The Intermediate Coronary Syndrome

¹ Associate Clinical Professor of Medicine, University of Southern California School of Medicine

1. Forty-seven patients with the intermediate coronary artery syndrome have been etiologically divided into six subgroups, depending upon the presence or absence of heart disease, and the precipitating factors. Each subclassification varies in course, prognosis, therapy and significance.

2. Although etiologically diverse, certain basic electrocardiographic criteria define the entire group. There are two patterns, both more frequent over the anterior and lateral surface of the heart; (a) the more frequent T wave inversion, and (b) the less frequent ST and J point depression with lowered T wave. Anterior ST and J point depression is usually accompanied by elevation of ST in AVR. Continuous cyclic progression and regression is the rule over a time period of ten days to two weeks.

3. The prognosis is impossible to ascertain at the start of the attack. It depends largely upon the underlying heart disease, and the SGO-T is almost always within the normal range.

4. Because of the difficulties in prognosis and the frequency of underlying serious heart disease, early and long-term anticoagulant therapy should be considered the therapy of choice at this time.