Robert E. Lee may have lost Gettysburg because of a heart attack

In July 1863, Confederate General Robert E. Lee hatched an audacious plan to invade the North, defeat the Union Army, and force an end to the war – with a Confederate victory. Everything – perhaps the entire Civil War – depended on the outcome at Gettysburg.

So maybe Lee should have stayed home to recover from his heart attack.

A study from the National Institute of Health’s Center for Biotechnology Information reviewed the general’s medical history in 1992. Despite his relatively good medical condition from 1864 to 1867, by the end of the decade, he suffered from exertional (stable) angina – chest pain from blocked arteries caused by activity. By 1870, his angina became unstable and he died at age 63.

“It often was stated that the loss of the war broke the heart of Lee, but in view of our modern day understanding, it probably is more accurate to say that advancing coronary atherosclerosis was the culprit,” the NIH said.

Robert E. Lee Heart Attack Gettysburg

“Say, you gents have any red meat and eggs?”

Harvard studies show the cardiac impact of six major risk factors: high total cholesterol, low HDL (“good”) cholesterol, high blood pressure, diabetes, obesity, and smoking. Anyone with two or more of these factors has a 69 percent chance of developing a cardiovascular disease – and 11 fewer years of life.

Lee had been suffering from what his doctors diagnosed as pericarditis since March 1863, which had a sudden onset and came with pain in his chest, back, and arms. It affected his ability to ride a horse and he was known to be anxious and depressed in the days and years after, both common conditions after heart attacks.

“It came on in paroxysms, was quite sharp,” he wrote. Doctors look at “my lungs, my heart, circulation, etc. and I believe they pronounced me tolerable sound.”

Robert E. Lee HEart Attack Gettysburg

“Cigarettes. Cigarettes for all!”

Pericarditis is an inflammation of the membrane surrounding the heart but the NIH study refutes that diagnosis because American doctors were unfamiliar with the idea of angina. The researchers proposed instead that Lee suffered from ischemic heart disease, which would keep blood and oxygen from getting to the muscles of the heart.

His heart disease may have affected his judgement in all areas of life, which would explain some of the inexplicable and uncharacteristic decisions he ordered that day, namely Pickett’s Charge.

Lee’s March 1863 episode was a heart attack, not Pericarditis. As the NIH diagnosis says, the loss at Gettysburg didn’t break Lee’s heart, it was broken when he got there.