Coronary Dilator Drugs

DR. LLOY1) HEFNER: This conference on coronary vasodilator drugs is best begun by presentation of a patient, a 59-year old white male semi-retired lumber dealer. He was first admitted to the University Hospital oIn September 28, 1955, complaining of chest pain. He had been entirely well until 3 months prior to admission, when after carrying a heavy suitcase about 23 yards, he noted an aching pain in the left side of the neck and a sensation of pressure ill the substernal area. Movement of the arms, thorax, or neck had no influence onl the pain. There was no associated feeling of dyspnea, faintness, weakness, palpitation, or belching. The painl disappeared within 2 mill. after he sat down. Since that time, he has had numerous similar attacks varying only inl severity and duration. The pains were precipitated usually by exertion or excitement and relieved by rest and by nitroglycerin. Two episodes of pain occurred at night, each following a nightmare. Two attacks of pain stood out as more severe than the rest. Each struck about 30 milm. after the noon meal while at rest, and lasted about 20 mill., requiring injections for relief. The first of these occurred 1 week after his first attack. At this time nitroglycerin tablets were prescribed and he was advised to restrict physical activity. The second episode appeared 2 weeks later. At this point, he was confined to bed for a period of 1 month, during which time he was free of chest pain. For the 1 month immediately preceding admission he