International Journal of Cardiology 172 (2014) e145–e146

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International Journal of Cardiology

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Letter to the Editor

Avicenna's description of cardiac tamponade

Behnam Dalfardi a,b,⁎, Golnoush Sadat Mahmoudi Nezhad a,b, Ahmad Ghanizadeh c,d
a
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
b
Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
c
Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Hafez Hospital, Shiraz, Iran
d
Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

a r t i c l e i n f o described the clinical triad of cardiac tamponade which includes in-

creased systemic venous pressure, hypotension, and a small and quiet
heart [7].
Article history:
Received 29 September 2013
Accepted 22 December 2013
Available online 4 January 2014

Keywords:
Avicenna
Cardiac tamponade
Medieval history
Persia

Man's familiarity with the pericardium can be traced back to a time

before Christ. Hippocrates (460–370 BC) is credited with providing the
first description of this structure. He expounded that this membrane is a
smooth covering around the heart and pointed to the presence of a
small quantity of fluid similar to urine within it [1,2]. Some centuries
later, Galen (131–201 AD) provided the earliest report on pericardial ef-
fusion, a condition which he observed in a monkey. It is supposed that
Galen also performed the first pericardial resection in a human. Yet, dis-
eases of the pericardium remained neglected for a long time after its dis-
covery [2,3].
Cardiac tamponade, a disease related to the pericardium, is a con-
dition with different etiologies in which fluid accumulation within
the pericardial space causes the compression of the heart's cham-
bers; consequently, cardiac filling, cardiac output, and blood pres-
sure are decreased. This disease can be life-threatening and can
lead to cardiogenic shock [4,5].
Historically, Ambroise Paré (1510–1590), a French surgeon, report-
ed a delayed death after a stab to the heart, which was probably due
to traumatic hemopericardium [6]. Some years after him in 1669, the
Cornish physician Richard Lower (1631–1691) gave the first explana-
tion of the tamponade impact of pericardial effusion. Later, in 1884,
the German surgeon Edmund Rose (1836–1914) coined the term
“Herztamponade” (cardiac tamponade) [2,3,6]. Afterwards, in 1935,
Claude Schaeffer Beck (1894–1971), an American thoracic surgeon,

⁎ Corresponding author at: Student Research Committee, Shiraz University of Medical Fig. 1. Opening of the third book of the Avicenna's Al-Qanun-fi-al-Tibb (The Canon of
Sciences, Shiraz, Iran. Tel.: +98 913 2483359; fax: +98 711 2122970. Medicine), belonging to the beginning of 15th century. (Courtesy US National Library
E-mail address: Dalfardibeh@gmail.com (B. Dalfardi). of Medicine).

0167-5273/$ – see front matter © 2014 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijcard.2013.12.099
e146 B. Dalfardi et al. / International Journal of Cardiology 172 (2014) e145–e146
As will be discussed here, a review of the medieval medical literature
will show that the great Persian physician, Avicenna, provided a de-
scription of cardiac tamponade long before any of the above-named
scholars.
Abu Ali Husain ibn Abdullah ibn Sina (980–1037), commonly known
by his Latin name Avicenna, was a scientist who had a great impact on
the medical knowledge of not only his time but also time thereafter.
His main surviving medical encyclopedia, Al-Qanun-fi-al-Tibb (The
Canon of Medicine), is considered to be the most influential work on
the healing arts in all the history of medicine (Fig. 1) [8,9].
A main part of the Canon is devoted to cardiovascular medicine and
includes the anatomy and function of the heart [10]. In the 11th subsec-
tion of the third book of the Canon, Fi Ahval-e al-Ghalb (About the
Heart), Avicenna illustrates a membrane surrounding the heart: “The
heart is placed within a thick ‘niam’ [pericardium]. … no other membrane
is similar to this one in thickness…. This thick membrane, the ‘niam’
[pericardium], is there to protect the heart…”. Later in the same part of
the book, Avicenna describes diseases of the heart and points to the
presence of a fluid between the aforementioned membrane and the
heart itself. He introduces the excess of this fluid as a disease. Avicenna
states: “… it is obvious that if the fluid becomes excessive, it will put the
heart under pressure and the heart will not be able to dilate…”. It could
be claimed that these statements are an early description of what is
known in modern medicine as cardiac tamponade [10].
References
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therapy. Würzburg, Germany: Springer; 2011 1.
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[10] Sharafkandi A. (Translator) The Persian translation of Al-Qanun-fi-al-Tibb (The
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