William Heberden on Angina Pectoris, 1772

“But there is a disorder of the breast marked with strong and peculiar symptoms, considerable for the kind of danger belonging to it, and not extremely rare, which deserves to be mentioned more at length. The seat of it and the 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 (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. In all other respects, the patients are, at the beginning of this disorder, perfectly well, and in particular have no shortness of breath, from which it is totally different. The pain is sometimes situated in the upper part, sometimes in the middle, sometimes in the bottom of the os. sterni, and often more inclined to the left than to the right side. It likewise very frequently extends from the breast to the middle of the left arm. The pulse is, at least sometimes, not disturbed by this pain, as I have had opportunities of observing by feeling the pulse during the paroxism. Males are more liable to this disorder, especially such as have past their fiftieth year. After it has continued a year or more, it will not cease so instantaneously upon standing still; and it will come on not only when the persons are walking, but when they are lying down, especially if they lie on the left side and oblige them to rise out of their beds. In some 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 any disturbance of mind.

Such is the most usual appearance of this disease; but some varieties may be met with. Some have been seized while they were standing still, or sitting, also upon first waking out of sleep; and the pain sometimes reaches to the right arm, as well as to the left and even down to the hands, but this is uncommon; in a very few instances the arm has at the same time been numbed and swelled. In one or two persons the pain has lasted some hours or even days; but this happened when the complaint has been of long standing, and thoroughly rooted in the constitution; once only the very first attack continued the whole night.

I have seen nearly a hundred people under this disorder, of which number there have been three women and one boy twelve years old. All the rest were men near or past the fiftieth year of their age…

The termination of the angina pectoris is remarkable. For if no accident interferes, but the disease goes on to its height, the patients all suddenly fall down, and perish almost immediately. Of which indeed their frequent faintness and sensations as if all the powers of life were failing, afford no obscure intimation.”(Henry Blackburn)

References

Heberden, W. 1772. Some account of a disorder of the breast.

Medical Transactions. The Royal College of Physicians of London. 2: 59-67.