Symptoms Of Ischemic Heart Disease

Symptoms Of Ischemic Heart Disease

F.Nikaeen MD,F.Nikaeen MD,

Interventional CardiologistInterventional Cardiologist

Shariaty HospitalShariaty Hospital

References:References:

References:References:

Symptoms Of Ischemic Heart DiseaseSymptoms Of Ischemic Heart Disease

Acute setting (Acute coronary syndromes)

Chronic (stable Setting):Stable Ischemic Heart Disease

Acute Vs ChronicAcute Vs Chronic

• In "stable" angina, chest pain with typical features occurring at predictable levels of exertion

• Diagnosis of acute coronary syndrome generally takes place in the emergency department

Symptoms Of Ischemic Heart DiseaseSymptoms Of Ischemic Heart Disease

• Angina• Anginal Equivalents• Heart failure

HX :Anginal pain HX :Anginal pain

Adjectives often used to describe anginal pain include :“squeezing,” “grip-like,” “suffocating,” “heavy,” tightness, pressure, discomfort , ”a band across the chest” and “a weight in the center of the chest” It is rarely sharp ,stabbing or frank pain Typically it does not vary with position or respiration. On occasion the patient might demonstrate Levine’s sign

Anginal pain caused by cardiac ischemia Anginal pain caused by cardiac ischemiaTypically lasts minutes.The location is usually substernal, Pain can radiate to the neck, jaw, epigastrium, or armsAngina is often precipitated by exertion or emotional stress and relieved

by rest.Sublingual nitroglycerin also usually relieves angina, within 30 seconds

to several minutesPain above the mandible, below the epigastrium, or localized to a small

area over the left lateral chest wall is rarely angina. Pain reproduced by pressure on the chest wall suggests a

musculoskeletal etiology but does not eliminate the possibility of angina due to IHD.

04/20/23 F.NIKAEEN .M.D. 11

In ACSIn ACSProlonged pain is observed in 80% of patientsDe novo or accelerated angina is observed in 20%Atypical presentations are not uncommon & include epigastric

pain, indigestion, stabbing chest pain, pleuritic chest pain, or increasing dyspnea.

Atypical complaints are more often observed in

1)Elderly >75 years

2)women

3)diabetics

4)chronic renal failure

5)dementia

Nausea, Vomiting,Mid epigastric discomfort,Sharp chest pain

*women and the elderly, can present with atypical symptoms such as :*women and the elderly, can present with atypical symptoms such as :

*In the WISE (Women’s Ischemic Syndrome Evaluation) study,75% of women with ischemia presented with atypical symptoms

AMI Chest pain (Gender differences) AMI Chest pain (Gender differences)

Women suffering from acute myocardial infarction have been reported to have pain more frequently in the back, in the neck, and in the jaw

symptoms such as nausea, vomiting and dyspnea are more frequent in Women with acute MI whereas sweating is more frequent in men.

Anginal EquivalentsAnginal EquivalentsShortness of breath Dyspnea Discomfort limited to areas (that are ordinarily sites of

secondary radiation) such as the ulnar aspect of the left arm and forearm, lower jaw, teeth, neck, or shoulders,

Development of gas and belching, nausea, “indigestion,” Dizziness, and diaphoresis.Anginal equivalents above the mandible or below the

umbilicus are quite uncommon

Anginal EquivalentsAnginal Equivalents

Elderly patients, especially women with ACS, often present with atypical angina

Symptoms with a clear relationship to exertion or stress or are relieved promptly with TNG

"anginal equivalents" that occur at rest may be difficult to recognize the cardiac origin

Anginal EquivalentsAnginal Equivalents

No chest discomfort but present solely with jaw, neck, ear, arm, or epigastric discomfort

Isolated unexplained new-onset or worsened exertional dyspnea is the most common anginal equivalent symptom

Other presentations : Nausea and vomiting, diaphoresis, and unexplained fatigue ,Syncope,….

Special groups need special attentionSpecial groups need special attention

Diabetic patients may have atypical presentations due to autonomic dysfunction.

Elderly patients may have atypical symptoms such as generalized weakness, stroke, syncope, or a change in mental status.

Women may present more frequently than men with atypical chest pain and symptoms.