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

“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 but the moment they stand still, all this uneasiness vanishes” #historyofmedicine #history

In response to his paper he was contacted by a physician who was experiencing anginal symptoms. This physician wished to donate his body so that it may be examined to understand angina better!

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!

Edward Jenner performed further autopsies on patients with angina & wrote a letter to Heberden in 1786 describing coronary artery disease as a possible cause.

Later, John Hunter described emotion as a precipitant for angina. Later he proved this theory, collapsing and dying after a dispute with a colleague!

In 1856, Rudolf Virchow identified factors that predispose blood vessels to thrombus formation.
#history #historyofmedicine #cardiology

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.

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.

Andreas Gruentzig was a German radiologist and Cardiologist. He used techniques used by US doctor Charles Dotter - who had developed angioplasty for treating peripheral vascular disease, to pioneer angioplasty for the coronary arteries.

He constructed the specially shaped coronary catheters in his kitchen.

Famously 20mins after Gruentzig had cardiac catheterization performed on himself by his fellows, he headed back to his office to resume his work whilst applying pressure to the puncture site with his hand in his pocket.

He felt that if "knowing the coronary anatomy via angiography was good for his patients it would be good for himself”

What we see during angiography are the epicardial coronary arteries. A significant proportion (40%) of patients with symptoms matching Heberden’s classical description of angina, would subsequently be found to have normal epicardial coronary artery appearances on angiography.

This suggested that epicardial stenosis is only part of the disease spectrum.

Close examination of canine hearts in the 1960s demonstrated the microscopic aspects of the coronary “microcirculation” #cardiology #history

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.

A crucial part of the endothelium that responds to different stimuli and regulates vessel responses. #CardioEd #cardiology