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On being admitted to the in-patient department the patient complained of pain in the chest.

He had been suffering from pain of various intensity in the chest and behind the breastbone for several weeks. The patient noted the pain to radiate to the left shoulder and down the arm. The patient also observed the pain have been growing worse on moving and on physical exertion. He stated that it frequently began suddenly at night during sleep.

During the attacks of pain he was covered with cold perspiration and his face was pale. The incidence of attacks was frequently associated with physical and mental overstrain.

On physical examination the doctor revealed areas of very sensitive skin from the 7th cervical vertebra to the 5th upper thoracic one. On percussion, palpation and auscultation of the heart no significant abnormality was revealed.

The electrocardiogram taken during the attack showed a disturbance in the coronary blood circulation. The most important readings of the electrocardiogram were either diminished or deviated. By having repeated the electrocardiogram after the end of the attack the cardiologist found the adequate readings of the electrocardiogram to return to normal ones.

During the attacks of moderate pain no changes in the peripheral blood or elevation of body temperature were noted. However the temperature rose insignificantly and there was an accompanying slight leucocytosis when the attacks of pain were particularly severe.

The doctor made the diagnosis of angina pectoris with a severe course. Its main cause was atherosclerosis of the coronary arteries.

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