[Rational diagnosis of coronary heart disease].

Despite all preventive efforts the coronary heart disease also furthermore is of great health-political importance with regard to frequency and as pre-stage of the myocardial infarction. The early stage of the coronary heart disease up to now cannot be diagnosed, but the cases in question are always already manifest morphological changes of the coronary vessels. Alone by an exact anamnesis concerning the evocation and enlargement of the angina pectoris by physical, psychic or thermic stress and its reactivity to nitroglycerin already the most important diagnostic information is to be obtained. It is confirmed by the ECG, in which case the decisive evidence mostly appears under ergometry in form of the horizontal or descending decrease of the ST-interval. This examination should possibly be performed without medication and under exertion. The sensitiveness of circa 70% is increased to 90%, when a simultaneous angina pectoris is present. For the most patients with coronary heart disease thus already the non-invasive diagnostic process has finished, particularly then, when only a medicamentous therapy is planned. The other clinical, radiological and laboratory examinations as well as the echo-cardiography are without any decisive diagnostic value for the coronary heart disease. They above all serve for the recognition of risk factors and the exclusion of other diseases. The biphasic 201-thallium myocardial scintigraphy is not necessary in an unequivocal anamnesis and ECG-findings, but only when taking into consideration the high expenses in atypical complaints, non-evaluable ECG and in asymptomatic patients with positive electrocardiogram after work.(ABSTRACT TRUNCATED AT 250 WORDS)