Coronary heart disease in the presence of pulmonary disease.

In the course pf our studies of pulmonary heart disease we have been impressed by the frequent co-existence of coronary heart disease noted at necropsy but less frequently recognized during life. Pulmonary disease even before the advent of heart failure, was readily recognized by its symptoms of dyspncea and cough and by its radiological signs. The co-existent coronary heart disease was often symptomless, or if pain was present it required differentiating from pleuropulmonary pain. Radiology was able to help only by showing an enlarged left ventricle in some of the cases. It seemed that electrocardiography would be the best examination to reveal the presence of the coronary heart disease with pulmonary disease, but consideration of the electrocardiographic signs of both conditions immediately revealed difficulties of interpretation. Such difficulties are exemplified in Fig. 1, 2, and 3. The patient whose electrocardiogram is shown in Fig. 1 had pure pulmonary heart disease which, in the space of three years, had produced