HYPERTENSIVE AND ISCHAeMIC HEART DISEASE: A COMPARATIVE CLINICAL AND PATHOLOGICAL STUDY

Abstract

The group studied consisted of 12 controls, 27 cases of hypertension and 15 cases of ischemic heart disease. The hypertensive cases were characterized clinically by even sex distribution, dyspnea, steady deterioration, retinopathy, cerebral symptoms, impairment of renal function, anemia, auricular fibrillation and by clinical, radiological and ecg. evidence of left ventricular enlargement before the onset of heart failure. Only one case originally classified as hypertensive developed angina or infarction. Death was rarely abrupt. Characteristic of the ischemic group were: unequal sex distribution[long dash]favoring men, older age of women, seldom early dyspnea, no anemia, no retinopathy, no cerebral symptoms, good renal function, normal rhythm, normal size up to failure, good temporary recovery, abrupt death. Comments on pathology are: moderate atheroma does not necessarily cause narrowing. Size of coronary vessels varies directly with heart wt. irrespective of the cause of hypertrophy. Hypertensive coronary arteries are large with smooth bores, while in ischemic disease they are narrow and frequently occluded. Heart wt. in. hypertensive disease varies with the degree of failure during life and not with blood pressure. Coronary size increases pari passu with hypertrophy and there is no evidence of relative ischemia. In great hypertrophy there is an excess of fibrous tissue. In ischemic cases hypertrophy is the rule and can be correlated with the duration of failure. Infarction can occur in the absence of occlusion and is probably then due to circulatory failure.