Article1 July 1955MYOCARDIAL INFARCTION IN WOMENTHOMAS N. JAMES, M.D., HENRY W. POST, M.D., F. JANNEY SMITH, M.D., F.A.C.P.THOMAS N. JAMES, M.D., HENRY W. POST, M.D., F. JANNEY SMITH, M.D., F.A.C.P.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-43-1-153 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptEven more striking than the relative rarity of coronary thrombosis in women in the reproductive phase of life is the fact that thrombosis is seldom due to spontaneous arteriosclerosis. The unusual facets of myocardial infarction in women have evoked a number of interesting observations on the sexual aspects of this disease. Dock1demonstrated a remarkably thinner intima of the coronary arteries in females even in infancy. Wuest, Dry and Edwards2carefully examined the coronary arteries of bilaterally oophorectomized women and found they had a greater amount of atherosclerosis than a control group. Barr3was able to lower the cholesterol/phospholipid ratio...Bibliography1. Dock W: The predilection of atherosclerosis for the coronary arteries, J. A. M. A. 131: 875, 1946. CrossrefMedlineGoogle Scholar2. WuestDryEdwards JHTJJE: The degree of coronary atherosclerosis in bilaterally oophorectomized women, Circulation 6: 401, 1952. Google Scholar3. Barr DP: Some chemical factors in the pathogenesis of atherosclerosis (The George E. Brown Memorial Lecture), Circulation 8: 641, 1953. CrossrefMedlineGoogle Scholar4. SmithKeyesDenham FJJWRM: Myocardial infarction: a study of the acute phase in 920 patients, Am. J. M. Sc. 221: 508, 1951. CrossrefMedlineGoogle Scholar5. LevineRosenbaum SAFF: Prognostic value of various clinical and electrocardiographic features of acute myocardial infarction, Arch. Int. Med. 68: 1215, 1941. CrossrefGoogle Scholar6. MasterDackJaffe AMSHL: Age, sex and hypertension in myocardial infarction due to coronary occlusion, Arch. Int. Med. 64: 767, 1939. CrossrefGoogle Scholar7. Clawson BJ: Incidence of types of heart disease among 30,265 autopsies, with special reference to age and sex, Am. Heart J. 22: 607, 1941. CrossrefGoogle Scholar8. YaterWelshStapletonClark WMPPJFML: Comparison of clinical and pathologic aspects of coronary artery disease in men of various age groups: a study of 950 men autopsied cases from the Armed Forces Institute of Pathology, Ann. Int. Med. 34: 352, 1951. LinkGoogle Scholar9. EnosHolmesBeyer WFRHJ: Coronary disease among United States soldiers killed in action in Korea, J. A. M. A. 152: 1090, 1953. CrossrefMedlineGoogle Scholar10. WhiteEdwardsDry NKJETJ: The relationship of the degree of coronary atherosclerosis with age in men, Circulation 1: 645, 1950. CrossrefGoogle Scholar11. LevyBoas HEP: Coronary artery disease in women, J. A. M. A. 107: 97, 1936. CrossrefGoogle Scholar12. BakerWillius TWFA: Coronary thrombosis among women, Am. J. M. Sc. 196: 815, 1938. CrossrefGoogle Scholar13. GlendyLevineWhite RESAPD: Coronary disease in youth, J. A. M. A. 109: 1775, 1937. CrossrefGoogle Scholar14. SmithGoodrich FJBE: The neutrophilic partition in myocardial infarction, Tr. Am. Clin. and Climatol. A. 51: 247, 1935. MedlineGoogle Scholar15. Wright IS: The pathogenesis and treatment of thrombosis, 1952, Grune & Stratton, New York. Google Scholar16. Bruzelius S: Dicoumarin in clinical use, Acta chir. Scandinav. 92: Supp. 100, 1945. Google Scholar17. OliverBoyd MFGS: The effect of estrogens on the plasma lipids in coronary artery disease, Am. Heart J. 47: 348, 1954. CrossrefMedlineGoogle Scholar18. RivinDimitroff AUSP: The incidence and severity of atherosclerosis in estrogen-treated males, and in females with a hypoestrogenic or hyperestrogenic state, Circulation 9: 533, 1954. CrossrefMedlineGoogle Scholar19. PickStamlerRodbardKatz RJSLN: Estrogen-induced regression of coronary atherosclerosis in cholesterol-fed chicks, Circulation 6: 858, 1952. CrossrefMedlineGoogle Scholar20. Altschul R: Selected studies on arteriosclerosis, 1950, C. C Thomas, Springfield, Ill. Google Scholar21. LandesmanDouglasDreishpoonHolze RRGGE: The vascular bed of the bulbar conjunctiva in the normal menstrual cycle, Am. J. Obst. and Gynec. 66: 988, 1953. CrossrefMedlineGoogle Scholar22. BestTaylor CHNB: The physiological basis of medical practice, 5th Ed., 1950, The Williams and Wilkins Co., Baltimore. Google Scholar23. UhlBrownZlatkisZakMyersBoyle HSHHABGBAJ: Effect of ethylenediamine tetraacetic acid on cholesterol metabolism in rabbits: preliminary report on effect of parenteral and oral administration of disodium and calcium salts, Am. J. Clin. Path. 23: 12, 1953. CrossrefGoogle Scholar24. Pohle FJ: The blood platelet count in relation to the menstrual cycle in normal women, Am. J. M. Sc. 197: 40, 1939. CrossrefGoogle Scholar25. Wintrobe MM: Clinical hematology, 3rd Ed., 1951, Lea & Febiger, Philadelphia. Google Scholar26. AckermanDryEdwards RFTJJE: Relationship of various factors to the degree of coronary atherosclerosis in women, Circulation 1: 1345, 1950. CrossrefMedlineGoogle Scholar27. White PD: Principles and practice of prognosis, with particular reference to heart disease (Billings Lecture), J. A. M. A. 153: 75, 1953. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Detroit, Michigan*Received for publication January 14, 1955.From the Division of Cardiology of the Henry Ford Hospital, Detroit, Michigan.†Now on active duty with the United States Army. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDietary fat and hormonal influences on lipoprotein fluidity and composition in premenopausal womenSex hormones and coronary disease: a review of the clinical studiesEffect of estradiol on low density lipoprotein uptake by bovine aortic endothelial cellsSerum estrogen levels in men with acute myocardial infarctionThe effect of oestrogen implants on high density lipoproteins and its subfractions in women in their pre-mature menopauseIntraindividual changes of blood pressure, serum lipids, and body weight in relation to menstrual status: Results from a prospective population study of women in Göteborg, SwedenAtherosclerosis in males and femalesA survey of 246 suggested coronary risk factorsEFFECT OF PENTOBARBITONE ANESTHESIA, AGE AND SEX IN THE ACUTE PHASE OF MYOCARDIAL INFARCTION IN RATSCoronary Artery Disease in Young Australian WomenRAISED PLASMA ŒSTRADIOL AND ŒSTRONE LEVELS IN YOUNG SURVIVORS OF MYOCARDIAL INFARCTIONCoronary artery disease in young women: Clinical and angiographic features and correlation with risk factorsMyocardial Infarction in Younger WomenMenopause and Risk of Cardiovascular Disease The Framingham StudyWILLIAM B. KANNEL, M.D., F.A.C.P., MARTHANA C. HJORTLAND, Ph.D., PATRICIA M. McNAMARA, TAVIA GORDONMyocardial infarction in young womenResolution of an obstructive coronary lesion as demonstrated by selective angiography in a patient with transmural myocardial infarctionMyocardial Infarction in Young Women with Normal Coronary ArteriogramsMyocardial infarction and oral contraceptive agentsBiological Properties of Estrogen SulfatesExperimental atherosclerosis and hypertensionExperimental atherosclerosis and hypertensionMyocardial Infarction—A Ten-year Experience in a Midwestern General HospitalC. T. ANASTASSIADIS, M.D., S. E. SIVERTSON, M.D.Long-term estrogen substitution and atherosclerosisEpidemiology of ischemic heart disease among white malesDas Klimakterium der FrauEffects of Long-Term Administration of Estrogens on Serum Lipids of Postmenopausal WomenEpidemiologic studies on cardiovascular-renal diseases: I. Analysis of mortality by age-race-sex-occupationDie Coronarerkrankungen. Coronarinsuffizienz, Angina pectoris und HerzinfarktEFFECTS OF SEX STEROIDS ON LIPIDSKlimakterium und innere MedizinKlimakterium und innere MedizinAcute myocardial infarction in a city hospitalESTROGEN REPLACEMENT THERAPY IN WOMEN WITH CORONARY ATHEROSCLEROSIS*ROGER W. ROBINSON, M.D., WILLIAM D. COHEN, Ph.D., NORIO HIGANO, M.D.Myocardial trauma produced by nonpenetrating chest injuryA STUDY OF MYOCARDIAL INFARCTION IN WOMEN*HERBERT L. WEINREB, M.D., ELAINE GERMAN, M.D., BENJAMIN ROSENBERG, M.D., F.A.C.P.Stable and brittle diabetesTHE MENOPAUSE AND MYOCARDIAL INFARCTION 1 July 1955Volume 43, Issue 1Page: 153-164KeywordsCoronary arteriesEstrogensHypertensionMagnesiumMenopauseMyocardial infarctionPolycythemiaStable coronary artery diseaseStenosisThrombosis ePublished: 1 December 2008 Issue Published: 1 July 1955 PDF downloadLoading ...

Evidence is set forth to show the value of continuous long-term anticoagulant therapy by comparison with a control group of patients who have also had multiple coronary occlusions or single infarcts, followed by severe angina pectoris or episodes of coronary failure. Statistical life-estimate determinations are included. Bleeding complications are encountered less frequently with improved methods of management and are considered a justifiable risk, in view of the serious consequences of the natural progress of the disease. After a program of long-term anticoagulant treatment has been instituted, cessation of therapy may be hazardous.

The diagnosis of coronary thrombosis is frequently doubtful and the electrocardiograph has been shown to be of decided assistance. Numerous cardiac irregularities have been noted which are not characteristic. The alteration of the electrocardiogram characteristic for occlusion has generally been confined to changes in the T-waves. No definite alteration of the T-waves in coronary thrombosis has been uniformly accepted by the many writers as characteristic. We have reported three cases with electrocardiograms, one having been confirmed by autopsy. In experimental investigations, where injury was produced to the ventricular muscle, Eppinger and Rothberger, Smith, and Samajloff found that the T-waves of the electrocardiogram were elevated and branched directly from the R- or S-wave. They further noted that with time this elevation of the T-wave, descended to isoelectric with a reappearance of the isoelectric R-T or S-T interval. In Samajloff's experiments he found the same change in the T-waves of the electrocardiogram due to the interference of the demarcation current between the injured area of negativity and the positively charged surface of the uninjured muscle. The published clinical curves all find their counterpart in the series of tracings obtained by these various experimenters. The experimental curves were taken by leads directly on the heart, whereas the clinical records are from arm and leg leads. This change in the electrocardiogram has been observed in acute rheumatic infections by Cohn and Swift. They consider it due to possible blood vessel involvement causing muscular injury with subsequent electrical disturbance. A characteristic electrocardiographic change appears when the coronary obstruction causes injury to the left ventricle, but is not as constant when the right ventricle is involved. The similarity of the electrocardiograms obtained by experimental injury to the ventricular muscle through various methods with electrocardiograms from clinical examples of coronary thrombosis, suggests that the acute muscular insult in both instances causes similar electrical disturbances which produce a characteristic change in the T-waves of the curves. For clinical purposes this change consisting of elevation of the T-waves which branch directly from the R or S limb may be considered as strong presumptive evidence of coronary occlusion. If this peculiar change is typical for coronary thrombosis in the human subject it is essentially more or less transient and soon is replaced by changes not characteristic.

In spite of the fact that quinidin has been widely used over a period of six years in the treatment of auricular fibrillation, there still exists a difference of opinion concerning its indications and contraindications, as well as its true value and dangers. It therefore seems worth while to add to the already existing reports of its use, so that more material may be available for determining our final opinion regarding the usefulness of this drug in complete arrhythmia. TYPES OF AURICULAR FIBRILLATION For convenience, cases of auricular fibrillation may be divided into three types: established, transient and paroxysmal. Established: In this type the abnormal rhythm has been present for more than two weeks and has shown no tendency to alternate with sinus rhythm, and the presence of the irregularity is not dependent on a transient contributory factor. Transient: This group includes the patients showing auricular fibrillation lasting from