Clinical Presentation of Ischemic Heart Disease

Abstract

American physicians refer to James B. Herrick as the first to describe the clinical presentation of a nonfatal myocardial infarction in 1912. In his description Herrick indicated his familiarity with an earlier report by Obraztsov and Strazhesko in a German translation in which they discussed five cases of myocardial infarction, three of which were confirmed by autopsy

• A 49-year-old artillery man was admitted to the medical division of the Aleksandrovsky Hospital on December 5, 1899. For 12 days prior to admission, he had experienced substernal pain radiating to the throat, head and left arm. The attacks lasted 2 to 4 hours and after a brief pause would begin again. During the attacks he experienced shortness of breath and the inability to breathe deeply. The chest pain was so severe that the intern on my service, who was young and inexperienced, in response to my question as to the patient’s admitting diagnosis responded “rheumatism of the chest.”

• Objective Findings: He was well nourished and well developed. There was moderate cyanosis of the mucous membranes. His facial expression revealed distress from the substernal pain which radiated to the neck and head. No vessel motion was visible in the neck. The respiratory and abdominal organs were without abnormalities. The cardiac impulse was not visible, but was weakly palpable in the 5th intercostal space in the left mammary line. The heart sounds were distant and there were no murmurs. Direct auscultation revealed presystolic splitting of the first sound. Pulse 90 and barely palpable. Rhythm regular. After the initial examination the diagnosis of coro- nary thrombosis was made. The patient died 4 days later on December 9, 1899.

• Autopsy Findings: On cross section of the left ventricle its entire thickness was of a muddy-gray yellowish color, as seen with necrosis. These changes occurred in almost the entire wall of the left ventricle and septum.

• Near the origin of the right coronary artery there was 1 cm long yellowish projection from the wall of the vessel producing some luminal narrowing. The changes in the left coronary were more severe. The left anterior descending coronary artery was occluded by grayish-red thrombus 1 cm long and 1 mm in diameter. The left circumflex was occluded by a 3 cm long soft yellow thrombus.