Biomedical subjects
Publications and source records attributed to E Besterman.
Angina pectoris was first adequately described and named in 1772. However, coronary artery disease, as the cause, was noted in 1779. The pathology and clinical features of myocardial infarction were only recognized in 1912. The distinction between angina and infarction was clarified in the 1920s. Nitrate therapy remained the sole treatment until modern medical and surgical developments which this review does not cover.
The screening programme of the Heart Foundation of Jamaica has found hypertension in 71% of women and 47% of men. Of these patients, 13% were newly discovered hypertensives. Left ventricular hypertrophy was present in 18% of hypertensive women and in 27% of men. Inadequate control of raised blood pressure was a frequent finding. Ischaemic electrocardiographic (ECG) changes were only found in 4% of the 14,739 patients seen in the past two years but this is an underestimation of the prevalence of ischaemic heart disease. Arrhythmias seen over 15 years were usually benign, of sinus origin or ectopics in the absence of heart disease. Uncontrolled atrial fibrillation remains the most serious arrhythmia encountered and usually in hypertensive patients. Obesity found in 80% of women is a problem requiring public education. 'Silent' ischaemia in diabetic and left ventricular hypertrophy in hypertensive patients indicate the need for ECG examination in all newly diagnosed patients with either condition, and annual ECGs thereafter.
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The performance of the St Mary's Hospital London W2 coronary care unit was studied in each of 2 years, 1969 and 1975, results of which could be compared with each other and with national figures from the annual reports of the Hospital In-patient Enquiry. In 1975 the admissions were 42% more than in 1969; the increase was confined to mild cases over 45 years of age, and was out of proportion to national trends. The hospital fatality rate was unchanged and when age-standardized was 69% and 78% of contemporaneous national rates. In both years, 50% of the patients admitted came from outside the health district and 10% of local admissions were visitors from abroad. In 1975 there was an increased proportion of ex-smokers among the patients and more gave a history of previous myocardial infarction. The value and limitations of this kind of surveillance of a clinical unit are argued.
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