Clinical Presentation of Ischemic Heart Disease



American physicians refer to James B. Herrick as the first to describe the clinical presentation of a nonfatal myocardial infarction in 1912. In his description Herrick indicated his familiarity with an earlier report by Obraztsov and Strazhesko in a German translation in which they discussed five cases of myocardial infarction, three of which were confirmed by autopsy
  • A 49-year-old artillery man was admitted to the medical division of the Aleksandrovsky Hospital on December 5, 1899. For 12 days prior to admission, he had experienced substernal pain radiating to the throat, head and left arm. The attacks lasted 2 to 4 hours and after a brief pause would begin again. During the attacks he experienced shortness of breath and the inability to breathe deeply. The chest pain was so severe that the intern on my service, who was young and inexperienced, in response to my question as to the patient’s admitting diagnosis responded “rheumatism of the chest.”

  • Objective Findings: He was well nourished and well developed. There was moderate cyanosis of the mucous membranes. His facial expression revealed distress from the substernal pain which radiated to the neck and head. No vessel motion was visible in the neck. The respiratory and abdominal organs were without abnormalities. The cardiac impulse was not visible, but was weakly palpable in the 5th intercostal space in the left mammary line. The heart sounds were distant and there were no murmurs. Direct auscultation revealed presystolic splitting of the first sound. Pulse 90 and barely palpable. Rhythm regular. After the initial examination the diagnosis of coro- nary thrombosis was made. The patient died 4 days later on December 9, 1899.

  • Autopsy Findings: On cross section of the left ventricle its entire thickness was of a muddy-gray yellowish color, as seen with necrosis. These changes occurred in almost the entire wall of the left ventricle and septum.

  • Near the origin of the right coronary artery there was 1 cm long yellowish projection from the wall of the vessel producing some luminal narrowing. The changes in the left coronary were more severe. The left anterior descending coronary artery was occluded by grayish-red thrombus 1 cm long and 1 mm in diameter. The left circumflex was occluded by a 3 cm long soft yellow thrombus.


Myocardial Infarction Acute Myocardial Infarction Unstable Angina Aortic Dissection Left Bundle Branch Block 
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  1. 1.
    Muller JE: Diagnosis of myocardial infarction: Historical notes from the Soviet Union and the United States. Am J Cardiol 40: 269–271, 1977.PubMedCrossRefGoogle Scholar
  2. 2.
    Herrick JB: Clinical features of sudden obstruction of the coronary arteries. JAMA 59: 2015–2020, 1912.Google Scholar
  3. 3.
    McGovern B, DiMarco JP, Garan H, Ruskin JN: New concerns in the management of ventricular arrhythmias and sudden death. Curr Probl Cardiol Vol 7, No 11, February, 1983.Google Scholar
  4. 4.
    Solomon HA, Edwards AL, Killip T: Prodroma-ta in acute myocardial infarction. Circulation 40: 463–471, 1969.PubMedGoogle Scholar
  5. 5.
    Alonzo AA, Simon AB, Feinleib M: Prodromata of myocardial infarction and sudden death. Circulation 52: 1056–1062, 1975.PubMedGoogle Scholar
  6. 6.
    Margolis JR, Kannel WS, Feinleib M, et al: Clinical features of unrecognized myocardial infarction — silent and symptomatic. 18 year follow up: The Framingham Study. Am J Cardiol 32: 1–7, 1973.PubMedCrossRefGoogle Scholar
  7. 7.
    Pathy MS: Clinical presentation of myocardial infarction in the elderly. Br Heart J 29: 190–197, 1967.PubMedCrossRefGoogle Scholar
  8. 8.
    Chin PL, Kaminski J, Rout M: Myocardial infarction coincident with cerebrovascular accidents in the elderly. Age and Aging 6: 29–37, 1977.CrossRefGoogle Scholar
  9. 9.
    Tarhan S, Moffitt EA, Taylor WF, Giulioni ER: Myocardial infarction after general anesthesia. JAMA 220: 1451, 1972.PubMedCrossRefGoogle Scholar
  10. 10.
    Scanion PF: The intermediate coronary syndrome. Progr Cardiovasc Dis 23: 351–364, 1981.CrossRefGoogle Scholar
  11. 11.
    Ambrose JA, et al.: Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 5: 609–616, 1985.PubMedCrossRefGoogle Scholar
  12. 12.
    Hecht HS, Rahimtoola SH: Unstable angina. A perspective. Chest 82: 466–472, 1982.PubMedCrossRefGoogle Scholar
  13. 13.
    Conti CR, Hodges M, Hutter A, Resnekov L, Rosatti R, Russell R, et al: Unstable angina — A National Cooperative Study comparing medical and surgical therapy. In Rahimtoola SH, et al. (eds): Coronary Bypass Surgery. Philadelphia, FA Davis Co, 1977, p 167.Google Scholar
  14. 14.
    Lewis HD, et al: Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N Engl J Med 309: 396–403, 1983.PubMedCrossRefGoogle Scholar
  15. 15.
    Cairns JA, et al: Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med 313: 1369–75, 1985.PubMedCrossRefGoogle Scholar
  16. 16.
    Holland RP, Arnsdorf MF: Solid angle theory and the electrocardiogram: Physiologic and quantitative interpretations. Progr Cardiovasc Dis 19: 431, 1977.CrossRefGoogle Scholar
  17. 17.
    Roberts R, Sobel BE: Creatine kinase isoenzymes in the assessment of heart disease. Am Heart J 95: 521, 1978.PubMedCrossRefGoogle Scholar
  18. 18.
    Roberts R, Parker CW, Sobel BE: Detection of acute myocardial infarction by radioimmunoas-say for creatine kinase MB. Lancet 2: 319, 1977.PubMedCrossRefGoogle Scholar
  19. 19.
    Willerson JT, Stone MJ, Ting R, Mukherjee A, Gomez-Sanchez CE, Lewis P, Hersh LB: Radioimmunoassay of creatine kinase-B iso-enzyme in human sera: Results in patients with acute myocardial infarction. Proc Natl Acad Sci 74: 1711–1715, 1977.PubMedCrossRefGoogle Scholar
  20. 20.
    Cohen L, Morgan J, Gustafson G: Enzyme and isoenzyme analysis in the coronary care unit. In Das Gupta DS (ed): Principles and Practice of Acute Cardiac Care. Chicago, Year Book Medical Publishers, 1984, pp 383–403.Google Scholar
  21. 21.
    Grande P, Christiansen C, Pedersen A, Christen-sen MS: Optimal diagnosis in acute myocardial infarction. A cost-effectiveness study. Circulation 61: 723–728, 1980.PubMedGoogle Scholar
  22. 22.
    Siegel AJ, Silverman LM, Holman L: Elevated creatine kinase MB isoenzyme levels in marathon runners. Normal myocardial scintigrams suggest non-cardiac source. JAMA 246: 2049–2051, 1981.PubMedCrossRefGoogle Scholar
  23. 23.
    Parkey RW, Bonte FJ, Buja LM, Stokely EM, Willerson JT: Myocardial infarct imaging with technetium-99M phosphate. Semin Nucl Med 7: 15–28, 1977.PubMedCrossRefGoogle Scholar
  24. 24.
    Anagnostopoulos CE, Prabhakar MJS, Kittle FC: Aortic dissections and dissecting aneurysms. Am J Cardiol 30: 263–273, 1972.PubMedCrossRefGoogle Scholar
  25. 25.
    Kolff J, et al: Aortic dissection: Re-evaluation of the indications for medical and surgical therapy. Am J Cardiol 39: 727–733, 1977.PubMedCrossRefGoogle Scholar
  26. 26.
    Bettmann MA, Salzman EW: Current concepts in the diagnosis of pulmonary embolism. Mod Conc Cardiovasc Dis 53: 1–5, 1984.Google Scholar
  27. 27.
    McNeil BJ: Ventilation-perfusion studies and the diagnosis of pulmonary embolism. J Nucl Med 21: 319–323, 1980.PubMedGoogle Scholar
  28. 28.
    Swamy N: Esophageal spasm. Clinical and manometric response to nitroglycerine and long acting nitrates. Gastroenterology 72:27, 1977.Google Scholar
  29. 29.
    Wolf E, Stern S: Costosternal syndrome. Arch Intern Med 136: 189–191, 1976.PubMedCrossRefGoogle Scholar
  30. 30.
    Kayser HL: Tietze’s syndrome. Am J Med 21: 982–989, 1956.PubMedCrossRefGoogle Scholar
  31. 31.
    Schroeder JS, Lamb IH, Harrison DC: Patients admitted to the coronary care unit for chest pain: High risk subgroup for subsequent cardiovascular death. Am J Cardiol 39: 829–832, 1977.PubMedCrossRefGoogle Scholar
  32. 32.
    Mather HG, Morgan DC, Pearson NG, et al.: Myocardial infarction: A comparison between home and hospital care for patients. Br Med J 1: 925–929, 1976.PubMedCrossRefGoogle Scholar
  33. 33.
    Fuchs R, Scheldt S: Improved criteria for admission to cardiac care units. JAMA 246: 2037–2041, 1981.PubMedCrossRefGoogle Scholar
  34. 34.
    Pozen MW, D’Agostino RB, Selker HP, Sytkowski PA, Hood WB Jr: A predictive instrument to improve coronary-care-unit admission practices in acute Ischemic heart disease. N Engl J Med 310: 1273, 1984.PubMedCrossRefGoogle Scholar
  35. 35.
    Fineberg HV, Scadden D, Goldman L: Care of patients with a low probability of acute myocar-dial infarction. N Engl J Med 310: 1301, 1984.PubMedCrossRefGoogle Scholar
  36. 36.
    Goldman L, Weinberg M, Weisberg M, et al: A computer-derived protocol to aid in the diagnosis of emergency room patients with acute chest pain. N Engl J Med 307: 588–596, 1982.PubMedCrossRefGoogle Scholar
  37. 37.
    Rowley JM, Hampton JR: Diagnostic criteria for myocardial infarction. Br J Hosp Med 253–256, 1981.Google Scholar

Copyright information

© Martinus Nijhoff Publishing, Boston. 1986

Authors and Affiliations

  1. 1.Cardiovascular DivisionBrigham and Women’s HospitalBostonUSA
  2. 2.CardiologistGreen Lane HospitalAucklandNew Zealand

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