CONTENT

To the Editor,

The health of national leaders has always attracted public attention. In contemporary times, advances in medicine and preventive care have enabled many heads of state to live long lives despite stressful demands. However, the disclosure of a leader’s health problems remains a sensitive issue, as it may be perceived as a vulnerability with implications for national security and political stability.

Mustafa Kemal Atatürk’s health has long been a subject of speculation and historical debate.¹ As a young officer, he managed to lead a defeated country to independence and established a powerful republic under extremely challenging conditions. However, his extraordinary success was accompanied by an extraordinary workload and an unhealthy lifestyle—all of which contributed to a high risk for cardiovascular disease (CVD).

In their recent article published in Anadolu Kardiyoloji Dergisi, Köken AH and colleagues² provided a valuable historical–cardiological analysis of Atatürk’s CVD, combining archival materials with modern diagnostic frameworks. Building on their contribution, I’d like to add further insights—particularly concerning the early onset CVD—based on additional historical sources, especially Eren Akçiçek’s comprehensive book Atatürk’ün Sağlığı, Hastalıkları ve Ölümü (Atatürk’s Health, Diseases, and Death),³ and aides’ diaries,⁴ both of which may allow for a more detailed reconstruction of his clinical course.

While many consultations were documented,^{3- 4} Atatürk’s official medical records were never fully disclosed. His long-time personal physician, Dr. Neşet Ömer İrdelp, left no personal notes and likely destroyed those of other doctors.³ He consistently attributed Atatürk’s cardiac symptoms to “fatigue.”^{2- 3,5- 6} This may have been an attempt to conceal the health problems of a national leader, or it may reflect a diagnostic oversight. Either way, the truth remains unknown. Caring for a national leader is rarely straightforward; transparency is often sacrificed for the sake of political continuity. Moreover, physicians themselves may experience ethical dilemmas or professional pressure, at times hesitating to implement what they believe to be the most appropriate medical approach.

A careful review of contemporaneous documents suggests that Mustafa Kemal Atatürk experienced at least 5 coronary episodes between 1923 and 1927.³ Table 1 summarizes his cardiovascular risk profile, clinical course, and therapeutic strategies during each episode.

Accordingly, the first cardiac episode occurred on November 11, 1923, when Atatürk was 42 years old. Only 2 weeks had passed since the proclamation of the Republic on October 29, 1923, and the stressful transition from empire to republic was ongoing. During lunch, Atatürk developed sudden retrosternal chest pain lasting approximately 20 minutes, radiating to the left arm, and accompanied by diaphoresis and marked fatigue.^2,3 Dr. Refik Saydam, administered morphine, which relieved the pain. Physical examination revealed a blood pressure (BP) of 140/90 mm Hg and extrasystoles every 20-40 beats.

Two days later, on November 13, 1923, Atatürk experienced another episode while walking in the garden after lunch and coffee. He reported profound fatigue, followed by syncope and shortness of breath. Eyewitnesses described him as pale and weak, requiring assistance. This event likely indicated a second ischemic episode, possibly accompanied by arrhythmia.

On November 14, 1923, Dr. Neşet Ömer İrdelp examined Atatürk and attributed the episodes to “elemi asabi” (nervous exhaustion), rather than CVD. He recommended strict rest and a change of climate, leading to more than 50 days in İzmir under close observation. Tobacco and coffee were prohibited, and a milk–vege diet was implemented. Atatürk recovered well and returned to near-normal function. However, he soon resumed smoking, coffee intake, and irregular working hours. During this period, he also received a low-dose iodine treatment for 2 months, a now-abandoned practice once believed beneficial for CVD.³

At the age of 46, Atatürk experienced his most severe cardiac event on the night of May 22 and May 23 1927, during the intense preparation of his historical Great Speech, Nutuk. He developed severe retrosternal pain radiating to the left arm, accompanied by diaphoresis, pallor, nausea, and distress while at rest. In the following days, he suffered 2 additional anginal episodes—reportedly less intense but longer in duration—again with retrosternal pain and progressive breathlessness. Witnesses recalled him shouting: “Take this pain away from me!” He was treated with morphine. His BP was 145/90 mm Hg, with frequent extrasystoles.^2-6

In June 1927, German professors Friedrich Kraus (Berlin) and Ernst von Romberg (Munich) were invited to examine Atatürk. Their report noted a normal cardiac exam and a negative Wassermann test (used to exclude syphilitic aortitis, a routine consideration in CVD at the time),³ and they offered a diagnosis of “tobacco-induced angina.” Despite the cautious language, the overall clinical picture strongly supported post-infarction angina with underlying myocardial damage. Treatment remained empirical: bed rest, morphine, and a milk–vege diet.^3-5 Tobacco was initially prohibited, but he was later permitted to resume smoking in reduced amounts—reflecting both medical uncertainty and Atatürk’s strong dependency.

Atatürk’s cardiovascular history probably exemplifies the multifactorial nature of premature CVD, shaped by a combination of genetic, infectious, and lifestyle factors. His father⁷ died young at age 46-47, and his mother reportedly suffered from high BP and died of heart failure⁸—probably suggesting familial predisposition (Table 1). He also had severe chronic infections, including malaria and pyelitis,⁹ both of which are associated with systemic inflammation and endothelial damage. His personal habits further increased the risk: an unbalanced diet, consumption of 10-15 cups of coffee and 30-40 (50) cigarettes per day,minimal and irregular sleep, and extreme work hours, sometimes exceeding 30 hours without rest.^2-6

Without access to aspirin, anticoagulants, β-blockers, statins, cholesterol testing, or revascularization therapies, his treatment was restricted to bed rest and symptomatic relief. Unfortunately, prolonged immobilization carried its own dangers—particularly deep vein thrombosis and pulmonary embolism—which may have contributed to his coronary episodes and also progression of a probable myocardial dysfunction after 1927. Eyewitnesses and photographs from this time suggest worsening dyspnea, edema, abdominal obesity (distension), and declining functional capacity (Figure 1).^3,10

Chronic passive hepatic congestion from right-sided heart failure may have contributed to the cirrhosis recognized in 1938, which was diagnosed quite late, despite long-standing symptoms such as severe pruritus and recurrent nasal bleeding. Although often attributed solely to alcohol,¹¹ the etiology of his cirrhosis may have been multifactorial, including heart failure and malaria and/or anti-malaria drugs. Regardless, his clinical course underscores both the therapeutic limitations of early 20^th-century cardiology and the complex politics surrounding the care and disclosure of health conditions in high-profile leaders.

Atatürk’s ability to lead through and beyond multiple myocardial infarctions is a remarkable testament to his resilience. That he remained so successful despite life-threatening illness and progressive decline invites further exploration—possibly rooted in traits such as intense drive, hyperfocus, hyperactivity, and an unshakable sense of duty.

Footnotes

Declaration of Interests: The author have no conflicts of interest to declare.

References

1. Vatanoglu-Lutz EE, Hot I, Coban M. What do we know about the medical biography of Kemal Atatürk (1881-1938)? A summary of the state of knowledge and outlook on relevant issues for further research. J Med Biogr. 2013;21(3):136-142.
2. Köken AH, Bolat M, Çelik İE. Atatürk's (1881-1938) heart disease: a qualitative research. Anatol J Cardiol. 2025;29(8):431-443.
3. Akçiçek E. . Atatürk’ün Sağlığı, Hastalıkları ve Ölümü. ;():-.
4. Akansel İH. Atatürk ve Yaverleri. Military Academy Printing House. 2006;():-.
5. Soyak HR. . Atatürk'ten Hatıralar I. 1973;():725-727.
6. Arar A. . Son Günlerinde Atatürk. 1958;():12-.
7. Akçiçek E. Father Ali Rıza Efendi’s health. . 2005;():11-.
8. Akçiçek E. Mother Zübeyde Hanım’s health. . 2005;():11-.
9. Akçiçek E. . Malaria. 2005;():143-.
10. Özel M. Turkish Ministry of Culture. Atatürk. ;():-.
11. Akçiçek E. Was Atatürk’s cirrhosis due to alcohol or hepatitis?. . 2005;():245-.