eds). Advances in Cardiopulmonary Resuscitation. Springer, New York, NY. 1977: 259-262
- Centennial Celebration: Claude S. Beck, 1894-1971. University Hospital Archives, 1994
- Theruvath TP, Ikonomidis JS. Historical perspectives of The American Association for Thoracic Surgery: Claude S. Beck (1894-1971). J Thorac Cardiovasc Surg. 2015 Mar;149(3):655-60
- Bibliography. Beck, Claude S. (Claude Schaeffer) 1894-1971. WorldCat Identities
Eponymous terms
- Pick F. Ueber chronische, unter dem Bilde der Lebercirrhose verlaufende Pericarditis (pericarditische Pseudolebercirrhose) nebst Bemerkungen über die Zuckergussleber (Curschmann) Zeitschrift für klinische Medicin. 1896; 29: 385.
- Reagan LB, Young KR, Nicholson JW. Ventricular defibrillation in a patient with probable acute coronary occlusion. Surgery. 1956 Mar;39(3):482-486. [First successful Defibrillation in hospital, not in operating room]
- Sternbach G. Claude Beck: cardiac compression triads. J Emerg Med. 1988 Sep-Oct;6(5):417-9
- Meyer JA. Claude Beck and cardiac resuscitation. Ann Thorac Surg. 1988 Jan;45(1):103-5
- Cadogan M. History of the Electrocardiogram. LITFL
- Cadogan M. First defibrillation. Eponym A Day. Instagram
- Cadogan M. Beck’s Triads. Eponym A Day. Instagram
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