Coronary sclerosis: An analysis of nine hundred twenty-eight cases

Abstract Nine hundred twenty-eight (928) cases of coronary sclerosis were studied. Deaths resulting from coronary sclerosis represented about one-fourth of all deaths from noncongenital cardiac disease, or about 4 per cent of all deaths in patients above 6 months of age, in the autopsy material in the Department of Pathology at the University of Minnesota from 1910 to 1936, inclusive. Nothing definite can be said concerning the primary cause of the disease. Death occurred most frequently in the fifth, sixth, seventh, and eighth decades, but it may take place early in the third decade. Death from coronary sclerosis was about two and one-half times as common in males as in females. Hypertension was the most common condition associated with coronary sclerosis. The great frequency suggested a causal relation. Sudden death or death following symptoms of but a few minutes' duration was common (28 per cent). Such deaths were more common in the patients without hypertension than in those with hypertension. In patients with symptoms lasting one to five years, or more, hypertension was more common. Pain was the most common complaint, being present in more than half of the cases. The location and variety of the pain had a marked variation. Dyspnea was the next most common symptom. Fainting, dizziness, and paralysis were not uncommon. Effort was not a conspicuous factor in the death of these patients (10 per cent). At least 75 per cent died while at rest in the hospital or else-where. The left coronary artery, especially the anterior descending branch, was the one most frequently involved. Severe right coronary involvement without a relatively severe affection of the left coronary artery rarely caused death. Thrombosis of the arteries was present in nearly half the cases (45 per cent), 32.5 per cent in the left alone, 10 per cent in the right alone, and 3 per cent in both arteries. Thrombosis was more common in the patients with hypertension than in those without hypertension. Hypertrophy was more than twice as common in the hypertensive as in the nonhypertensive group. There was no evidence to support the claim that cardiac hypertrophy results from coronary sclerosis. On the other hand, the hypertrophy appeared to be the result of essential hypertension. Infarction of the myocardium was noted in 30.5 per cent of the entire group but was more frequent among the cases of hypertension. In most cases the infarction was preceded by thrombosis. Rupture of the myocardium was relatively rare (5 per cent). Some myocardial fibrosis was observed in nearly all of the hearts examined, severe in 48.5 per cent, slight in 46 per cent, and absent in 5.5 per cent. Pericardial fibrous adhesions were noted, as a rule, only about infarcted areas. Edema and chronic passive congestion of the liver were frequently present, but more commonly in the hypertensive group. Excepting thrombosis, infarction, and rupture of the myocardium, the anatomic changes noted did not appear to be sufficient to be the final cause of death. In more than half of the cases, something not manifested anatomically had to be assumed to be the cause of death.