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March 2, 1957


JAMA. 1957;163(9):727-731. doi:10.1001/jama.1957.02970440023007

• Seven patients with severe coronary heart disease, old myocardial infarction, and angina pectoris ingested a fatty meal with heavy cream for the purpose of inducing acute anginal attacks. Nineteen attacks were induced in this way after latent periods ranging from five to five and a half hours. Within 15 minutes after the onset of pain the patient received an intravenous injection of a solution either of sodium chloride or of heparin (5 to 25 mg.). The patients did not know which substance they were receiving. The sodium chloride did not afford subjective relief in any of the four cases in which it was used, and it had to be followed, by an intravenous injection of heparin to terminate the attack. The heparin afforded subjective relief within 10 minutes in 14 of the 15 cases in which it was given. Glyceryl trinitrate afforded prompt subjective relief in four other attacks similarly induced. Objective evidence of relief was seen in ballistocardiograms, electrocardiograms, and pneumograms. Studies of the blood showed that the heparin abated the postprandial lipemia as measured by the turbidity of the plasma, the concentration of neutral fat in the serum, and the paper electrophoretic lipoprotein patterns. It is recommended that dietary fat restriction, with or without administration of an antilipemic agent, be considered in the management of patients of this type.