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

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

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.