Cardiac fibrosis as a result of coronary obstruction / by G. A. Gibson and Robert Muir.

  • Muir Robert, Sir, 1864-1959.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Cardiac fibrosis as a result of coronary obstruction / by G. A. Gibson and Robert Muir. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    in such cases, was the following. The large branch on the anterior wall and its branches beyond showing very slight periarteritic and endarteritic thickening at some places, were practically normal. At no place was there any distinct encroachment of their lumen, or any thrombosis. In the dense fibrous tissue, as one would expect, some of the capil- laries and small arteries were lying compressed and closed, but even there many of the arterioles had quite normal walls, with wide lumen. In short, there was no evidence of there being any primary lesion of the branches of the coronary arteries of importance in relation to the other changes. Clinical Remarks.—The most important points of clinical interest to be drawn from the study of the case which we have described, are connected with the physical signs. There is one subjective symptom, however, which must not be passed over without comment. The presence of prtecordial pain has been noted in most of the cases of this nature which have been placed on record. It was, unfortunately, impossible to trace out the exact distribution of the pain in the present instance, and we must therefore content ourselves with the simple mention of the symptom. As regards the physical signs which were observed, the first point worthy of notice is the fact that the pulse was throughout absolutely regular. In cases of cardiac failure, irregularity of the heart’s action is extremely common, and it is a matter of interest to observe that in this patient there was no approach to arhythmia. The only remaining aspect of the case requiring remark from the clinical point of view is the entire absence during life of physical signs indicating aortic regurgitation. There was nothing resembling the water-hammer pulse of aortic incom- petence, and no diastolic murmur could be heard. The reason for the absence of both phenomena is probably to be sought in. the pronounced condition of cardiac failure. Pathological Remarks.—The special points of interest pathologically in this case are the marked stenosis of the left coronary artery, the degenerative changes in the wall of the left ventricle, and the process of sclerosis in the situations described. The importance of lesions of the coronary arteries in relation to the nutrition of the heart wall has long been