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
  • 19231924 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 operation I 1959

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.

Beck operation II 1959
Beck II operation. (A) Creation of vein graft anastomosis between the coronary sinus and the descending aorta.
(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: (1) maintenance of pulmonary ventilation with 100% oxygen; (2) immediate surgical exposure of the heart; (3) manual cardiac massage to support the circulation; (4) defibrillation by counter-shock; and (5) 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
Beck first human open defibrillation 1947
Fig. 2. (a) First recorded electrocardiogram at operation showing coarse ventricular fibrillation, (b) Electrocardiogram taken immediately before first shock applied to heart. Ventricular fibrillation is still present, (c) Electrocardiogram recorded following successful defibrillation showing supraventricular tachycardia at a rate of 175. [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.

1953Reagan, 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
Cardiovalvulotome 1924 Beck and Cutler
Beck, Cutler. Cardiovalvulotome. 1924

Major Publications

References

Biography

Eponymous terms


Cite this article as: Mike Cadogan, "Claude Beck," In: LITFL - Life in the FastLane, Accessed on December 1, 2021, https://litfl.com/claude-schaeffer-beck/.

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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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