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Myron Prinzmetal 1908–1987: The man behind the variant angina
International Journal of Cardiology 123 (2008) 129 – 130 www.elsevier.com/locate/ijcard
Myron Prinzmetal 1908–1987: The man behind the variant angina Ariel Roguin⁎ Department of Cardiology, Rambam Medical Center, B. Rappaport - Faculty of Medicine Technion - Israel Institute of Technology, Haifa 31096 Israel Received 22 October 2006; accepted 21 November 2006 Available online 26 March 2007
Abstract Prinzmetal or variant angina refers to decrease in blood flow secondary to spontaneous spasm of the arterial wall usually without significant atherosclerotic plaques. These symptoms happen at rest and often may wake up the patient during the night. This angina is named after Myron Prinzmetal (1908–1987), who worked most of his life in Los Angeles and published 165 medical publications during his brilliant career. His interests ranged from disease of the lung, kidneys, and peripheral vascular disease to cardiac arrhythmias, circulatory shock, hypertension, and coronary syndromes. In 1959, with Dr. Rexford Kennamer and others, he published their first observations on the variant form of angina pectoris, a landmark report that was to ensure him a place in the annals of medicine. This report describes his life. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Angina; Coronary artery disease; History of medicine
Normal angina pectoris is associated with atherosclerosis of the coronary arteries and is caused by obstructive reduction of the arterial blood flow, causing oxygen deficiency in the heart cells and subsequently the classic central chest pain. This typically happens on exertion. In Prinzmetal or variant angina the pain and the oxygen deficiency are caused by spontaneous spasm of the arterial wall, leading to blood flow decrease. These symptoms happen at rest and often may wake up the patient during the night. Usually, significant atherosclerotic plaques are not present. Prinzmetal Angina was first described by the late American Cardiologist Myron Prinzmetal in an article in the Journal of the American Medical Association in 1959 and described as “angina pectoris-like central chest pain during periods of rest, associated with typical ECG changes” (Fig. 1). Myron Prinzmetal was born in Buffalo, New York, on February 8, 1908, the second son of Anna and Harry Prinzmetal. The family moved to Los Angeles. His father died when Myron was a child and the young family faced difficult times. Despite these hard beginnings, his brother, Isadore, became an outstanding lawyer, while Myron would leave his name in the history of medicine. His interests ranged ⁎ Tel.: +972 4 854 2181; fax: +972 4 854 3451. E-mail address: [email protected]. 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.11.217
from disease of the lung, kidneys, and peripheral vascular disease to cardiac arrhythmias, circulatory shock, hypertension, and coronary syndromes. Myron Prinzmetal attended Roosevelt High School in Los Angeles and subsequently studied at the University of California, Los Angeles [1]. In 1929 he received his B.A. degree. He obtained a M.A. degree in pharmacy, and graduated M.D. in 1933. While still a student he was a coauthor of a paper on the effect of broncho-constricting drugs on intrapleural pressure, the first of over 165 medical publications during his brilliant career. He completed his internship in San Francisco and his residency at Bames Hospital at Washington University in St. Louis [2]. During these years he published 20 articles on pulmonary disease, ventricular tachycardia, emphysema, and his first papers on electrocardiography. In 1935 he became Sutro Fellow at Mt. Sinai Hospital in New York City. Eleven more studies, including his first publication on hypertension [3], led to his next appointment in England. From 1936 to 1937 he was a Fellow of the American College of Physicians at the prestigious University College of London. There he worked with Dr. GW Pickering on renin. He returned to California at U.S.C. where he continued his studies on hypertension. In 1939 he began working in his laboratory at Cedars of Lebanon Hospital and
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A. Roguin / International Journal of Cardiology 123 (2008) 129–130
Fig. 1.
began private practice. He later became clinical professor of cardiology at UCLA [1,2]. Loss of sight on one eye prevented Prinzmetal from serving in the U.S. Armed Forces during the Second World War. For the war effort he turned to the study of shock due to muscle trauma and burns and continued his work on pulmonary disease. With Dr. Clarence Agress, he was the first on the West Coast to use radioactive iodine in the treatment of Graves disease [1]. At the end of the war, he began his first studies on the coronary circulation. From 1950 he published a large number of papers on the auricular arrhythmias, making use of high-speed cine-electrocardiography [4–10]. These included the conformation of the circus movement in atrial flutter, first suggested by Sir Thomas Lewis; the mechanism of ventricular activity; the origin of the RS-T segment changes in acute myocardial infarction; and the nature of spontaneous atrial fibrillation. In 1959, with Dr. Rexford Kennamer and others, he published their first observations on the variant form of angina pectoris, a landmark report that was to ensure him a place in the annals of medicine [11]. This type of angina became known as “Prinzmetal's angina”. Many other articles and several books were to follow until illness forced him to retire from research and practice [12]. Myron Prinzmetal died on January 8, 1987. With his first wife Blanche Keiler he had four children, Byron, Anita, William, and Cynthia. In addition to belonging to many leading medical societies, Dr. Prinzmetal was on the editorial board of the American Heart Journal and the American Journal of Cardiology. He was a prime moving force in the formation of the American College of Cardiology and the development of cardiology on the West Coast. He was the recipient of numerous awards and was a guest lecturer in many foreign countries, especially England. He will be remembered also for his love of classical music and rare book collections. He owned all four folio editions of Shakespeare and a first edition of Harvey's Exercitatio ana-
tomica de motu cordis et sanguinis in animalibus (Frankfurt am Main; Wilhelm Fitzer, 1628), the only one not owned by a museum. He restored to the Royal College of Physicians in London the only known portrait of Harvey. Most outstanding was his collection of the memorabilia of his idol, Sir William Osler. References [1] Agress CM. Myron Prinzmetal. Clin Cardiol 1994;17:681–2. [2] Sternbach G. William Heberden and Myron Prinzmetal: angina pectoris. J Emerg Med 1991;9:81–3. [3] Prinzmetal M, Wilson C. The nature of the peripheral resistance in arterial hypertension with special reference to the vasomotor system. J Clin Invest 1936;15:63–83. [4] Prinzmetal M, Corday E, Spritzler RI, Flieg W. Radiocardiography and its clinical applications. JAMA 1949;139:617–22. [5] Prinzmetal M, Corday E, Brill IC, et al. Mechanism of the auricular arrythmias. Circulation 1950;1:241–5. [6] Osborne JA, Corday E, Fields J, Kennamer R, Smith LA, Prinzmetal M. Studies on the mechanism of ventricular activity. I. The nature of the P–R interval. Am Heart J 1951;42:503–12. [7] Prinzmetal M, Corday E, Oblath RW, et al. Auricular flutter. Am J Med 1951;11:410–30. [8] Kennamer R, Prinzmetal M. The cardiac arrhythmias. N Engl J Med 1954;250:509–20. [9] Prinzmetal M, Corday E, Oblath RW, et al. Auracular flutter. Am J Med 1954;146:1275–81. [10] Pipberger H, Schwartz L, Massumi RA, Weiner S, Prinzmetal M. Studies on the mechanism of ventricular activity. XXI. The origin of the depolarization complex with clinical applications. Am Heart J 1957;54:511–29. [11] Prinzmetal M, Kennarner R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris. (Preliminary report). Am J Med 1959;27:375–88. [12] Prinzmetal M, Ekmekci A, Kennamer R, Kwoczynski JK, Shubin H, Toyoshima H. Variant form of angina pectoris, previously undelineated syndrome. JAMA 1960;174:1794–800.
Myron Prinzmetal 1908–1987: The man behind the variant angina Ariel Roguin⁎ Department of Cardiology, Rambam Medical Center, B. Rappaport - Faculty of Medicine Technion - Israel Institute of Technology, Haifa 31096 Israel Received 22 October 2006; accepted 21 November 2006 Available online 26 March 2007
Abstract Prinzmetal or variant angina refers to decrease in blood flow secondary to spontaneous spasm of the arterial wall usually without significant atherosclerotic plaques. These symptoms happen at rest and often may wake up the patient during the night. This angina is named after Myron Prinzmetal (1908–1987), who worked most of his life in Los Angeles and published 165 medical publications during his brilliant career. His interests ranged from disease of the lung, kidneys, and peripheral vascular disease to cardiac arrhythmias, circulatory shock, hypertension, and coronary syndromes. In 1959, with Dr. Rexford Kennamer and others, he published their first observations on the variant form of angina pectoris, a landmark report that was to ensure him a place in the annals of medicine. This report describes his life. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Angina; Coronary artery disease; History of medicine
Normal angina pectoris is associated with atherosclerosis of the coronary arteries and is caused by obstructive reduction of the arterial blood flow, causing oxygen deficiency in the heart cells and subsequently the classic central chest pain. This typically happens on exertion. In Prinzmetal or variant angina the pain and the oxygen deficiency are caused by spontaneous spasm of the arterial wall, leading to blood flow decrease. These symptoms happen at rest and often may wake up the patient during the night. Usually, significant atherosclerotic plaques are not present. Prinzmetal Angina was first described by the late American Cardiologist Myron Prinzmetal in an article in the Journal of the American Medical Association in 1959 and described as “angina pectoris-like central chest pain during periods of rest, associated with typical ECG changes” (Fig. 1). Myron Prinzmetal was born in Buffalo, New York, on February 8, 1908, the second son of Anna and Harry Prinzmetal. The family moved to Los Angeles. His father died when Myron was a child and the young family faced difficult times. Despite these hard beginnings, his brother, Isadore, became an outstanding lawyer, while Myron would leave his name in the history of medicine. His interests ranged ⁎ Tel.: +972 4 854 2181; fax: +972 4 854 3451. E-mail address: [email protected]. 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.11.217
from disease of the lung, kidneys, and peripheral vascular disease to cardiac arrhythmias, circulatory shock, hypertension, and coronary syndromes. Myron Prinzmetal attended Roosevelt High School in Los Angeles and subsequently studied at the University of California, Los Angeles [1]. In 1929 he received his B.A. degree. He obtained a M.A. degree in pharmacy, and graduated M.D. in 1933. While still a student he was a coauthor of a paper on the effect of broncho-constricting drugs on intrapleural pressure, the first of over 165 medical publications during his brilliant career. He completed his internship in San Francisco and his residency at Bames Hospital at Washington University in St. Louis [2]. During these years he published 20 articles on pulmonary disease, ventricular tachycardia, emphysema, and his first papers on electrocardiography. In 1935 he became Sutro Fellow at Mt. Sinai Hospital in New York City. Eleven more studies, including his first publication on hypertension [3], led to his next appointment in England. From 1936 to 1937 he was a Fellow of the American College of Physicians at the prestigious University College of London. There he worked with Dr. GW Pickering on renin. He returned to California at U.S.C. where he continued his studies on hypertension. In 1939 he began working in his laboratory at Cedars of Lebanon Hospital and
130
A. Roguin / International Journal of Cardiology 123 (2008) 129–130
Fig. 1.
began private practice. He later became clinical professor of cardiology at UCLA [1,2]. Loss of sight on one eye prevented Prinzmetal from serving in the U.S. Armed Forces during the Second World War. For the war effort he turned to the study of shock due to muscle trauma and burns and continued his work on pulmonary disease. With Dr. Clarence Agress, he was the first on the West Coast to use radioactive iodine in the treatment of Graves disease [1]. At the end of the war, he began his first studies on the coronary circulation. From 1950 he published a large number of papers on the auricular arrhythmias, making use of high-speed cine-electrocardiography [4–10]. These included the conformation of the circus movement in atrial flutter, first suggested by Sir Thomas Lewis; the mechanism of ventricular activity; the origin of the RS-T segment changes in acute myocardial infarction; and the nature of spontaneous atrial fibrillation. In 1959, with Dr. Rexford Kennamer and others, he published their first observations on the variant form of angina pectoris, a landmark report that was to ensure him a place in the annals of medicine [11]. This type of angina became known as “Prinzmetal's angina”. Many other articles and several books were to follow until illness forced him to retire from research and practice [12]. Myron Prinzmetal died on January 8, 1987. With his first wife Blanche Keiler he had four children, Byron, Anita, William, and Cynthia. In addition to belonging to many leading medical societies, Dr. Prinzmetal was on the editorial board of the American Heart Journal and the American Journal of Cardiology. He was a prime moving force in the formation of the American College of Cardiology and the development of cardiology on the West Coast. He was the recipient of numerous awards and was a guest lecturer in many foreign countries, especially England. He will be remembered also for his love of classical music and rare book collections. He owned all four folio editions of Shakespeare and a first edition of Harvey's Exercitatio ana-
tomica de motu cordis et sanguinis in animalibus (Frankfurt am Main; Wilhelm Fitzer, 1628), the only one not owned by a museum. He restored to the Royal College of Physicians in London the only known portrait of Harvey. Most outstanding was his collection of the memorabilia of his idol, Sir William Osler. References [1] Agress CM. Myron Prinzmetal. Clin Cardiol 1994;17:681–2. [2] Sternbach G. William Heberden and Myron Prinzmetal: angina pectoris. J Emerg Med 1991;9:81–3. [3] Prinzmetal M, Wilson C. The nature of the peripheral resistance in arterial hypertension with special reference to the vasomotor system. J Clin Invest 1936;15:63–83. [4] Prinzmetal M, Corday E, Spritzler RI, Flieg W. Radiocardiography and its clinical applications. JAMA 1949;139:617–22. [5] Prinzmetal M, Corday E, Brill IC, et al. Mechanism of the auricular arrythmias. Circulation 1950;1:241–5. [6] Osborne JA, Corday E, Fields J, Kennamer R, Smith LA, Prinzmetal M. Studies on the mechanism of ventricular activity. I. The nature of the P–R interval. Am Heart J 1951;42:503–12. [7] Prinzmetal M, Corday E, Oblath RW, et al. Auricular flutter. Am J Med 1951;11:410–30. [8] Kennamer R, Prinzmetal M. The cardiac arrhythmias. N Engl J Med 1954;250:509–20. [9] Prinzmetal M, Corday E, Oblath RW, et al. Auracular flutter. Am J Med 1954;146:1275–81. [10] Pipberger H, Schwartz L, Massumi RA, Weiner S, Prinzmetal M. Studies on the mechanism of ventricular activity. XXI. The origin of the depolarization complex with clinical applications. Am Heart J 1957;54:511–29. [11] Prinzmetal M, Kennarner R, Merliss R, Wada T, Bor N. Angina pectoris. I. A variant form of angina pectoris. (Preliminary report). Am J Med 1959;27:375–88. [12] Prinzmetal M, Ekmekci A, Kennamer R, Kwoczynski JK, Shubin H, Toyoshima H. Variant form of angina pectoris, previously undelineated syndrome. JAMA 1960;174:1794–800.