Chronic stable angina historical perspective: Difference between revisions
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==Overview== | ==Overview== | ||
Chronic stable angina is a form of chest pain classified by lack of blood flow to the myocardium of the heart ([[ischemia]]). The term angina was originally derived from the Greek word ''ankhon'' and the Latin word ''pectus'', which when combined, loosely translates as “a strangling feeling in the chest.” Attempts to classify this disease state began as early as the 4th century B.C., when [[Lucius Annaeus Seneca]] first described the symptoms he was experiencing as “to have any other malady is to be sick; to have this is to be dying.” Throughout history many renowned researchers and health care professionals have contributed to the understanding, definition, and recognition of angina. | |||
Circa 1707, the Italian anatomist [[Giovanni Battista Morgagni]] attempted to describe an episode angina that preceded the onset of an aortic aneurysm. Later, [[John Hunter]], [[Edward Jenner]] and [[Caleb Hillier Parry]] also became influential contributors to the clinical definition and diagnosis of angina. [[John Hunter]], a well known Scottish surgeon, personally suffered from angina, and subsequently died due to [[myocardial infarction]]. Shortly after, in 1799, [[Edward Jenner]] became the first physician to identify a correlation between the existence of coronary arterial sclerosis and the presence of [[angina pectoris]]. Jenner was not the only one aware of this correlation; Caleb Hillier Parry also recognized the association between cardiovascular disease and the presence of angina. However, unlike Jenner, he attributed an attack of angina to a temporary paralysis of the heart and coined the term “syncope anginosa.” | |||
In 1768, [[William Heberden]] presented a classic description of angina pectoris based upon his more than 40 years clinical experience 'in the chambers of the sick' in a lecture at the [[Royal College of Physicians]]. His notes were published first in 1772. The French physician Nicolas François Rougnon de Magny wrote a letter which also contained the description of angina in a patient who subsequently died in February 1768 (4 months earlier than Heberden’s letter). In recent years a debate arose between French and English physicians regarding who first described angina. In 1970, this subject was reviewed in detail by Evan Bedford. He reported that Nicolas François Rougnon de Magny did not describe the same syndrome as [[William Heberden]] which was effort angina. Perhaps Nicolas François Rougnon de Magny was describing unstable angina in so far as the patient died. | In 1768, [[William Heberden]] presented a classic description of angina pectoris based upon his more than 40 years clinical experience 'in the chambers of the sick' in a lecture at the [[Royal College of Physicians]]. His notes were published first in 1772. The French physician Nicolas François Rougnon de Magny wrote a letter which also contained the description of angina in a patient who subsequently died in February 1768 (4 months earlier than Heberden’s letter). In recent years a debate arose between French and English physicians regarding who first described angina. In 1970, this subject was reviewed in detail by Evan Bedford. He reported that Nicolas François Rougnon de Magny did not describe the same syndrome as [[William Heberden]] which was effort angina. Perhaps Nicolas François Rougnon de Magny was describing unstable angina in so far as the patient died. | ||
Revision as of 20:53, 20 July 2011
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Case Studies | ||
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Chronic stable angina historical perspective On the Web | ||
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to Hospitals Treating Chronic stable angina historical perspective | ||
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Risk calculators and risk factors for Chronic stable angina historical perspective | ||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Chronic stable angina is a form of chest pain classified by lack of blood flow to the myocardium of the heart (ischemia). The term angina was originally derived from the Greek word ankhon and the Latin word pectus, which when combined, loosely translates as “a strangling feeling in the chest.” Attempts to classify this disease state began as early as the 4th century B.C., when Lucius Annaeus Seneca first described the symptoms he was experiencing as “to have any other malady is to be sick; to have this is to be dying.” Throughout history many renowned researchers and health care professionals have contributed to the understanding, definition, and recognition of angina.
Circa 1707, the Italian anatomist Giovanni Battista Morgagni attempted to describe an episode angina that preceded the onset of an aortic aneurysm. Later, John Hunter, Edward Jenner and Caleb Hillier Parry also became influential contributors to the clinical definition and diagnosis of angina. John Hunter, a well known Scottish surgeon, personally suffered from angina, and subsequently died due to myocardial infarction. Shortly after, in 1799, Edward Jenner became the first physician to identify a correlation between the existence of coronary arterial sclerosis and the presence of angina pectoris. Jenner was not the only one aware of this correlation; Caleb Hillier Parry also recognized the association between cardiovascular disease and the presence of angina. However, unlike Jenner, he attributed an attack of angina to a temporary paralysis of the heart and coined the term “syncope anginosa.”
In 1768, William Heberden presented a classic description of angina pectoris based upon his more than 40 years clinical experience 'in the chambers of the sick' in a lecture at the Royal College of Physicians. His notes were published first in 1772. The French physician Nicolas François Rougnon de Magny wrote a letter which also contained the description of angina in a patient who subsequently died in February 1768 (4 months earlier than Heberden’s letter). In recent years a debate arose between French and English physicians regarding who first described angina. In 1970, this subject was reviewed in detail by Evan Bedford. He reported that Nicolas François Rougnon de Magny did not describe the same syndrome as William Heberden which was effort angina. Perhaps Nicolas François Rougnon de Magny was describing unstable angina in so far as the patient died.
This classic description by William Heberden (based upon his study of hundred cases) was translated from the Latin and published with minor changes in 1802 a year after his death by his son (also named William Heberden). The description was published in the book Commentaries on the History and Cure of Diseases in a chapter entitled "Pectoris Dolor = Disorder of the breast". In its concise brevity this account of a “hitherto unrecognized malady” has never been bettered. The following paragraphs and quotations are taken from different parts of the original lecture notes[1]:
"There is a disorder of the breast, marked with strong and peculiar symptoms, considerable for the kind of danger belonging to it, and extremely rare, of which I do not recollect any mention among medical authors. The seat of it, and sense of strangling and anxiety, with which it is attended, may make it not improperly be called angina pectoris. Those who are afflicted with it are seized, while they are walking and more particularly when they walk soon after eating, with a painful and most disagreeable sensation in the breast, which seems as if it would take their life away, if it were to increase or to continue: the moment they stand still all this uneasiness vanishes”.
“After it has continued some months, it will not cease so instantaneous upon standing still; and it will come on, not only when the persons are walking, but when they are lying down, and oblige them to rise up from their beds every night for many months together; and in one or two very inveterate cases it has been brought on by the motion of a horse or a carriage, and even by swallowing, coughing, going to stool or speaking, or by any disturbance of mind”.
“But all the rest, whom I have seen, who are at least twenty, were men, and almost all above 50 years old, and most of them with a short neck, and inclining to be fat. When a fit of this sort comes on by walking, its duration is very short, as it goes off almost immediately upon stopping. If it comes on in the night, it will last an hour or two; and I have met one, in whom it once continued for several days, during all which time the patient seemed to be in imminent danger of death”.
“But the natural tendency of this illness be to kill the patients suddenly, yet unless it have a power of preserving a person from all other ails, it will easily be believed that some of those, who are afflicted with it, may die in a different manner, since this disorder will last, as I have known it more than once, near twenty years, and most usually attacks only those who are above fifty years of age. I have accordingly observed one, who sunk under a lingering illness of a different nature”.
“The os sterni is usually pointed to as the seat of this malady, but it seems sometimes as if it was under the lower part of it, and at other times under the middle or upper part, but always inclining more to the left side, and sometimes there is with it a pain about the middle of the left arm”.
Later on, the syndrome of angina pectoris was described as rare in textbooks of medicine by Austin Flint in 1866 and by William Osler in 1892. Paul Dudley White wrote: "angina pectoris was uncommon in my early professional years. But when the automobile came in the 1920s and the population became more prosperous and over nourished, the current epidemic of coronary heart disease, as shown mainly by the symptom angina pectoris, began and incidentally involved younger and younger men".
References
- ↑ Fuster, O'Rourke, Walsh. Hurst's the heart. McGraw-Hill Professional Publishing, 2008