Clinical Presentation of Ischemic Heart Disease
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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.
KeywordsMyocardial Infarction Acute Myocardial Infarction Unstable Angina Aortic Dissection Left Bundle Branch Block
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- 2.Herrick JB: Clinical features of sudden obstruction of the coronary arteries. JAMA 59: 2015–2020, 1912.Google Scholar
- 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
- 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
- 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
- 26.Bettmann MA, Salzman EW: Current concepts in the diagnosis of pulmonary embolism. Mod Conc Cardiovasc Dis 53: 1–5, 1984.Google Scholar
- 28.Swamy N: Esophageal spasm. Clinical and manometric response to nitroglycerine and long acting nitrates. Gastroenterology 72:27, 1977.Google Scholar
- 37.Rowley JM, Hampton JR: Diagnostic criteria for myocardial infarction. Br J Hosp Med 253–256, 1981.Google Scholar