From Teare to the present day: a fifty year odyssey in hypertrophic cardiomyopathy, a paradigm for the logic of the discovery process.

This year marks the fiftieth anniversary of the first contemporary account of hypertrophic cardiomyopathy by Dr Robert Donald Teare, a pathologist working at St George’s hospital in London. In a now seminal case series in the British Heart Journal, Teare reported asymmetric hypertrophy of the interventricular septum in 8 patients between the ages of 14 and 44.1 Although widely recognised as a citation classic, Teare’s observations were not the earliest historical description of hypertrophic cardiomyopathy. Evolution of the current perspective on the disease can be traced from antiquity through the ages. Philosophers and science historians have expounded the view that discoveries per se are often fortuitous; logic comes into play in proving that the finding is a bona fide discovery, or in cultivating a novel paradigm from the discovery. In their 1977 dissertation on the nature of scientific discovery, Howard and Allan Adelman set forth the premise that logic is inherent to the discovery process itself, using a case study of hypertrophic cardiomyopathy2 as their primary example. References to sudden cardiac death are found in the 2400-year old Aphorisms of Hippocrates.3 In the seventeenth and eighteenth centuries, Theophile Bonet, John Baptiste Morgagni, William Harvey, and Giovanni Maria Lancisi variously reported enlarged hearts with increased muscle bulk, obstruction of blood flow from the left ventricle into the aorta, hypertrophy, degenerative changes, and fibrosis.4 Tentative connections were drawn between the anatomical findings, sudden death, and antecedent history, including chest pain, palpitation, and “swooning” (syncope). Two French pathologists, Hallopeau and Liouville, described the classic appearance of asymmetrical hypertrophy of the interventricular From Teare to the Present Day: A Fifty Year Odyssey in Hypertrophic Cardiomyopathy, a Paradigm for the Logic of the Discovery Process William J. McKennaa and Srijita Sen-Chowdhrya,b