Clinical Features of Sudden Obstruction of the Coronary Arteries

Obstruction of a coronary artery or of any of its large branches has long been regarded as a serious acci- dent.Several events contributed toward the prevalence of the view that this condition was almost always sud- denly fatal.Parry's writings on angina pectoris and its relation to coronary disease, Jenner's observations on the same condition centering about John Hunter's case, Thorvaldsen's tragic death in the theater in Copen- hagen with the finding of a plugged coronary, sharply attracted attention to the relation between the coronary and sudden death.In Germany Cohnheim supported the views of Hyrtl and Henle as to lack of considerable anastomosis, and as late as 1881 lent the influence of his name to the doctrine that the coronary arteries were end-arteries; his Leipsic necropsy experience, as well as experiments on dogs, forced him to conclude that the sudden occlusion of one of these vessels or of one of the larger branches, such as the ramus descendens of the left coronary, meant death within a few minutes.Other3 emphasized the same view.No one at all familiar with Ihe clinical, pathologic or experimental features of cardiac diseuse can question the importance of the coronarios.The influence of scle- rosis of these vessels in the way of producing anemic necrosis and fibrosis of the myocardium, with such pos- sible results as aneurysm, rupture or dilatation of the heart, is well known.So also is the relation of the coronaries to many cases of angina pectoris, and to cardiac disturbances nil her indefinitely classed as chronic myocarditis, cardiac irregularities, etc.It must be admitted, also, thai the reputation of the descending branch of the left coronary as the artery of sudden death is not undeserved.Hut there are reasons for believing that even large branches of the coronary arteries may be occluded at limes acutely occluded-without resulting death, at least wilhoiil death in Hie immediate future.Even the main trunk-may at times be obstructed and Ihe patient live.II.¡s Ihe object of this paper to present a few facts along Ibis line, and particularly to describe some of the clinical manifestations of sudden yet not immediately filial eases of coronary obstruction.Before presenting the clinical features of coronary obstruction, if may be well to consider certain facts that go to prove that sudden obstruction is not neces- sarily fatal.Such proof is afforded by a study of the anatomy of lite normal as well as of the diseased heart, by animal experiment and by bedside experience.