Arne Carlsten

Coronary angiography in the clinical analysis of suspected coronary disease

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 Paulins33 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 hearts 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.

Myocardial metabolism in coronary artery disease: Comparison of patients with diabetes or hypercholesterolemia without and with coronary artery disease

Abstract The myocardial arteriovenous differences of oxygen, glucose, lactate, pyruvate, individual free fatty acids and amino acids were compared in 9 patients without, and in 10 patients with, demonstrable coronary artery disease. The study included 8 patients with diabetes and 11 with essential hypercholesterolemia. The presence of coronary artery disease did not influence the arteriovenous differences. The patients were studied at rest and had no subjective symptoms of coronary insufficiency at the time of investigation.

Physiological analysis and subsequent surgical treatment of a case of carotid sinus syndrome.

Unilateral hypersensitivity of the carotid sinus reflex in a 37 year old man was diagnosed as representing the cardio-inhibitory type of the carotid sinus syndrome.Since the effect of methyl scopolamine nitrate only induced satisfactory prevention during the first 2-3 weeks and as 3 months of expectation gave no relief of the syncopal attacks, surgical denervation of the hypersensitive right carotid sinus was performed.Because of the risk of nerve regeneration the right sinus nerve in the present case was resected for 15 mm and the central end of the nerve was curved in a cranial direction.Several controls up to 14 months after operation have shown complete freedom of spontaneous and by local pressure provoked syncopal attacks.