In arriving at a diagnosis, when the question is whether or not arteriosclerosis is the main etiologic factor, the most important fact to know is the age of the patient. Other points that have been dwelt on fully must of necessity also be borne in mind.
Possibly the chief conditions that may be confused with some of the results of arteriosclerosis are pseudo angina pectoris which may be mistaken for true angina pectoris, and ulcer of the stomach, appendicitis (?) or other inflammatory abdominal condition which may be mistaken for angina abdominalis.
Differential tables are sometimes of value in fixing the chief points of difference graphically.
| Pseudo angina pectoris. | True angina pectoris. |
| Etiology rather certain; hysteria,neurasthenia, toxic agents, and reflexirritations. | Etiology not certain but almost alwaysassociated with arteriosclerosisof the coronary arteries and alsoaortic regurgitation. |
| No age is exempt. Usually inyoung people, chiefly females. | Age is important factor. Rare beforeforty, and males usually affected. |
| Paroxysms of pain occur spontaneously,are periodic and often nocturnal. | Paroxysms brought on by overexertionsor excessive mental emotion.Rarely periodic. |
| Pain, while severe, is diffuse andsensation is of distension of heart.No sense of real anguish. | Intense pain, radiating down arm;heart felt as in a vise. Sense of anguishand impending dissolution. |
| Duration may be an hour or more. | Duration from few seconds to severalminutes. |
| Restlessness and emotional symptomsof causative conditions areprominent. | Silent and fixed attitude, rigidityrather than restlessness. |
| Usually no increase in arterial tension. | Arterial tension is as a rule increased. |
| Prognosis favorable. | Prognosis most unfavorable. |
In differentiating between ulcer of the stomach and angina abdominalis the following points may be of service:
| Ulcer. | Angina abdominalis. |
| Occurs as a rule in young persons, more often females. | Only occurs in adults over forty who have been heavy eaters and drinkers, mostly males. |
| Pain of boring character increased by food and by certain positions with food in stomach. Felt through to left of spine. | Pain cramp-like, diffuse, although more localized in epigastrium. Not necessarily any connection with food. |
| Occult blood found in stools. | No occult blood in stools. |
| Considerable anemia apt to be present. | Anemia more often absent. |
| Arterial tension usually low. | Arterial tension high. (Splanchnic sclerosis.) |
Diseases in Which Arteriosclerosis Is Commonly Found
There are certain more or less chronic diseases in which arteriosclerosis is found either as a separate disease or as a result of the chronic disease itself, or the sclerosis may be the cause of the disease. As examples of the first class are diabetes mellitus and cirrhosis of the liver. As examples of the second class are chronic nephritis, gout, syphilis, and lead poisoning. Examples of the third class have already been fully described. Then certain rare diseases that have been briefly described in this chapter, viz.: Raynaud's disease and erythromelalgia are frequently associated with demonstrable arteriosclerosis.