Ischemic heart disease

An understanding of the natural history of angina pectoris is crucial to de cision making in the management of patients with this disease. Early invest igations suggested a highly variable annual mortality rate, ranging from 2. 5 to 9 percent These studies clearly pointed to the association of certain electrocardiographic changes, hypertension, cardiac enlargement-and congest ive heart failure with increased mortality. Several recent studies based on findings at. coronary arteriography indicate a high degree of correlation between the extent of coronary atherosclerotic occlusive disease and the li kelihood of-early death. A combination of data from several laboratories in dicates that if only one of the three major coronary arterial branches (lef t anterior descending, left circumflex or right) is significantly stenosed the annual mortality rate will be approximately 1 percent of the cohort. IS two of the three major arteries are stenosed the rate will be approximatel y 7 percent, and if all three arteries are stenosed, if will be approximate ly II percent Some data suggest that these mortality figures based on the e xtent of atherosclerotic occlusive disease are importantly modulated by the extent of ventricular myocardial impairment as reflected by cardiac enlarg ement or symptoms of congestive heart failure.