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The Differential Diagnosis of Coronary Artery Disease

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Abstract

During the past 15 years, there has been a progressive increase in the frequency with which the diagnosis of coronary thrombosis or angina pectoris has been made. This increase has resulted in part from an absolute increase in the incidence of coronary artery disease and in part from widespread diffusion of knowledge concerning its clinical features. In the great majority of cases, the presence of angina pectoris or coronary thrombosis is correctly recognized, but as a result of the popularity of these diagnoses, other diseases with similar symptoms undoubtedly are being included at times under the same classifications. Although such errors are not common, they are of importance because of their bearing upon prognosis and treatment. It is the purpose of this communication to review certain recent experiences in which other conditions were confused with or closely simulated coronary artery disease and to point out the significant features in the history and clinical findings upon which a correct diagnosis was, or might have been, established.

Upper Abdominal Disease

Early writers1,2 on coronary thrombosis directed attention to the fact that the disease might closely simulate acute surgical conditions in the upper abdomen, and the possibility of erroneously attributing the symptoms of coronary occlusion to upper abdominal disease has since been emphasized repeatedly. More recently, a few observers have pointed out the possibility that errors may be made in the reverse direction and have reported cases in which symptoms due to gall-bladder disease or perforated peptic ulcer suggested coronary artery disease.3,4,5 In. . .


 

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