CORONARY ARTERY DISEASE

CORONARY ARTERY DISEASE
Patients who suiter from disease of the coronary arterial tree present with a wide variety of symptoms of every grade of severity. On the one hand the clinical history may be dominated by an episode of myocardial infarction with prolonged pain, shock and a serious protracted illness ; such episodes may recur time and again in a particular patient. At the other extreme there are those who suffer transient restriction of effort due to pain, varying from trivial discomfort to extreme distress. Some patients combine both syndromes and suffer for years from angina of effort with superimposed attacks of myocardial infarction. There is every justification for considering these patients collectively, whatever be their dominant symptoms, and their general management over the years does not differ from one group to the next. In so far as treatment of the acute episode is concerned, the management of myocardial infarction is con¬veniently considered separately from that of angina of effort. It will be noted that the term myocardial infarction is used rather than coronary thrombosis,. for there is good evidence that while clotting in a coronary artery is a common;
cause of myocardial infarction it is by no means invariable and infarction of the heart muscle without coronary thrombosis is common.