Treatment of Coronary Artery Disease*

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Physicians in general are familiar with the treatment of coronary artery disease; however, a review of the methods and drugs of choice should be of value.

The most common cause of death after 50 years of age is heart disease, primarily coronary artery disease. The severity of symptoms in coronary artery disease depends entirely upon the degree of arteriosclerosis involving the coronary vessels or the aorta. Although extensive arteriosclerosis of the coronary vessels has been demonstrated post mortem without history of cardiac distress, such cases are unusual.

The 5 chief manifestations of coronary artery disease are (1) angina pectoris, (2) coronary thrombosis with infarction of the myocardium, (3) cardiac asthma with paroxysmal cardiac dyspnea, (4) Morgagni-Adams-Stokes syndrome, and (5) congestive myocardial failure. The two latter manifestations are often complications of coronary thrombosis with infarction of the myocardium.

Recent studies of series of cases by Master,1 Dack and Jaffe,2 and Rathe3 indicate that the prognosis of coronary artery disease, particularly myocardial infarction, is more favorable than has been believed. Only 20 per cent of patients die from the initial occlusion within the first month. Approximately 50 per cent survive the first month and live for several years. Thirty per cent recover and resume normal activity. A definite prognosis of angina pectoris is more difficult to make, but patients may live for years and carry on reasonably normal activities. Sir James Mackenzie, the well known English cardiologist, had his first attack of angina pectoris at 49, but lived for another 25 years. . .



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