Acute coronary artery diseases
1947; Elsevier BV; Volume: 2; Issue: 5 Linguagem: Inglês
10.1016/0002-9343(47)90096-x
ISSN1555-7162
Autores Tópico(s)Phonocardiography and Auscultation Techniques
ResumoAbstract Acute coronary artery diseases have existed for hundreds, probably thousands of years. The arteriosclerosis observed in Egyptian mummies was of the same nature as is this disease today. Descriptions in the Bible are suggestive of attacks of acute coronary occlusion. Hippocrates is quoted as saying that Cardiodynia, which occurs more frequently in senility, foretells sudden death. However, present knowledge of acute coronary became established only after the reports by Herrick in 1912 and 1918. Heart disease has, since 1912, been the chief cause of death in this country. Four to eight million people suffer from heart diseases. Coronary disease comprises from 25 to 50 per cent of all heart diseases. With the lengthening span of life and therefore an increasing older population, the number of victims will continue to increase in the future. There are two main divisions of acute coronary artery diseases: (1) Acute coronary occlusion, and (2) acute coronary insufficiency (myocardial necrosis or myomalacia or acute coronary occlusion). Acute coronary denotes sudden complete closure, a sequel of progressive arteriosclerosis. The attack is not related to effort and excitement. It takes place during sleep and rest and routine activities of the individual. The symptoms and signs are crushing substernal pain, not relieved by nitroglycerin, nausea and vomiting, shock, fall in blood pressure, change in heart sounds, gallop rhythm, fever, leukocytosis and increased sedimentation rate. The illness is prolonged and usually results in permanent changes in the heart. At autopsy the lumen of the coronary artery is found completely closed. The infarct is large, usually extending from endocardium to pericardium. The electrocardiogram is specific. In acute coronary insufficiency (without acute occlusion) the severity of the disturbance varies from the simple short episode of angina pectoris, in which the pain is momentary, to the more severe type in which the anoxia of the heart muscle is prolonged, so that a serious injury to the heart muscle may take place. The episode is often related to exertion, excitement and emotion; it may occur after sexual intercourse, straining at stool or following gastroenteritis; it may be induced by extremes of heat and cold, tachycardia, auricular fibrillation, auricular flutter, shock, heart failure, hypoglycemia, operation, anesthesia, anoxemia of any type, carbon monoxide poisoning, acute hemorrhage, chronic anemia, hyperthyroidism, hypothyroidism, etc. In a severe episode the heart muscle may contain many focal disseminated areas of subendocardial necrosis. These are often observed in the papillary muscles, but the endocardium and pericardium are not involved. The electrocardiogram discloses depression of the RS-T segments and T wave inversions which are characteristic. The prognosis of acute coronary insufficiency acute is usually better than that of acute coronary infarction. The former disease is compensable, the latter is not. The treatment of these two types of acute coronary diseases differs. A rational existence and avoidance of the known precipitating causes prevent acute coronary insufficiency. Administration of digitalis, diuretics, quinidine, blood transfusions, etc., are of value in preventing acute changes in the heart muscle. In acute coronary occlusion, on the contrary, avoidance of predisposing factors does not prevent the onset of the attack. The best treatment of this is passive. Direct measures should be employed only if there are complications. The distinction between acute coronary insufficiency and acute coronary is confused by careless use of terms. If the expression myocardial infarction is used as a diagnosis the qualifying phrases with acute occlusion or without acute occlusion are essential to accurate terminology. There is evidence that the number of instances of acute coronary may be as high as 1,000,000 attacks per year. This means that one man in thirty and one woman in ninety, forty years of age and over, in this country annually sustain an acute obstruction of a coronary artery. The incidence of acute coronary insufficiency is of the same magnitude and significance as that of acute coronary occlusion. In fact, in case of acute, sudden, unexpected death, acute coronary insufficiency is observed more frequently than is the acute complete obstruction. Coronary disease is of great importance to industry. Nearly 60,000,000 people are employed in this country. Hundreds of millions of dollars are paid out yearly in compensation disability benefits. Trauma, direct and indirect, can produce arrhythmias and damage to the heart. It very rarely if ever causes an acute coronary infarction. In a severe steering wheel, or similar accident, bruise of the chest wall and contusion of the wall of the left ventricle, an may rarely take place. Evidence gathered from observations of more than 1,000 attacks of acute coronary indicate that the onset of the attack is not related to external factors such as effort, work or trauma, nor is it confined to any particular occupation or social stratum. Acute coronary is the end result of an arteriosclerotic process and occurs as often in a sedentary person as in one engaged in active work. Fifty-three per cent of patients return to work after recovery from the attack of acute coronary occlusion, nearly all of them within the first year. The younger the patient, the more likely is he to return to his employment. Each successive attack of acute coronary reduces the probability of return to work. Only half the laborers resumed their occupations, whereas twothirds of the white collar and office workers, and four-fifths of the professional persons returned to their jobs. Our findings thus indicate that an attack of acute coronary is not in itself a reason for permanent disability. We believe that the outlook for a patient recovering from an attack of acute coronary may justifiably be regarded more hopefully than it has been in the past.
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