Starr-Edwards Valve

Other Known Aliases – caged-ball artificial heart valve

Definition – One of the first types of artificial heart valves produced.  When the pressure in the ventricle of the heart exceeds the pressure outside the ventricle, the ball is pushed against the cage and blood flows in.  After contraction, the pressure inside the ventricle drops below the outside of the ventricle and the ball moves back against the base, forming the seal.

Clinical Significance – This type of valve was one of the first to have long-term survival and you may still encounter these valves today because they were just discontinued in 2007.  Due to the make-up of the valve, patients needed to have INR levels from 2.5-3.5 to prevent thrombosis.

History – Named after Albert Starr (1926-) and Lowell Edwards (1898-1982), who were both noted American cardiovascular surgeons.  It was an interesting partnership as Starr was 30 years junior to Edwards at their initial meeting, but both had a passion for valvular research and worked well together.  The 1st valve was placed in August of 1960 and they went on to replace mitral valves in 8 patients that year and published their results in 1961.  This paper was voted one of the top 100 manuscripts of the 20th century and revolutionized valve surgery.

Edwards (Left) and Starr (Right)

Starr (suit, middle)

References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Matthews AM.  The development of the Starr-Edwards heart valve.  Tex Heart Int J.  1998;25(4):282-293
6. Starr-Edwards Heart Valve.  The National Museum of American History
7. Starr A, Edwards ML. Mitral Replacement: Clinical Experience with a Ball-Valve Prosthesis. Starr A, Edwards ML. Ann Surg 1961; 154: 726-740.

Levine’s Sign

Other Known Aliases – Palm Sign, Cossio’s Sign, Cossio-Levine’s Sign

Definition – Clenched fist held over the sternum while a patient is describing their chest pain and classically is the right hand, as cardiac pain can refer to the left arm.

Clinical Significance – There is very little significance to this sign and has been studied to only have a 14% sensitivity for cardiac chest pain, but is a classic physical exam finding and frequent pimp fodder.

History – Named after Samuel Albert Levine (1891-1966), who was an American cardiologist and attending physician at The Brigham Hospital in Boston, MA, and assistant professor of medicine at Harvard University.  He graduated Harvard at the age of 20 and was the first physician to diagnose President Franklin Roosevelt with poliomyelitis.  He was a pioneer in coronary thrombosis research and was the second physician to ever diagnose the condition, which he described it in his classic book Clinical Heart Disease in 1936. 

He is also the namesake of The Levine Scale, a 1 to 6 grading system to characterize the intensity  of heart murmurs, and Lown-Ganong-Levine syndrome, which is a pre-excitation syndrome causing a shortened PR interval with normal QRS complexes in tachycardia.

The Levine Scale

Lown-Ganong-Levine Syndrome

References

1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
5. Edmondstone WM. Cardiac chest pain: does body language help the diagnosis? BMJ. 1995;311(7021):1660-1. [pubmed]
6. Levine HJ.  Profiles in Cardiology: Samuel A. Levine (1891-1966).  Clin Cardiol.  1992;15:473-476
7. Bedford DE. Samuel Albert Levine (1891-1966). British heart journal. 1966; 28(6):853-4. [pubmed]
8. Silverman ME, Wooley CF. Samuel A. Levine and the history of grading systolic murmurs. The American journal of cardiology. 2008; 102(8):1107-10. [pubmed]
9. Lown B, Ganong WF, Levine SA. The syndrome of short P-R interval, normal QRS complex and paroxysmal rapid heart action. Circulation. 1952; 5(5):693-706. [pubmed]