[Pathomorphology of the heart in angina pectoris].
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Biomedical subjects
Publications and source records attributed to E Nüssel.
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Starting from generalized theories of the arteriosclerosis, a comprehensive model of factor analysis is presented which considers the clinical risk spectrum of coronary heart disease as presently known. Arteriosclerosis and morphological findings are also included in the analysis. A differentiation is made between "progressive remification" and "multiple variable" patterns, which combine the clinical risks in a specific structure. Fractions of unknown influencing factors could be estimated quantitatively and qualitatively in such a manner that suggestions concerning the huge dependency of time and the progressive increase with age could be determined.
Based upon factor analysis, initial findings of the risk factors for coronary heart disease are reported, following invesitgations performed on a large number of patho-anatomical cases which were selected for specified criteria. The so-called hypertensive form of arteriosclerosis was demonstrated in the spleen, pancreas, and adrenal gland. It was shown that diabetes mellitus is an influencing factor in arteriolosclerosis in the liver. Several types of arterial hypertension can be differentiated according to clinical features and findings in the heart. Renoparenchymatous and renovascular sclerosis, pyelonephritis, diabetes mellitus, and age are the factors correlated or associated with various types of hypertension. Primary (?) renal hypertension can be differentiated from the secondary (?) TYPE. The discussion suggests that the morphological findings of arteriosclerosis and its complications may be explained, to a certain extent, by the known risk factors of coronary diseases defined by the methods described.
A large number of cases were tested for the relevance of clinical risk factors in coronary heart disease with regard to coronary arteriosclerosis (atheroma, fibrosis; five different locations). The method applied was VARIMAX-rotated factor analysis. The resulting factors were interpreted as the multiple variables structures which are in different relationships to the risk criterion, coronary heart disease, and morphological vascular diagnosis of the coronary arteries. The importance of the known risk of the vascular diagnosis was estimated and the reterance of the clinically influencing criterion was discussed. It appears that in spite of limited methodology additional morphological criteria are required in order to be able to explain heart infarction which does not involve the epicardial branches of the coronary vascular system.
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The frequency and distribution of risk factors of arteriosclerosis were determined in 405 patients with implanted cardiac pacemakers and compared with the corresponding results of patients with cardiac infarction. The most frequent risk factors were smoking (43,5%), hypertension (35,2%), and diabetes (34,3%) in males, hypertension (52,3%) and diabetes (49,7%) in females. The frequency of cardiac infarction was in average 19,5%. In the infarction group diabetes was lower in both sexes (23,5% and 35,8%), respectively), hyperlipoproteinemia and smoking were more frequent. From the different distribution of risk factors it is suggested, that coronary arteriosclerosis is not the most important etiologic factor in the development of bradycardic dysrhythmias. The higher percentage of diabetes in the pacemaker group could point to metabolic disturbances or specific diabetic vascular disease as harmful factors to the conduction system.
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Well known qualitative and quantitative differences of cardiac pain were tested by the RASCH-Model to find out whether this test would be able to indicate differences within any kinds of diseases. This ability of differentiation could be corroborated for the RASCH-Model. By making a destination of the measure for the accordance of the sensual quality of a single patient with that of a special group of diseases, it is possible to test the same diseases also in the question of the quantitative equality.
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