Clinical aspects of coronary insufficiency

Some of the clinical features of coronary insufficiency have been given brief consideration. A classification of the common types has been presented for the purpose of correlating diverse manifestations, all of which are caused by an inadequate coronary blood flow. The importance of recognizing infarction has been stressed. It has been demonstrated that atherosclerotic changes in the coronary arteries often progress insidiously and that, in many instances, processes of repair compensate adequately for the damages of disease. Some of the cardinal points in diagnosis have been discussed. Too little attention has been given to cardiac enlargement alone which, in the absence of hypertension, valvular deformity or other obvious causes, affords presumptive evidence of coronary heart disease. The use and limitations of the anoxemia test as an aid in the recognition of coronary insufficiency have been described. Because prolonged rest in bed has been credited with certain undesirable effects on the circulation, the impression apparently has been created that the importance of rest, in general, in the treatment of cardiac ailments has been overemphasized. In the author's opinion, there has been too much criticism of the use of rest. It is the most valuable single therapeutic procedure in the management of the patient with coronary heart disease. The fault lies not in the remedy but in lack of discrimination in its application. Acute coronary insufficiency is the most common cause of sudden death. In the few cases of coronary disease in which the mechanism of the dying heart has been recorded, ventricular fibrillation usually has occurred just before respiration ceased. Less frequently, ventricular tachycardia has been followed by total cardiac standstill.