Coronary angiography in the clinical analysis of suspected coronary disease

Abstract Of 420 patients studied with coronary arteriography, 10 were selected and described in detail, the aim being to illustrate diagnostic possibilities of the method. Current pathophysiologic and etiologic concepts are discussed against the background of findings in the 10 patents and in the whole series. The coronary arteriograms were performed according to Paulin's 33 method, including contrast injection through a loop-end catheter placed immediately above the aortic valves, without any general anesthesia or pharmacologic interference with heart action. The validity of the method was shown by good agreement between the angiographic and postmortem findings in 39 patients who died at different times after the investigation and had normal to severely diseased coronary arteries. Even if there is generally a good correlation between the electrocardiographic changes and the arteriographic picture, there are also many exceptions. These can be explained by basic differences in methods. Arteriography pictures the patency of only part of the heart's vascular system. The electrocardiogram depicts a sort of integrated electrical function of the cellular activity of the heart. Extensive investigations have been made to establish some risk factors that may have value in predicting coronary heart disease. However, it cannot be emphasized enough that these risk factors are too loose to be of any great importance in the evaluation of the single patient. Our results show that a carefully taken history of pain and use of the symptom “angina pectoris” based on strict criteria is a diagnostic method with a value at least equal to that of the electrocardiogram. Our experience does not support the view that coronary arterial disease is a continuous process but indicates that it may instead have a more episodic character. Even if coronary arteriography is often of great value in diagnosis and in the management of patients, we believe that it is still not a method to be used routinely. It should be used by those with a scientific interest in coronary heart disease. As a tool in present and future clinical research, it has an important place in solving specific problems.