Introduction

After graduating from the War Academy in 1905, Atatürk held various domestic and international posts, playing key roles in major conflicts like the Tripoli War, Balkan Wars, and World War I.^1,2 Appointed Inspector of the Ninth Army on April 30, 1919, Atatürk launched the Turkish National Struggle upon arriving in Samsun on May 19, marking the start of a difficult period leading to the Republic’s founding.³ Before the Grand National Assembly was established, Atatürk faced strong political opposition, including efforts to dismiss, arrest, or execute him. He also dealt with revolts, assassination attempts, and opposition groups, enduring harsh conditions on the front lines and in military campaigns.^4,5

Throughout his 57 years, Atatürk dedicated himself to his nation's independence and progress. Despite illness, he prioritized building a modern Turkish state over his health. After surviving an assassination attempt in İzmir, he declared, “My mortal body will surely turn to dust one day, but the Republic of Türkiye will live on forever,” reflecting this commitment.⁶

Despite serving as Atatürk’s personal physician from the founding of the Republic until his death, Ord. Prof. Dr. Neşet Ömer İrdelp (1882-1948) stated, “No one has observed Atatürk closely and for as long as I have. I have notes and one day I will write my memoirs. I treated Atatürk for nearly twenty years and his mother for about ten years.” Nevertheless, he left behind no written documents or memoirs regarding Atatürk’s health.⁷ After Atatürk’s death, Dr. Neşet İrdelp planned to travel abroad for rest. When he sought permission from President İsmet İnönü, İnönü asked him not to write about Atatürk’s health. Dr. İrdelp replied that he had no such intention.⁸

Throughout his life, Atatürk suffered from various illnesses, including malaria, and diseases of the kidneys, heart, respiratory and digestive systems, as well as the ears. Since childhood, he also experienced minor injuries like war wounds, eye injuries, facial abscesses, rib fractures, and even dog bites and horse kicks.^7,9 Although several people close to Atatürk, including his physicians, published memoirs and notes about his final disease and overall health, these accounts lack detailed and comprehensive medical information.⁸ His diseases have been the subject of numerous studies. The most well-known and widely discussed is his liver disease, which is considered to have ultimately led to his death.^10,11 Among these, his heart disease is undoubtedly one that warrants serious consideration.

This research aims to clarify the symptoms, diagnosis, treatment, and causes of Atatürk’s heart disease, as well as the roles of his physicians, by analyzing key primary sources such as memoirs, newspapers, and official archives. The clinical approach will also be examined through the lens of history of medicine, combining contemporary cardiology with the knowledge of his era.

Methods

Research Design

Document analysis, a qualitative research method, involves collecting, reviewing, and analyzing various documents as primary data sources. This includes printed, electronic, visual, and historical materials. By selecting and interpreting relevant documents, researchers can gather meaningful data aligned with the study’s focus.^12,13 Any text-based document related to the case or period studied (such as books, newspaper articles, academic papers, or institutional reports) can be analyzed as part of the research.¹⁴ For this reason, the method is more commonly preferred in historical research.

Another qualitative method is the case study, which enables an in-depth examination of a specific event or process. It allows the use of various data collection tools over a defined period to explore cause-and-effect relationships. Key features of this methodology include (1) it is a research strategy, not merely a data collection method; (2) it requires inclusion of data relevant to the research topic; (3) it allows flexibility in sourcing materials (e.g., books, archives, manuscripts, visual/audio documents); and (4) the subject of analysis may involve an individual, group, organization, event, or decision.¹⁵ Therefore, this method is well-suited for social research in the fields of medicine and health, allowing for a comprehensive understanding of complex medical and healthcare-related phenomena.

When applied to history of medicine research, these methods help contextualize past medical phenomena within their historical period and connect them to modern medical understanding.

Data Collection and Selection of Documents for Analysis

Sources on Atatürk’s heart disease were examined using the Presidential State Archives of the Republic of Türkiye, the National Library of Türkiye, the Istanbul University Newspaper Archive (Gazeteden Tarihe Bakış), and the Wikilala database. Archival documents, primary sources, copyrighted works, analytical studies, and newspapers were reviewed. Only sources relevant to the research topic were included; unrelated materials were excluded from analysis.

This study relies on published memoirs, official documents, and primary sources related to Atatürk’s medical history, with careful attention to the reliability of historical records. Most documents were authored by physicians of the time or individuals close to Atatürk. However, the potential subjectivity of these accounts and the differences between historical and modern medical terminology were also taken into account.

Research Team

Arif Hüdai KÖKEN (MD/PhD on History of Medicine and Ethics), Mahmut BOLAT (PhD on History of Republic), İbrahim Etem ÇELİK (MD, Cardiologist).

Data Analysis

Information specific to Atatürk’s heart disease was extracted from primary printed sources and thematically analyzed by the research team. Using the documents’ chronological order, data were identified on the physicians involved, symptoms, physical findings, diagnostic methods, treatments, recommendations, etiology, and outcomes. The findings were organized into tables, excluding duplicate or similar statements from different sources. Each entry included in the tables was referenced to its original source.

All data used in the research were systematically documented and analyzed by the research team without the use of software. The study’s design and writing followed the SRQR Checklist, an internationally recognized standard for qualitative research.^16,17 (https://onlinelibrary.wiley.com/pb-assets/assets/15532712/SRQR_Checklist-1529502683197.pdf)

The article was originally written in Turkish by the researchers. For the English translation, artificial intelligence (AI) and AI-assisted translation tools were utilized, and the final version of the text was refined through subsequent revisions.

Results

Information regarding Atatürk’s heart disease has been identified in the following sources (Figure 1):

Findings indicate that Atatürk suffered from 2 cardiac-related health episodes, one in November 1923 and another in May 1927. After thematic analysis of the findings regarding the heart diseases that Atatürk had suffered from, in light of the documents examined, 2 different tables were prepared. In addition, an observation report originally prepared in French to be presented to the physicians invited from Germany due to Atatürk’s heart condition, but accessed in its Turkish translation, was also included in the findings in tabular form.

Documents related to the national and international correspondence regarding Atatürk’s 2 cardiac illnesses, experienced in 1923 and 1927, have been identified in the Ottoman Archives, the Republic Archives, and the Archives of the Ministry of Foreign Affairs.

It has been understood from 2 national newspaper articles that Atatürk’s heart condition attracted significant attention from the national public as well.

Discussion

What Happened Regarding Ataturk's Heart Disease?

The political turmoil and wars in the late Ottoman Empire created conditions that demanded greater focus on public health. While various measures were introduced to protect it, not all health-related challenges of the period were fully resolved.¹⁹ In this context, the demanding duties and extraordinary conditions Atatürk faced until the Republic’s establishment likely led to significant stress. His lifestyle also resulted in irregular eating, lack of sleep, and excessive coffee and cigarette consumption. Although the proclamation of the Republic brought some relief, the accumulated fatigue began to affect his health, first appearing as cardiac symptoms.^4,5

The first reports about Atatürk’s health after his election as President emerged in November 1923. It is known that during a lunch, he suffered a heart attack at the table, and Dr. Refik Saydam, who was present, intervened and administered a morphine injection.²⁰ According to Mango, Atatürk became ill on November 11 after lunch. Dr. Refik Saydam performed the initial examination and diagnosed a cardiac spasm. Two days later, Atatürk had another episode while walking in the garden. Dr. Neşet İrdelp, urgently called from Istanbul, confirmed the diagnosis on November 13 and advised rest and dietary restrictions.^4,5 This incident is regarded as Atatürk’s first documented cardiac event (Table 1).⁴ Six days after the incident, Dr. Neşet İrdelp told journalists that Atatürk’s condition was not a heart attack but the result of fatigue, and that he had fully recovered after 6 days of rest.⁵ Following Dr. Neşet İrdelp’s recommendation for rest, Atatürk traveled to İzmir, where Dr. İrdelp continued monitoring his condition. In an official statement dated February 2, 1924, Dr. İrdelp noted that Atatürk had experienced chest pain (angine de poitrine) due to overwork, but that his heart, blood vessels, and blood pressure were normal, and his overall health had significantly improved with rest.^4,21 Archival documents from 1923 reveal that Dr. Neşet İrdelp was invited from within Türkiye to diagnose and treat Atatürk’s heart condition. Additionally, they show that Prof. Kraus, a prominent foreign cardiologist, was identified as a suitable expert and invited for consultation. The records include details of negotiations regarding his requested terms, agreed-upon remuneration, and his condition to be accompanied by an assisting physician (Figure 2).^22–25 Based on this information, it is clear that in 1923, Dr. Neşet İrdelp played a direct role in diagnosing and treating Atatürk’s heart disease. Although plans were made to bring Prof. Kraus and a second physician of his choice to Türkiye as consultants, available records indicate that they did not travel to Türkiye at that time and did not take part in Atatürk’s cardiac care.

News of Atatürk’s disease spread both within Türkiye and abroad, understandably generating widespread concern and public interest.²¹ Indeed, when Atatürk traveled to İzmir for rest on December 14, 1923, following medical advice, the newspaper İstikbal reported the event with the headline: “The President is Going to İzmir for Rest.”²⁶ After news of Atatürk’s illness circulated from Rome and reached Greece, Foreign Minister Tevfik Rüştü Aras, then in Athens as Chairman of the Turkish Delegates of the Mixed Exchange Commission, requested clarification from the Prime Ministry. In an official response dated December 18, 1923, it was stated that the reports were unfounded and that Atatürk’s health was in good condition.²⁷ Following Dr. Neşet Ömer İrdelp’s statement on February 2, 1924, regarding Atatürk’s condition in İzmir, Tanin newspaper reported the news with the headline: “His Excellency the President of the Republic is Completely and Absolutely Well” on February 4, 1924 (Figure 3).²⁸ At the time, opponents of the Republic remained active and sought opportunities to further their agendas, while unresolved issues persisted in the international political landscape. For these reasons, it is believed that Atatürk’s illness was deliberately kept confidential to avoid jeopardizing the stability and continuity of the Turkish state. Nonetheless, it is clear that his first cardiac episode in 1923 was closely monitored by both national and international public opinion.

Following the proclamation of the Republic, a politically turbulent period began, marked by growing challenges in governance. Efforts to build the new state brought numerous political struggles at both national and international levels. As a result, Atatürk was forced to continue living under conditions that negatively impacted his health.²⁰ Atatürk’s second cardiac episode occurred in late May 1927. He experienced intense chest and left arm pain, reportedly saying, “Take this pain away from here.” Dr. Refik Saydam and Dr. İsmail Arar responded immediately, and Dr. Neşet İrdelp was urgently called to Ankara. After examining Atatürk, Dr. İrdelp attributed the episode to extreme fatigue. At the time, Atatürk was facing political pressures while also working tirelessly on the Great Speech, sometimes for up to 30 hours straight. It was then decided to invite Prof. Dr. Kraus, Director of Internal Medicine at the University of Berlin, and Prof. Dr. von Romberg, Director of Internal Medicine at the University of Munich, for consultation. The Turkish Embassy in Berlin was instructed accordingly. A medical observation report in French, prepared by Dr. Asım İsmail, detailing Atatürk’s health history, was created for the visiting physicians (Table 2).⁴

The observation report states that the patient, aged 46, experienced radiating chest and left arm pain on 3 occasions. His medical history notes that his mother died of heart failure secondary to aortitis and that he had no serious childhood illnesses. He was identified as a heavy smoker and had suffered physical and mental exhaustion over the past 9 years due to intense and stressful work. Three years prior, he had retrosternal pain lasting about 20 minutes, followed 2 days later by exertion-induced pain of a similar nature, which resolved with rest and diet. The second significant episode occurred on the night of May 22-23, 1927, with recurring pain of the same type. His general condition was described as good. During the 1923 episode, blood pressure measured with a Vaquez sphygmomanometer was 14/9, with extrasystoles observed every 20-40 beats. In the 1927 episode, blood pressure measured with a Pachon sphygmomanometer was 14.5/9, with similar extrasystoles. Auscultation and percussion findings were normal. Radioscopic examination showed the heart and aortic vessels to be of normal size. The digestive and excretory systems were also normal. Rales had been present at the base of the left lung for the past year, and decreased leg reflexes were noted. Morphine was administered during both episodes. Iodine was prescribed for 2 months following the first. For the second episode, recommendations included rest, a ban on smoking and alcohol, and dietary restrictions.^8,18 Hasan Rıza Soyak also confirms the details provided in the observation report. He further notes that on May 28, Atatürk developed a fever reaching 40°C, accompanied by chills. His condition improved over the following days with treatment, and a peripheral smear test yielded negative results (Table 3).⁴

Prof. Dr. Kraus and Prof. Dr. von Romberg arrived in Ankara on June 6, 1927, and examined Atatürk at Çankaya. They stayed in Ankara for 4 days.²⁹ After a thorough examination, the German professors diagnosed Atatürk with angina caused by excessive smoking and strongly recommended rest along with a complete ban on tobacco use. In a 1958 article, Dr. Asım Aras referenced their diagnosis of angine de poitrine due to tabagique (excessive tobacco use), interpreting it in modern medical terms as a “myocardial infarction.”¹⁸

Among the archival documents, one dated December 8, 1927, stands out regarding Atatürk’s heart condition. According to this document, Russia inquired whether Atatürk was suffering from kidney disease. In response, the Turkish Ministry of Foreign Affairs stated that he did not have such a condition and that his overall health was good (Figure 2).³⁰ As in 1923, Atatürk’s serious heart disease in 1927 was kept secret. This was considered necessary, as the internal and external challenges of the time threatened to undermine efforts to establish order in the newly founded state and could have provided an opportunity for both domestic opposition and foreign intervention.

However, around 8 months after Atatürk’s heart disease, the French newspaper L'Echo de Paris published an article on February 13, 1928, titled “Kemal Pasha's Health is in Danger.” The report claimed that Atatürk had fainted in the street in Ankara. On the same day, The Daily Telegraph in London also published the story, which was then picked up by the Reuter Agency and circulated widely across the European press. This news triggered pessimistic commentary in Türkiye and sparked public concern over the future of the country.²⁰

Doctors Working During Atatürk's Heart Disease

Dr. Refik Saydam (1881-1942): He graduated from the Imperial School of Medicine (Mekteb-i Tıbbiye) in 1905 with the rank of captain. After serving in several military hospitals, he was sent to Germany in 1910. Upon returning, he held various medical and health-related positions during the Balkan Wars, World War I, and the years that followed. In 1919, he joined Atatürk in Samsun and actively participated in the Turkish National Struggle. Ord.Prof. Dr. Neşet Ömer İrdelp (1882-1948): He graduated from the Civil Imperial School of Medicine (Mekteb-i Tıbbiye-i Mülkiye) in 1902. In 1908, he went to Paris, where he worked with 2 leading physicians of the time, Henry Vaquez and Vidal. Upon returning to Istanbul, he completed his specialization in internal medicine at the Darülfünun Medical Faculty in 1910. During the war years, he served both on the front lines and in efforts to combat epidemics across various regions. In 1921, he rejoined the faculty and was appointed professor of internal medicine, later becoming an Ordinary Professor in 1933. His significant contributions to cardiology include lectures on cardiac diseases (Emraz-ı Kalbiye Konferansları, 1911), diseases of the heart and viscera (Kalp ve Ev’iye Emrazı, 1923), and clinical electrocardiography (Klinik Elektrokardiyografi, 1934). Dr. İbrahim Talî Öngören (1875-1952): He graduated from Mekteb-i Tıbbiye in 1893 with the rank of captain and became a certified surgeon in 1896. He served on various fronts, holding military ranks such as senior captain (kolağası), colonel (miralay), and also served as a district governor. In 1912, he conducted research on military surgery in Germany. In 1919, he joined Atatürk in Samsun and participated in the Turkish National Struggle. Dr. Asım Arar (1890-1955): He graduated from the Darülfünun Faculty of Medicine in 1911 and began his specialization in internal medicine at the same institution. Between 1916 and 1918, he completed his training in Berlin. Prof. Dr. Friedrich Kraus (1858-1936): He was born in Böhmen/Bodenbach and graduated from the University of Prague in 1882. Between 1882 and 1885, he worked as an assistant in the institutes of physiology, anatomy, pathology, and chemistry. In 1893, he joined the Rudolf Hospital in Vienna and, a year later, became a professor of medical pathology and therapy. In 1902, he moved to the Berlin Medical School, where he served as dean and continued working until his retirement. His main focus was internal medicine, with a particular interest in heart diseases. Prof. Dr. Ernst Von Romberg (1865-1933): He was born in Berlin and pursued his medical studies in Tübingen, Heidelberg, and Berlin, completing his doctorate in Leipzig in 1888. In 1891, he finished his specialization in internal medicine and became a professor in 1895. He conducted extensive research and authored works on heart and circulatory system diseases.⁷ Prof. Kraus was a highly knowledgeable, cultured, and internationally renowned physician. Known for his open-mindedness and exceptional intelligence, he was frequently consulted in the treatment of monarchs and their families, with many relying on his medical opinions and recommendations. He even traveled to Istanbul during World War I to treat Sultan Reşad. While not as internationally recognized as Kraus, Prof. von Romberg was well-regarded within German medical circles, particularly for his expertise in heart disease.¹⁸ An examination of these physicians’ backgrounds reveals that they were notable specialists in cardiac diseases of their time, possessing significant expertise and recognition in the field of cardiology (Figure 4).

Evaluation of the Diagnosis and Treatment of Atatürk's Heart Disease in Terms of Medical Developments

Wilhelm Conrad Röntgen’s 1895 discovery of X-rays quickly found medical use, especially in locating foreign objects from injuries and gunshots, proving vital in military surgery. In 1896, Dr. Esat Feyzi, an intern at Mekteb-i Tıbbiye-i Şahane in Istanbul, took the first radiographs in the Ottoman Empire. These efforts advanced radiographic work at the medical school, leading to the use of X-rays for diagnosing war injuries during the 1897 Turkish-Greek War.³¹ In 1896, American radiologist Morton began using X-rays to outline the heart. A year later, Walsh produced a chest X-ray showing the heart’s size and position, marking the start of radiographic diagnosis of cardiac and aortic conditions. In 1902, Albert Abrams began measuring normal heart dimensions, later using fluoroscopy, orthodiography, and radiography. Kassabian’s 1907 textbook included Moritz’s heart size chart from Germany. Later, Claytor and Merrill studied the link between heart and body size, and lesions were identified using orthodiagrams.³² From the perspective of the period, radiology was a contemporary scientific method used to detect pathologies by visualizing the heart and aorta. It appears that this method was also employed in diagnosing Atatürk’s heart disease.

Dutch physiologist Willem Einthoven invented electrocardiography in 1902, advancing earlier, limited electrophysiologic studies of the heart. This invention provided physicians with a powerful tool for diagnosing conditions like arrhythmias and acute myocardial infarction (AMI). As a result, clinical practice began shifting from reliance solely on the senses and stethoscope to incorporating machines and technical methods.³³ There is no definitive record of when electrocardiography was first used in the Ottoman Empire. However, given Dr. Neşet İrdelp’s strong interest in cardiology, it is likely that he closely followed advancements in this field. If an electrocardiography device existed in Türkiye at the time, it was most likely housed in the Internal Medicine Clinic of the Darülfünun Medical Faculty, where Dr. İrdelp worked. Therefore, it is plausible that an electrocardiogram (ECG) could not be performed on Atatürk while he was in Ankara.

Human blood vessels were first imaged in January 1896, just a month after the discovery of X-rays. Haschek and Lindenthal used Teichmann’s mixture of calcium carbonate to visualize the vessels of an amputated hand. In 1920, a radiographic atlas published in England included clear images of arteries in cadavers. Arterial radiography on living patients began in 1923. By 1938, Castellanos et al published detailed angiocardiographic images, identifying both normal and pathological conditions such as atrial and ventricular septal defects, pulmonary stenosis, tetralogy of Fallot, and transposition of the great arteries, marking a significant advancement in cardiac imaging (Figure 5).³² Although arterial angiography on living patients began in 1923, the first cardiac angiography was not performed until 1938. Therefore, considering the scientific context of the time, the absence of angiographic methods in diagnosing Atatürk’s heart disease is entirely expected.

In 1920, Eyster and Meek reported capturing radiographs of the human heart simultaneously with electrocardiographic tracings. By 1922, Karshner and Kennicott had described radiographic findings associated with various cardiac conditions, including mitral stenosis with pulmonary edema, mitral regurgitation, aortic regurgitation, and pericardial effusion. In a seminar presentation, it was emphasized that X-ray imaging provided the most accurate method for assessing cardiac size and morphology in clinical practice. This was particularly important in patients where physical examination was limited, such as those with obesity or emphysema, making radiography potentially the only viable diagnostic tool. The presentation also noted that X-rays could reveal pericardial calcifications and aortic aneurysms, and accurately assess the size of the aorta, left atrium, and, in some cases, the left ventricle. Additionally, abnormalities in hilar shadows and pulmonary arteries were sometimes detectable only through radiological means. The use of fluoroscopy to observe the heart and major vessels in real-time further highlighted the growing diagnostic value of radiographic techniques in cardiology during that period.³² Scientific advancements indicate that after 1920, cardiovascular diseases began to be diagnosed using a combination of X-rays and electrocardiography. However, there is no evidence that this combined diagnostic method was applied in Atatürk’s case.

The discovery and clinical use of biomarkers, key tools in diagnosing and managing cardiovascular diseases, represent a major milestone in medical history. The first heart-related biomarker, AST, was identified in 1954. Over time, additional biomarkers were discovered, including lactate dehydrogenase, creatine kinase (CK, CK-MB), heart-type fatty acid-binding protein, CK-MB mass, troponins (TnI, TnT), B-type natriuretic peptide, high-sensitive C-reactive protein, Galectin-3, sLOX-1, and most recently, sST2 in 2013.³⁴ Considering this historical timeline, it is clear that biomarkers were not yet available for diagnostic use during the period when Atatürk experienced his cardiac diseases.

The medical diagnostic potential of sound waves was recognized as early as the 17th century. However, research specifically focused on the diagnostic use of echocardiography began in the 1950s, and it was introduced into clinical practice as a cardiac imaging and diagnostic tool in the early 1960s.^35,36 The use of echocardiography in the diagnosis of heart diseases emerged well after the period in which Atatürk’s cardiac disease was observed.

According to the European Society of Cardiology (ESC) guidelines, acute coronary syndrome (ACS) is diagnosed based on recent-onset clinical symptoms or signs, with or without changes on a 12-lead ECG and elevated cardiac troponin levels. Acute coronary syndrome is categorized into 2 main types: unstable angina and AMI. Acute myocardial infarction s diagnosed by elevated cardiac troponin levels, in line with the fourth universal definition of myocardial infarction. Unstable angina involves myocardial ischemia without detectable myocardial necrosis. It is typically marked by retrosternal chest pain lasting over 20 minutes, possibly radiating to the left arm, new and severe chest pain, angina that is worsening in frequency or duration, and angina occurring shortly after a recent myocardial infarction.³⁷ At the time of Atatürk’s diagnosis, only clinical symptoms and patient history (anamnesis) were used, as diagnostic tools such as ECG and cardiac troponin testing were not yet available. He was diagnosed with angina, attributed primarily to excessive fatigue and tobacco use, rather than ACS. However, in 1958, Dr. Asım Arar, who documented Atatürk’s medical history, retrospectively described the condition as a myocardial infarction based on the clinical picture.

Aspirin is one of the oldest known medications. After Felix Hoffmann synthesized acetylsalicylic acid in 1897, Bayer registered it under the trademark Aspirin in 1899. It was patented in the U.S. in 1900, and by 1904, Bayer began producing it in tablet form.³⁸ It took until 1925 for the drug to enter Türkiye.³⁹ In 1948, Paul Gibson recommended salicylic acid for the treatment of coronary thrombosis. By then, even in its aspirin form, the drug was already well-known for its analgesic and antipyretic properties.³⁸ In 1974, Elwood et al conducted the first randomized controlled trial on the secondary prevention of myocardial infarction, demonstrating the beneficial effects of aspirin in reducing the risk of further cardiac events.^{38 ,40} Recent evidence from contemporary studies confirms that aspirin remains a highly effective medication for both the treatment and prevention of cardiovascular diseases.^{40 ,41} In ACS, aspirin should be given as soon as possible after diagnosis and then used as maintenance therapy.³⁷ In retrospect, Atatürk’s symptoms in 1923 and 1927 were most likely consistent with ACS. However, since the antiaggregant effect of aspirin was not yet known, it is believed that aspirin was not administered. Instead, morphine, still recognized today as an effective pain reliever, was prescribed during both cardiac episodes.

Atatürk spent much of his life engaged in struggle and hard work, often in wars and on the front lines. He endured long periods of intense effort and exhaustion, maintaining this demanding pace through the end of the War of Independence. These harsh working conditions inevitably affected his health. The founding of the Republic and the reform era that followed brought significant political challenges, adding intense stress that further impacted him physically.⁴² Heavy smoking and chronic stress are well-established risk factors for coronary artery disease and were likely major contributors to the cardiac episodes Atatürk experienced.

Limitations of the Research

Since modern cardiac diagnostic tools such as biomarker testing, electrocardiography (ECG), echocardiography, and angiography were not available during the period covered by this study, Atatürk’s heart conditions were evaluated solely based on clinical symptoms and physical examination findings. This limitation makes it difficult to establish a definitive diagnosis. The study is based on archival documents, physicians’ memoirs, and historical records from the time. However, the scarcity of primary sources and the unavailability of original medical records may have led to gaps in information or reliance on interpretation. Atatürk’s health status has been retrospectively assessed using current medical knowledge, but fully aligning the medical terminology of that era with today’s literature is not always possible. This evaluation considers early 20th-century medical practices, and thus, comparisons with modern cardiology have inherent limitations.

Conclusion

This study aims to evaluate the diagnostic and treatment processes of Atatürk’s heart conditions within the context of the medical capabilities of his time, using historical data analyzed through qualitative research methods. Findings indicate that Atatürk experienced at least 2 cardiac episodes, in 1923 and 1927, both marked by chest pain radiating to the left arm. Based on the medical understanding of the period, these symptoms align with what is now classified as ACS. However, in the absence of widely available diagnostic tools such as cardiac biomarkers, electrocardiography (ECG), echocardiography, and angiography, diagnosis relied solely on clinical observation and symptom evaluation.

Atatürk’s heart disease is linked to predisposing factors such as excessive workload, chronic stress, and heavy smoking. Current scientific evidence identifies these as major risk factors for coronary artery disease, with poor management potentially leading to myocardial infarction. In this context, the historical classification of his condition as angine de poitrine (angina pectoris), and its contemporary interpretation as a possible ACS, either unstable angina or ACI, is particularly significant.

According to the medical practices of the time, preventive measures for Atatürk’s cardiac health focused on rest, dietary regulation, and limiting tobacco use. However, the absence of routinely used cardiovascular therapies, such as antiplatelet agents (e.g., aspirin), statins, ACE inhibitors, and beta-blockers, which are now essential in managing ACS, represented a significant limitation in the long-term treatment and management of his condition.

This historical analysis of Atatürk’s cardiac condition offers important perspectives on the history of medicine and highlights the cardiological practices of the early 20th century. The findings underscore how scientific advancements in diagnosing and treating cardiovascular diseases have significantly contributed to the development of modern medicine. In this context, it can be concluded that history of medicine research not only enriches the understanding of past practices but also provides valuable insights for contemporary clinical care and the ongoing evolution of medical knowledge.

Footnotes

Ethics Committee Approval: As this research was conducted using historically significant documents that are publicly accessible and available for use and employed historical methodology and the qualitative research method of document analysis, ethics committee approval was not required.

Informed Consent: As this research did not involve the collection of data from human subjects, informed consent was not required.

Peer-review: Externally peer reviewed.

Author Contributions: A.H.K., M.B., İ.E.Ç.: Conception and design of the study. A.H.K., M.B., İ.E.Ç.: Acquisition and analysis of data. A.H.K., M.B., İ.E.Ç.: Writing, review and revision of the manuscript. İ.E.Ç.: Study supervision. A.H.K., M.B., İ.E.Ç.: All authors read and approved the final manuscript.

Declaration of Interests: The authors have no conflict of interest to declare.

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