Angina pectoris: A clinical and pathologic correlation

Abstract

1. 1. A clinico-pathologic study of angina pectoris was carried out in a group of 848 cases in which the coronary arteries were injected and dissected by the Schlesinger technic. The group consisted of 177 patients with angina pectoris of one month's duration or longer and 671 control patients without cardiac pain. 2. 2. Not a single patient with angina pectoris in the entire series was found to be free of heart disease. All anginal patients had either coronary, valvular or hypertensive heart disease; 90 per cent of them had coronary narrowing or occlusion. 3. 3. To clarify the relative importance of various types of heart disease in the production of angina pectoris, the incidence of angina among patients with a single form of heart disease was determined. Angina was found in 52 per cent of patients with coronary occlusion, in 16 per cent of those with valvular lesions, in 5 per cent of those with coronary narrowing and in 3 per cent of those with hypertension. 4. 4. There was a clear positive correlation between the degree of coronary obstruction and the incidence of angina pectoris; among patients with occlusions of three main coronary arteries the incidence of angina pectoris was 85 per cent. 5. 5. The serious prognostic import of angina pectoris in this series is evident from the mortality figures. One-third of the patients were dead within one year after the onset of angina, half were dead within two years, three-quarters were dead within five years and nine-tenths within ten years. The average duration of angina pectoris differed according to the underlying etiology: it was shorter in valvular and longer in coronary heart disease. 6. 6. Congestive failure was of more serious prognostic importance than angina pectoris in coronary disease and less serious in valvular disease. 7. 7. An intercurrent episode of myocardial infarction did not shorten the prognosis of a patient with angina pectoris. 8. 8. The underlying mechanism of angina pectoris appears to be a relative disproportion between the requirements of the heart for blood and the supply furnished by the coronary arteries; this disproportion results in paroxysmal relative ischemia. In coronary artery disease, angina pectoris, myocardial fibrosis and intercoronary anastomoses all result from myocardial ischemia; the first is a clinical expression, the second a pathologic end result and the third a compensatory response to ischemia.