CORONARY OCCLUSION AND MYOCARDIAL INFARCTION ASSOCIATED WITH CHRONIC RHEUMATIC HEART DISEASE

Abstract

In 6000 consecutive autopsies there were 436 cases of rheumatic heart disease and 513 cases of coronary heart disease, 32 of which had both conditions (7% of the rheumatics and 6% of the coronary cases). Fifteen were male and 17 female. In 10,000 consecutive clinical cases 1346 were diagnosed as having rheumatic heart disease and 2840 coronary heart disease, 57 of which had both conditions (4.2% of the rheumatics and 2% of the coronary cases). 40 were men and 17 were women. Aortic valve disease was found in 28 of the 32 fatal cases of combined coronary and rheumatic heart disease (87%). It was present in only 69% of the fatal cases of uncomplicated rheumatic heart disease. Mitral valve disease was found in 27 of the 32 (84%). A completely correct ante-mortem diagnosis was made in only seven of the 32 cases, although either rheumatic or coronary heart disease was diagnosed in 31 of the cases. The rheumatic heart disease was overlooked in 21 of the 32 patients. Incomplete diagnosis was to some extent inevitable because of the moribund state of some of the patients when examined. To some extent it was probably also due to a common clinical unawareness that coronary and rheumatic heart disease may be associated. The low incidence of rheumatic heart disease among the coronary cases in the clinical series suggests that the former condition is still being overlooked in these patients. Complete diagnosis is an important preliminary to satisfactory management. The value of careful auscultation in establishing the diagnosis of concomitant rheumatic heart disease is emphasized. No evidence was found to suggest that rheumatic heart disease has any influence on the development of coronary artery degeneration.