(Circulation. 1998;97:2101-2102.)
© 1998 American Heart Association, Inc.
Herbert N. Hultgren, MD
1917–1997
William H. Barry, MD, Salt Lake City, Utah
Herbert N.
Hultgren, Professor of Medicine Emeritus at Stanford, died in October
1997 at age 80 of complications of acute myelogenous leukemia. Herb was
a native of northern California and graduated from Stanford University
in 1939 and from its School of Medicine in 1943. He completed residency
training in medicine and pathology at Stanford and served in Europe in
World War II with the US Army Medical Corps. He was a research fellow
in cardiology at the Thorndike Memorial Laboratory in
Boston, Mass, and then returned to Stanford in 1948, where he
established the first cardiac catheterization
laboratory in northern California and in 1955 became chief of
cardiology at Stanford.
In 1968, after the Stanford Medical School had relocated from San
Francisco to Palo Alto, Calif, Herb was appointed chief of
cardiology at the Palo Alto Veterans Administration
Hospital, a position he held until 1984. I worked with him at Stanford
as a cardiology fellow and then as junior faculty
member in the cardiology division from 1970 to 1977. I
and numerous Stanford students, residents, and faculty benefited
enormously from contact with Herb, as he was a superb teacher, clinical
cardiologist, and clinical investigator. He was chairman of the
American Board of Internal Medicine Subspecialty Board on
Cardiovascular Disease from 1972 to 1975 and was a
founding member of the Association of University Cardiologists, serving
as its president in 1970.
Herb was recognized as a world authority on altitude sickness and was
the first US investigator to define (in Medicine in 1961)
the clinical characteristics of high-altitude pulmonary edema,
although the pathophysiological basis of this
condition was unknown. In 1962, while serving as chief of
cardiology at the University of Utah, Hans Hecht
published a case report of pulmonary hypertension with a normal
left atrial pressure (measured at right heart
catheterization via a patent foramen ovale) in a
physician who had developed pulmonary edema while skiing at
Alta, Utah. A pulmonary artery wedge pressure could not be
recorded, and Hecht and associates concluded that
hypoxia-induced spasm of the postcapillary pulmonary
veins might be the cause of high-altitude pulmonary
hypertension and edema. In 1964, Hultgren and associates published a
remarkable study in Circulation in which they performed
right heart catheterization in a series of patients
with high-altitude pulmonary edema admitted to Chulec General
Hospital in the city of La Oroya, at 12 300 feet in the Peruvian
Andes. This study established that this form of pulmonary edema
was consistently associated with very significant
pulmonary hypertension and documented that it occurred with a
normal or low wedge pressure. Herb subsequently advanced the
still-accepted hypothesis that edema resulted from
hypoxia-induced focal pulmonary artery constriction,
with overperfusion of lesser-affected segments causing a
pulmonary capillary leak.
Herb was an avid mountaineer and climbed many of the highest
peaks in North and South America. He was chairman of the Medical
Committee of the American Alpine Club from 1974 to 1980. When I was at
the Palo Alto Veterans Administration Hospital, Herb was fond of taking
junior faculty and fellows to the Barcroft high-altitude research
laboratory on White Mountain Peak, at an altitude of 12 500 feet. Herb
always took an echocardiogram machine to the laboratory on the chance
that one of us would develop high-altitude pulmonary edema so
that he could demonstrate that this occurred in the presence of normal
echocardiographic ventricular function.
Although none of us ever did develop this disorder, we were routinely
embarrassed by Herb's endurance at high altitude on our climbs to the
top of White Mountain Peak, at 14 246 feet. Herb's endurance was also
demonstrated by his decision to undergo chemotherapy at age 79 so that
he could complete work on his excellent book, High-Altitude
Medicine, which was published last June.
Herb was also very interested in ischemic heart disease and was
cochair (with T. Takaro) of the Veterans Administration cooperative
study comparing the use of coronary artery bypass graft surgery
with medical treatment in patients with ischemic heart disease.
This was one of the first large, randomized, multicenter trials that
assessed benefits of a specific treatment in
cardiovascular disease. Analysis of data from
this study clearly established the beneficial effects of surgery on
survival in patients with left main disease and on exercise
hemodynamics in patients with ischemic
ventricular dysfunction. It had a major impact on practice
and on subsequent design and application of clinical trials in
cardiology. During his career, Herb was author of 176
papers and 34 book chapters. In 1990, his numerous clinical
contributions were recognized when he received the prestigious Albion
W. Hewlett Award at Stanford, which honors "the physician of care and
skill who has committed to discovering and using biologic knowledge,
wisdom, and compassion to return patients to productive
lives."
Herb and I became close friends during the years I spent with him
at the Veterans Administration Hospital and remained so subsequently. I
was fortunate to be able to enjoy many backpacking and trout-fishing
trips with Herb. In spite of his remarkable professional and personal
achievements, Herb remained totally self-effacing and modest. He is
survived by his wife, Barbara, three sons, and one grandson. His family
and friends, as well as the cardiology and
mountaineering communities, owe much to this remarkable man.
