Chronic stable angina historical perspective
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Overview
Although this form of heart related pain was not systematically described until the latter part of the 18th century, Lucius Annaeus Seneca first described his own sufferings as "to have any other malady is to be sick; to have this is to be dying" in the 4th century B.C.. Indeed, the term angina derives from the Greek ankhon ("strangling") and the Latin pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest". The Italian anatomist Giovanni Battista Morgagni gave a clear description of a paroxysm of angina in a case of aortic aneurysm in 1707.
The names of John Hunter, Edward Jenner and Caleb Hillier Parry are also intimately associated with definition and recognition angina in its early history. John Hunter suffered from angina himslef, and ultimately died during an anginal attack. Edward Jenner pointed out a definitive connection between sclerosis of the coronary arteries and angina pectoris in 1799. Although Caleb Hillier Parry recognized the connection of angina with heart disease, he considered the attacks due to paralysis of the heart and named it as "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:
"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".