Diagnosis, medical and surgical management of coronary insufficiency.

Abstract

Coronary artery injections of radio-opaque material into the vessels of autopsy hearts first disclosed that angina pectoris in most cases is due to extensive narrowing and occlusion of these vessels by atherosclerotic disease. These studies also showed that the development of coronary collateral anastomoses could compensate to a great extent for obstructions in the coronary arteries. The electrocardiographic hallmark of myocardial hypoxia, ST segment depression, has provided a valuable diagnostic method that identifies the presence of coronary insufficiency when it accompanies either spontaneous or induced anginal pain. The two-step test is a useful diagnostic method, and treadmill testing with electrocardiogram (EKG) monitoring provides a quantitative measure of the severity of angina as well as evidence of adaptation in the coronary circulation. Coronary arteriography discloses the extent of coronary obstructive disease, its accessibility for surgical correction, and the extent of compensatory collateral development. Surgical attempts at direct relief of coronary obstruction have been disappointing, but some brilliant successes point out the need for further study of this field. Control of serum lipid levels by diet and drugs offers hope of reducing the risk of coronary disease. A carefully graded walking exercise program may lead to improvement of clinical angina and treadmill performance in selected patients; this may provide a method for medical revascularization of the heart.