The Treatment of Coronary Artery Disease
The five chief manifestations of coronary artery disease are: (1) angina pectoris, (2) coronary thrombosis with infarction of the myocardium, (3) cardiac asthma (paroxysmal cardiac dyspnea), (4) Adams-Stokes syndrome, and (5) congestive myocardial failure. Each of these conditions gives rise to a well-differentiated clinical picture, and the management of each differs in important respects from that of the others. The diagnostic features and treatment of the various syndromes will be discussed in the present communication.
Angina pectoris is a descriptive term applied to paroxysmal attacks of substernal pain which characteristically are precipitated by exertion or excitement and are relieved promptly by rest. The patient often experiences difficulty in describing the pain and frequently refers to it as a sensation of fullness, pressure, tightness or heaviness in the anterior chest. The distress is of such a nature as to enforce cessation of all activity and at times is accompanied by a sense of impending death. There may or may not be radiation of the discomfort to the neck, jaws or inner aspect of the arms. Glyceryl trinitrate and similar preparations give prompt relief from the symptoms. Death may occur instantaneously during an attack.
The most important measure in the treatment of angina pectoris consists of impressing upon the patient the imperative need for limitation of his activity in order to avoid, so far as possible, the induction of attacks. Hurry and unusual exertion of all kinds must be prohibited. Certain conditions exert an important effect upon the ease with. . .