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angina pectoris.
    They who are afflicted with it, are seized while they are walking, (more especially if it be up hill, 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.
    Heberden had seen enough patients—“nearly a hundred under this disorder”—to be able to study its incidence and progress:
    Males are most liable to this disease, 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 up 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 by any disturbance of mind.
    Heberden was struck by the unremitting progression of the disease: “For if no accident intervene, but the disease go on to its height, the patients all suddenly fall down, and perish almost immediately.”
    James McCarty never had the luxury of a succession of bouts of angina pectoris; he succumbed to his very first experience of cardiac ischemia. His brain died because the fibrillating and finally stilled heart could no longer pump blood to it. The ischemic brain was followed gradually into lifelessness by every other tissue in his body.
    A few years ago, I met a man who was miraculously resuscitated from such an apparent sudden cardiac death. Irv Lipsiner is a tall, broad-shouldered stockbroker who has been an avid athlete all his life. Although he requires insulin for long-standing diabetes, the disease has had no physical effects on his vigorous good health, or so it would appear at first glance. But he did have a small heart attack when he was forty-seven years old, which is exactly the age at which his father died from the same cause. That episode left his heart muscle with only minimal damage, and he continued his active life without restriction.
    Late on a Saturday afternoon in 1985, when he was fifty-eight years old, Lipsiner was beginning his third hour of tennis at the Yale indoor courts when two of his partners left, necessitating a switch from doubles to singles. The practice rally was just beginning when, without warning or premonitory pain, he slumped to the floor unconscious. Two physicians, by luck playing on an adjacent court, rushed to his aid and found him glassy-eyed, unresponsive, and not breathing. There was no heartbeat. Assuming correctly that he was in ventricular fibrillation, they immediately began cardiopulmonary resuscitation, continuing it for what seemed to them an interminable time, until the ambulance arrived. By then, Lipsiner had begun to respond, even resuming a spontaneous regular heartbeat as his airway was intubated and he was placed in the ambulance. Soon, he was wide awake in the Yale–New Haven Hospital emergency room and wondering, as he put it, “what the fuss was all about.”
    In two weeks, Lipsiner was out of the hospital, fully recovered from his episode of ventricular fibrillation. I met him some years later, on the horse farm where he lives. Every day, he takes time out from work to go riding or play tennis, usually singles. Here is Irv Lipsiner describing what it felt like to drop dead on a tennis court:
    The only thing I can recall is just—not hurting, but just collapsing. And then the lights went out, as if you’re in a little room and you flip the switch. The only thing different from that was that it was in slow motion. In other words, it didn’t go out like that [here he snapped his fingers]. It went out like this [he made a lazy downward circle with his hand, like an airplane turning gently in descent toward a landing], gradually and almost in a spiral,