PRESENTATIONS OF ischemic heart disease (IHD)

Angina pectoris, acute MI or death may be the First presentation of IHD. Stable Angina Pectoris

  • stable angina pectoris is chest pain due to coronary :; ischemia which is of very short duration and easily -relieved (within 5-10 minutes) by simple measures like rest.
  • Exercise testing or ambulatory monitoring shows transient ST segmen

PRESENTATIONS OF ischemic heart disease (IHD)

ischemic heart disease EPIDEMIOLOGY —


  • The epidemiology of silent ischemia may be viewed from the standpoint of two groups of patients:
  • patients with a history of myocardial infarction or angina pectoris,


IHD Common in:


  • Men – 50 to 60 yrs
  • Women – 60 to 70 years


Symptomatic patients —

  • The largest number of patients at risk of silent ischemia are those with stable angina.
  • A number of studies have evaluated the prevalence of silent ischemia in patients with prior MI and in those with angina pectoris

PRESENTATIONS OF ischemic heart disease (IHD)

Character of ischemic heart disease IHD  pain:


Presents with chest discomfort –


  • heaviness, chok­ing, smothering, pressure.
  • Frank pain may be present or only substernal discomfort.
  • Patient can localize pain only with fist – diffuse pain.
  • Pain which can be pointed with a finger is not cardiac pain.
  • Squeezing, tightening or band-like constricting pain is typical of coronary ischemia.
  • sient, fleeting, stabbing pain, pricking pain, and localized pain is rarely angina.
  • Angina may be seasonal more in winters.


ischemic heart disease Durationion:


  • 1 to 5 minutes
  • ‘Radiation to left shoulder, both arms, ulnar surface of arms and ulnar syrfaces  and hands back-of neck, jaw, teeth, epithilium occurs.
  • pitated by:
  • Angina typically occurs due to stress, z.ise, activity, emotions, fear, flight, frustration, –;e, hurry and worry.


  • Angina may be precipitated by unusual exertion, heavy meal or exposure to cold.
  • Angina at rest may occur:
  • called rest angina
  • Angina in recumbent position is called decubitus an


Nocturnal angina :


  • Angina occurring at night, like an attack of PNO Paroxysmal nocturnal , nocturnal angina.
  • hreshold for an ina the level of exertion whictLQrings on pain) varies from elsn to erson, day to day.


Diurnal variation:

  • Angina is more common early in the morning than late in the day.


Angina equivalents:

  • are symptoms of myocardial is­chemia other than pain like dyspnoea, fatigue, faint­ness. Angina equivalents are more common in the elderly.


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