Natural history of coronary heart disease.

Abstract

We now possess enough data concerning prognosis so that we can highlight the areas of concentration for the practicing physician. A history of congestive failure, hypertension,or diabetes is of greatest importance. Smoking is in a similar category, but cholesterol elevation is not. Electrocardiographic findings can be used as an immediate discriminator, depending on whether they are normal or abnormal. Further refinements are possible, depending on whether there are ST-segment depressions or elevations, ventricular conduction defects, repetitive ventricular dysrhythmias, left ventricular hypertrophy, or Q waves of prior infarctions. The exercise electrocardiogram provides additional important information and, if markedly abnormal, can detect with reasonable degree of accuracy the presence and degree of ischemic heart disease. The coronary arteriogram, which influences many of the preceding clinical criteria, permits an accurate prediction of five-year mortality and in a preliminary fashion can be integrated with electrocardiographic and ventriculographic abnormalities to derive a significant measure of prognosis. Finally, cardiac function, if assessed according to specific criteria, becomes an extremely important variable in predicting natural history in coronary heart disease.