Harvey Feigenbaum

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Harvey Feigenbaum is the Father of Echocardiography.. He developed the world's first long lasting practical use of echocardiography (the examination of the heart with ultrasound) He wrote the first textbook of Echocardiography in 1972 which is currently in its 8th edition and has published over 300 articles on the subject. He has trained generations of cardiologists including many of the world's pioneers in the field through his numerous visitors, frequent workshops, annual courses in Indianapolis, Indiana beginning in 1968 and formal fellowship training. In addition he has given presentations at many of the world's cardiology meetings and has had countless lectures in virtually every major country in the world. He founded the field of cardiac sonography in 1965 and the American Society of Echocardiography in 1975. His seminal article on the diagnosis of pericardial effusions published in 1965 with his technique "brought echocardiography to the attention of thousands of practitioners"

Personal History

Feigenbaum was born on November 20, 1933 in East Chicago, Indiana. He is the youngest of the 4 children of Tillie and Julius Feigenbaum. His parents were immigrants from Europe. He graduated from East Chicago Washington High School where he was valedictorian, violin player, top player on the tennis team and concertmaster of the symphony orchestra. He worked as a shoe salesman during his college years, a skill he would later use to sell his idea of using echocardiography to study the form and function of the heart.

Background

The basis of echocardiography is utilizing the properties of ultrasound as a detective medium. Sound is a vibration in either water or air. It is divided into infrasound, audible sound and ultrasound depending on the frequency. Audible sound is in the frequency between 20 Hertz and 20,000 Hertz and is detected by the tympanic membrane of the inner ear. Ultrasound is any frequency above the audible limit.

Ultrasound in echocardiography is produced by taking a plate of cut quartz and producing a mechanical stress which then develops and electrical charge on its surface which can be used to create ultrasonic vibrations. This was first demonstrated by the Curie brothers in 1880 and is known as the piezoelectric or pressure electric effect

The next year, the Curie brothers then observed that the opposite of the piezoelectric effect took place. In this case, the electric charge created with the quartz plate could produce a vibration and the vibration could in turn produce an electrical energy that could be detected. This later became the basis for all ultrasonic cardiac studies..

The first use of pulsed ultrasound was done in the 1940's by Firestone to detect flaws in metals. His work served as a building block to the engineering principle of the complex sound equipment used in medical diagnosis today. In the late 1940's and early 1950's several workers reported their experience using reflected ultrasound to identify intracranial structures and cerebral neoplasms as well ass assessing the integrity of other organs of the body

In 1953 Dr. Hertz examined the heart using a commercial ultrasonoscope. Together with Dr. Edler, they published a paper on the use of ultrasonic reflectoscope for continuous recording of movements of the heart walls. Both Drs. Hertz and Edler gave up their interest in echocardiography only to have others, including Dr. Feigenbaum, to pick up the torch to light the way forward

Indiana University

Harvey Feigenbaum attended Indiana University in Bloomington and graduated with a degree in Anatomy and Physiology in 1954. He finished his doctorate in medicine at the same institution 4 years later. He went on to spend his medical internship at Philadelphia General Hospital from 1958 to 1959. He then returned to the Indiana University Medical Center in Indianapolis for his residency and fellowship in cardiology under the direction of Dr. Charles Fisch. During his fellowship, Dr. Feigenbaum completed training in cardiac catheterization at the National Institute of Health in Bethesda, Maryland and then started the catheterization program at the Indiana University Medical Center.

Dr. Feigenbaum became interested in studying cardiac hemodynamics in his role as cardiac catheterization director. He was interested in studying the left ventricle but there were limitations to using this modality to measure cardiac volume.

One day he was reading an advertisement in a non-peer-reviewed medical journal which claimed that an ultrasound machine manufactured by Biosonar was able to measure heart volumes and that it would be displayed at the upcoming American Heart Association meeting in San Francisco in 1963. Sensing an opportunity, he met with the Biosonar representative at the meeting. The representative said that the machine was called an echoencephalograph and that its primary use was in examining the brain to detect shifts in the midline caused by a space occupying mass or fluid. The salesman went on to say that he was not entirely clear why he was at a cardiology convention.

Not to be deterred, Dr. Feigenbaum began playing with the transducer of the echoencephalograph and placed it on his own chest. He saw a moving signal (echo) and concluded that it must be coming from the back of his heart. He asked the salesman what fluid would look like with ultrasound? The man said that fluid would be echo-free. Dr. Feigenbaum suspected that this instrument could be used to detect pericardial effusion which is a potentially dangerous collection of fluid in the pericardial sac that surrounds the heart.

After the AHA meeting and his encounter with the echoencephalograph, he went back to the work and found out that the neurology department had an echoencephalograph that was not being used and he was able to borrow it. He could easily duplicate what he found on his own heart on everyone he examined, a singular moving echo from the back wall of the heart. To test his hypothesis, he asked his colleagues if there were any patients with pericardial effusions. Dr. Walter Judson located a patient with that condition. When Dr. Feigenbaum examined the patient, as predicted there were now two signals, the moving echo from the back wall and a stationary echo from the pericardial sac separated by an echo-free space (the pericardial fluid). With this momentous discovery, he needed to confirm his observations. He went to his friend, a cardiac surgeon, John Waldhausen, who had an animal research laboratory. Using dogs, they were able to inject fluid into the pericardial space, artificially inducing a pericardial effusion. With the echoencephalographic machine, or ultrasound, they were able to detect the fluid in 5 consecutive hearts. They used this data along with antidotal ultrasound images of a patient before and after removal of a pericardial effusion and one with dilated cardiomyopathy and no pericardial effusion. He submitted his findings, which were later published in JAMA in 1965 Realizing the potential of ultrasound as a noninvasive modality to examine the heart, he began using the instrument to see if he could calculate heart volumes, in particular the left ventricle, the structure responsible for pumping oxygenated blood from the lungs out to every cell in the body. He was measuring left ventricular structures but was having difficulties measuring volumes. He and a cardiac fellow, Richard Popp, attended a meeting in New Orleans, where Ray Gramiak was demonstrating how injecting indocyanine dye into the heart cavity by catheterization the heart cavity would light up like a Christmas tree. The liquid is known to have a surface tension that creates tiny bubbles that produce a clod of echoes, which makes it a perfect ultrasound contrast agent. Back in his own laboratory, he began using this technique to visualize the left ventricular cavity. He used this information to measure left ventricular dimensions. But he still needed to be able to correlate this to left ventricular volumes. At that same time, Hal Dodge in Birmingham, Alabama was measuring left ventricular volumes angiographically. Drs. Feigenbaum and Popp visited Dr. Dodge regularly and were able to show clearly that there was a correlation between echo recorded dimensions and angiographically calculated volumes. They wrote up their findings and submitted them to every medical journal of any significance, and were rejected every time. The information was finally published when Dr. Popp moved to Stanford, repeated the same experiments using the same correlations. But this time when Dr. Popp submitted the paper, Dr. Feigenbaum was the principal reviewer, and the paper was accepted. Many consider measuring the size of the left ventricular chamber and estimating its function to be the seminal work that brought echocardiography to the mainstream of cardiology. This was because pericardial effusions are common and serious, they are not every-day concerns. Information on left ventricular size and function is vital for every patient with known or suspected heart disease.

Dr. Feigenbaum with his trainees and colleagues over the past 6 decades went on to create multiple advances in echocardiography. They described how echocardiography could detect many abnormalities of the cardiac valves and chambers, early strip chart recorders for M-mode echocardiograms, early 2-dimensional echocardiographic transducers, digital techniques for recording and displaying echocardiograms, and performing echocardiograms with exercise and pharmacologic stress were all developed at Indiana University

Awards

• 1976 Texas Heart Institute Medal and Ray C. Fish Award for Outstanding Achievement in Cardiovascular Disease
• 1977 Modern Medicine Award fro Distinguished Achievement
• 1977 Lewis A. Conner Lecture, American Heart Association
• 1979 Richard and Hinda Rosenthal Award, American Heart Association, Outstanding Achievement in Cardiovascular
• Research
• 1980 Distinguished Alumnus, IU School of Medicine
• 1986 Distinguished Alumnus, IU College of Arts and Sciences
• 1988 Gifted Teacher Award, American College of Cardiolgoy
• 1989 Robert J. and Claire Pasarow Foundation, Award for Excellence in Carddiovascular Medicine, Los Angeles,
• California
• 1992 Eugene Drake Memorial Award, American Heart Association
• 1997 Luminary Award for Scholarly Accomplishment in Science, Pisa, Italy
• 1998 Louis F. Bishop Lecture, American College of Cardiology
• 1998 World of Difference Lifetime Achievement Award from the Indiana Health Industry Forum
• 2000 Feigenbaum Lecture inaugeration at the American Society of Echocardiography
• 2002 Cor vitae Award from the Midwest Affiliate of the American Heart Association
• 2004 Primio Mantevergine Award as the "Father of Modern Echocardiography" Naples, Italy
• 2005 Living Legend Award from the Indiana Historical Society
• 2005 American Heart Association Distinguished Scientist
• 2006 International Honory Member, Japanese College of Cardiology
• 2006 Honorary Member of the Mexican Society of Cardiology
• 2016 Honorary Member of the European Society of Cardiovascular Imaging
• 2020 IU Bicentenial Medal by Indiana University

References

Harvey Feigenbaum is a physician, cardiologist and researcher. He has been referred to as the Father of Echocardiography[1][2]. He developed the world's first long lasting practical use of echocardiography (the examination of the heart with ultrasound)[3] He wrote the first textbook of Echocardiography in 1972 which is currently in its 8th edition and has published over 300 articles on the subject[4]. He has trained generations of cardiologists including many of the world's pioneers in the field through his numerous visitors, frequent workshops, annual courses in Indianapolis, Indiana beginning in 1968 and formal fellowship training[5]. In addition he has given presentations at many of the world's cardiology meetings and has had countless lectures in virtually every major country in the world. He founded the field of cardiac sonography in 1965 and the American Society of Echocardiography in 1975[6]. His seminal article on the diagnosis of pericardial effusions published in 1965 with his technique[7] "brought echocardiography to the attention of thousands of practitioners"[8].

Personal History

Feigenbaum was born on November 20, 1933 in East Chicago, Indiana. He is the youngest of the 4 children of Tillie and Julius Feigenbaum. His parents were Jewish immigrants from Europe. He graduated from East Chicago Washington High School where he was valedictorian, violin player, top player on the tennis team and concertmaster of the symphony orchestra. He worked as a shoe salesman during his college years, a skill he would later use to sell his idea of using echocardiography to study the form and function of the heart [9].

Background

The basis of echocardiography is utilizing the properties of ultrasound as a detective medium[10]. Sound is a vibration in either water or air. It is divided into infrasound, audible sound and ultrasound depending on the frequency. Audible sound is in the frequency between 20 Hertz and 20,000 Hertz and is detected by the tympanic membrane of the inner ear[11]. Ultrasound is any frequency above the audible limit.

Ultrasound in echocardiography is produced by taking a plate of cut quartz and producing a mechanical stress which then develops and electrical charge on its surface which can be used to create ultrasonic vibrations. This was first demonstrated by the Curie brothers in 1880 and is known as the piezoelectric or pressure electric effect [12]

The next year, the Curie brothers then observed that the opposite of the piezoelectric effect took place. In this case, the electric charge created with the quartz plate could produce a vibration and the vibration could in turn produce an electrical energy that could be detected. This later became the basis for all ultrasonic cardiac studies( . His work seved as a building block to the engineering principle of the complex sound equipment used in medical diagnosis today. In the late 1940's and early 1950's several workers reproted their experience using reflected ultrasound to identify intracranial structures and cerebral neoplasms as well ass assessing the integrity of other organs of the body[13]

In 1953 Dr. Hertz examined the heart using a commercial ultrasonoscope. Together with Dr. Edler, they published a paper on the use of ultrasonic reflectoscope for continuous recording of movements of the heart walls[14]. Both Drs. Hertz and Edler gave up their interest in echocardiography only to have others, including Dr. Feigenbaum, to pick up the torch to light the way forward [15].

Indiana University

Harvey Feigenbaum attended Indiana University in Bloomington and graduated with a degree in Anatomy and Physiology in 1954. He finished his doctorate in medicine at the same institution 4 years later. He went on to spend his medical internship at Philadelphia General Hospital from 1958 to 1959. He then returned to the Indiana University Medical Center in Indianapolis for his residency and fellowship in cardiology under the direction of Dr. Charles Fisch. During his fellowship, Dr. Feigenbaum completed training in cardiac catheterization at the National Institute of Health in Bethesda, Maryland and then started the catheterization program at the Indiana University Medical Center.

Dr. Feigenbaum became interested in studying cardiac hemodynamics in his role as cardiac catheterization director. He was interested in studying the left ventricle but there were limitations to using this modality to measure cardiac volume.

One day he was reading an advertisement in a non-peer-reviewed medical journal which claimed that an ultrasound machine manufactured by Biosonar was able to measure heart volumes and that it would be displayed at the upcoming American Heart Association meeting in San Francisco in 1963. Sensing an opportunity, he met with the Biosonar representative at the meeting. The representative said that the machine was called an echoencephalograph and that its primary use was in examining the brain to detect shifts in the midline caused by a space occupying mass or fluid. The salesman went on to say that he was not entirely clear why he was at a cardiology convention.

Not to be deterred, Dr. Feigenbaum began playing with the transducer of the echoencephalograph and placed it on his own chest. He saw a moving signal (echo) and concluded that it must be coming from the back of his heart. He asked the salesman what fluid would look like with ultrasound? The man said that fluid would be echo-free. Dr. Feigenbaum suspected that this instrument could be used to detect pericardial effusion which is a potentially dangerous collection of fluid in the pericardial sac that surrounds the heart.

After the AHA meeting and his encounter with the echoencephalograph, he went back to the work and found out that the neurology department had an echoencephalograph that was not being used and he was able to borrow it. He could easily duplicate what he found on his own heart on everyone he examined, a singular moving echo from the back wall of the heart. To test his hypothesis, he asked his colleagues if there were any patients with pericardial effusions. Dr. Walter Judson located a patient with that condition. When Dr. Feigenbaum examined the patient, as predicted there were now two signals, the moving echo from the back wall and a stationary echo from the pericardial sac separated by an echo-free space (the pericardial fluid). With this momentous discovery, he needed to confirm his observations. He went to his friend, a cardiac surgeon, John Waldhausen, who had an animal research laboratory. Using dogs, they were able to inject fluid into the pericardial space, artificially inducing a pericardial effusion. With the echoencephalographic machine, or ultrasound, they were able to detect the fluid in 5 consecutive hearts. They used this data along with antidotal ultrasound images of a patient before and after removal of a pericardial effusion and one with dilated cardiomyopathy and no pericardial effusion. He submitted his findings, which were later published in JAMA in 1965 [16]

Dr. Feigenbaum along with his former cardiac fellow, Richard Popp, MD were able to accurately calculate left ventricular volumes[17]Many consider measuring the size of the left ventricular chamber and estimating its function to be the groundbreaking work that brought echocardiography to the mainstream of echocardiology. Even though pericardial effusions are serious, they are not very common. Information on left ventricular size and function is vital for every patient with known or suspected heart disease.[18]

Dr. Feigenbaum with his trainees and colleagues over the past 6 decades went on to create multiple advances in echocardiography. They described how echocardiography could detect many abnormalities of the cardiac valves and chambers[19], early strip chart recorders for M-mode echocardiograms[20], early 2-dimensional echocardiographic transducers, digital techniques for recording and displaying echocardiograms[21], and performing echocardiograms with exercise and pharmacologic stress[22] were all developed at Indiana University

Awards

1976 Texas Heart Institute Medal and Ray C. Fish Award for Outstanding Achievement in Cardiovascular Disease 1977 Modern Medicine Award fro Distinguished Achievement 1977 Lewis A. Conner Lecture, American Heart Association 1979 Richard and Hinda Rosenthal Award, American Heart Association, Outstanding Achievement in Cardiovascular

   Research

1980 Distinguished Alumnus, IU School of Medicine 1986 Distinguished Alumnus, IU College of Arts and Sciences 1988 Gifted Teacher Award, American College of Cardiolgoy 1989 Robert J. and Claire Pasarow Foundation, Award for Excellence in Carddiovascular Medicine, Los Angeles,

   California

1992 Eugene Drake Memorial Award, American Heart Association 1997 Luminary Award for Scholarly Accomplishment in Science, Pisa, Italy 1998 Louis F. Bishop Lecture, American College of Cardiology 1998 World of Difference Lifetime Achievement Award from the Indiana Health Industry Forum 2000 Feigenbaum Lecture inaugeration at the American Society of Echocardiography 2002 Cor vitae Award from the Midwest Affiliate of the American Heart Association 2004 Primio Mantevergine Award as the "Father of Modern Echocardiography" Naples, Italy 2005 Living Legend Award from the Indiana Historical Society 2005 American Heart Association Distinguished Scientist 2006 International Honory Member, Japanese College of Cardiology 2006 Honorary Member of the Mexican Society of Cardiology 2016 Honorary Member of the European Society of Cardiovascular Imaging 2020 IU Bicentenial Medal by Indiana University [23]

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