The term “angina pectoris” comes from Greek “ankhonē” which means “strangling” & Latin “pectoris” meaning “chest”

The term has been used to describe a diagnosis rather than a symptomology.

Welcome to my tweetorial on a background to “angina pectoris”!
#tweetorials #meded 1/14

A history:

Descriptions date back as far as 400BC when Hippocrates observed that some people experienced chest pain precipitated by cold winds.

“Angina pectoris” was first coined by William Heberden in 1768 in his seminal paper “Some account of a Disorder of the Breast”

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“Those who are afflicted with it, are seized while they are walking (more especially if it be uphill, and soon after eating) with a painful and most disagreeable sensation in the breast, which seems as if it would extinguish life if it were to increase or to continue"
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“but the moment they stand still, all this uneasiness vanishes”

Heberden’s description has a poetry to it.

In response to his paper he was contacted by a physician who was experiencing angina. The physician requested he perform an autopsy on him to understand it better.
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Edward Jenner (best known for later introducing vaccination in 1798) performed the autopsy with John Hunter (another surgeon) in 1772.
At the time there was no real appreciation for the link between angina and coronary artery disease- so the coronary arteries weren’t examined! 5

Jenner performed further autopsies on patients with angina & wrote a letter to Heberden in 1786 highlighting coronary artery disease.
John Hunter described emotion as a precipitant for angina. Later he proved this after collapsing and dying after a dispute with a colleague. 6

In 1856, Rudolf Virchow identified factors that predispose blood vessels to thrombus formation.
Near the end of the 19th century, cardiovascular physiologists noted that occlusion of a coronary artery in the dog caused “quivering” of the ventricle which was rapidly fatal.
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In 1880 Carl Weigert, a German Pathologist proposed that occlusion of the epicardial coronary artery was the cause for Myocardial Infarction.
Selective coronary angiography was developed in 1958 by Sones, Judkins and Amplatz as a method for identifying coronary stenosis.
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A significant proportion (40%) of patients with symptoms matching Heberden’s classical description of angina, would subsequently be found to have normal coronary artery appearances on angiography.

This suggested that epicardial stenosis is only part of the disease spectrum.
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Close examination of canine hearts in the 1960s demonstrated the microscopic aspects of the coronary circulation leading to a wider interest. 10 https://twitter.com/drraviele/status/1065201293013204993?s=20

In 1985, Cannon and Epstein demonstrated that patients with anginal symptoms (and normal epicardial arteries) developed increased vascular resistance in response to certain stimuli.
“microvascular angina” describes this response of the intramural pre arteriolar coronaries.
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The coronary arteries are therefore not a passive conduit for blood but an active organ that adjust their resistance according to various stimuli.
The coronary circulation can be subdivided into different sub compartments based on structure and function.
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A crucial part of the coronary circulation is the artery endothelium that responds to stimuli and regulates vessel responses.

https://twitter.com/drraviele/status/962791822346129408?s=20

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Understanding coronary physiology is crucial in understanding the mechanisms of coronary artery disease and angina. Very happy to do another thread on this if there’s interest!

Thankyou to @drraviele for his posted images. 14/14