1. Symptoms Of Ischemic Heart Disease F.Nikaeen MD, Interventional Cardiologist Shariaty Hospital

2. References:

5. Symptoms Of Ischemic Heart Disease  Acute setting (Acute coronary syndromes)  Chronic (stable Setting):Stable Ischemic Heart Disease

6. Acute 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 departmentacute coronary syndromeemergency department

8. Symptoms Of Ischemic Heart Disease Angina Anginal Equivalents Heart failure

9. 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

10. Anginal pain caused by cardiac ischemia  Typically lasts minutes.  The location is usually substernal,  Pain can radiate to the neck, jaw, epigastrium, or arm s  Angina is often precipitated by e xertion or e motional stress and relieved by rest.  Sublingual nitroglycerin also usually relieves angina, within 30 seconds to several minutes  Pain 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.

11. 10/24/2015F.NIKAEEN.M.D.11

15. In ACS  Prolonged pain is observed in 80% of patients  De 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

16.  Nausea,  Vomiting,  Mid epigastric discomfort,  Sharp chest pain * 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

17. 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.

20. Anginal Equivalents  Shortness 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

21. Anginal 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

22. Anginal 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,….

23. Special 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.