Samuel Albert Levine (1891 – 1966) Polish-American cardiologist
Innovator in the treatment of coronary thrombosis patients. He recommended arm-chair recuperation within the first few days following an attack, instead of traditional bed rest.
An early advocate for the use of the ‘mechanical-electro-cardiograph’ to study heart patients, but he impressed upon his students the value of simple bedside methods of examination. He believed a physician should use the cardiogram to supplement his stethoscope.
- Born 1 January 1891 Łomża, Poland
- 1894 – Relocated to Boston, USA, aged 3
- 1914 – Graduated from Harvard Medical School. Undertook internship at the Peter Bent Brigham Hospital, and a fellowship at the Rockefeller Institute.
- 1917 – Volunteered to join the British medical corps during World War 1. Levine was assigned to the British Heart Hospital, Colchester, where he worked under renowned cardiologists: Sir Clifford Allbutt, Sir William Osler, Sir James McKenzie, and Sir Thomas Lewis.
- 1919 – Returned to the Peter Bent Brigham Hospital
- 1921 – Advised the diagnosis of poliomyelitis for the paralytic illness of future President Franklin D. Roosevelt.
- 1921 – Started a summer postgraduate cardiology course, which ran for 36 years at Harvard Medical School – the longest running course at the University.
- 1940 – Appointed physician at Peter Bent Brigham Hospital
- 1948 – Clinical Professor of Medicine at Harvard
- Died 31 March 1966, in Massachusetts
- Lown–Ganong–Levine syndrome (1952) Pre-excitation syndrome with short PR interval (A-V conduction time), normal QRS duration and paroxysms of tachycardia: Lown B – Ganong WF – Levine SA
- Levine Scale (Levine Grading Scale) (1933) a six-point grading system that is used to define the volume or intensity of a heart murmur with an acoustic stethoscope
- Levine sign – placing clenched fist against the sternum to describe ischaemic chest pain
- Cossio-Levine Sign (1934) placing the extended palm against the sternum to describe ischaemic chest pain
- Samuel A. Levine Professorship (Harvard, 1954) founded with a gift from the late Charles E. Merrill of New York
Key Medical Attributions
- Published over 250 articles
- Wrote one of the first cases of coronary thrombosis
- Contributed to the pathophysiology understanding of pernicious anaemia (the lack of gastric hydrochloric acid)
- Reported one of the first successful cases of mitral valvulotomy in a 12-year-old girl
- Long-standing medical educator, with students such as Dr W Proctor Harvey, and Dr Bernard Lown
- Several textbooks in cardiology, and clinical skills
Dr SA Levine taught that a ‘clenching the fist over the chest whilst describing pain’ increased the potential that the pain was ischaemic in nature (84% sensitive but 9% specific for ischaemic heart disease; Table 3). No specific published work by Levine SA, but referenced in major cardiology textbooks to acknowledge the bedside teachings of Levine. Original source of term still being sought.
Earlier (1934), the Argentinian cardiologist Pedro Cossio (1900-1986) described the ‘Palm sign’ – extended palm placed against the sternum – to define ischaemic chest pain (67% sensitive; 38% specific). This is referred to as the Cossio-Levine Sign
Of note, Levine RI wrote to the NEJM to have a different ‘Levine sign’ popularised – that is, the use of carotid massage to slow the pulse in patients presenting with chest pain, with an easing of the pain ‘confirming’ the an ischaemic in origin…
The ‘other’ Levine sign (1964)
- Levine SA, Tranter CL. Infarction of the heart simulating acute surgical abdominal conditions. American Journal Of The Medical Sciences. 1918;155:57-65.
- Levine SA, Ladd WS. Pernicious anemia: A clinical study of one hundred and fifty consecutive cases with special reference to gastric anacidity. Johns Hopkins Hospital Bulletin. 1921;32(366):254-286.
- Cutler EC, Levine SA: Cardiotomy and valvulotomy for mitral stenosis: Experimental observations and clinical notes concerning an operated case with recovery. Boston Medical and Surgical Journal. 1923;188:1023-27
- Levine SA: Coronary Thrombosis: Its Various Clinical Features. Williams and Wilkins, Baltimore. 1929.
- Levine SA. The systolic murmur: its clinical significance. JAMA 1933; 101(6): 436–438. [Levine Grading Scale for cardiac murmurs]
- Freeman AR, Levine SA. The clinical significance of the systolic murmur. A study of 1000 consecutive “non-cardiac” cases. Ann Intern Med 1933; 6: 1371-1385. [Levine Grading Scale]
- Levine S, Harvey W. Clinical auscultation of the heart. Philadelphia: WB Saunders, 1949. [‘The Little Green Book’]
- Levine SA. Clinical Heart Disease. 1936. SaundersLevine SA, Lown B. The “chair” treatment of acute thrombosis. Trans Assoc Am Physicians. 1951;64:316-27. [PMID 14884265]
Levine SA, Lown B. “Armchair” treatment of acute coronary thrombosis. J Am Med Assoc. 1952 Apr 19;148(16):1365-9. [PMID 14907380].
- Lown B, Ganong WF, Levine SA. The syndrome of short P-R interval, normal QRS complex and paroxysmal rapid heart action. Circulation. 1952 May;5(5):693-706. [PMID 14926053] [Lown–Ganong–Levine syndrome]
- Samuel Albert Levine (1891-1966). Br Heart J. 1966;28(6):853-4. [PMC490104]
- Levine HJ. Samuel A. Levine (1891-1966). Clin Cardiol. 1992 Jun;15(6):473-6. [PMID: 1617831]
- Edmondstone WM. Cardiac chest pain: does body language help the diagnosis? 1995; BMJ. 311 (7021): 1660–1 [PMC2539106]
- Levine RI. Levine Sign. New England Journal of Medicine, 1964; 271(27): 1425–1425.
- Silverman ME, Wooley CF. Samuel A. Levine and the history of grading systolic murmurs. Am J Cardiol. 2008 Oct 15;102(8):1107-10. [PMID 18946930]
the person behind the name