• Rehan Ahmad
  • Aftab Rabbani
  • Zahid Aslam Awan


Background: The prevalence of Ischemic Heart Disease (IHD) is on the rise, from increasinglifespan of population and availability of better medical facilities. We studied chronic IHD caseswith and without previous myocardial infarction, in Hazara, NWFP, Pakistan to evaluate leftventricular (LV) dysfunction, wall motion abnormalities and complications of IHD. Methods:All patients presenting with history of chest pain in Medical ‘C’ Unit, Ayub Teaching Hospital,Abbottabad from June 2004 to May 2005 were included in the study. Patients with non-cardiacchest pain were excluded from the study. Cases with congenital and rheumatic heart disease,cardiomyopathies, unstable angina and acute MI were excluded. Patients with IHD with orwithout myocardial infarction (MI) were studied for left ventricular dysfunction (ejectionfraction, left atrial size, E/A ratio), wall motion abnormalities and complications of IHD (Mitralregurgitation, Ventricular Septal Defect (VSD), LV aneurysm, LV clot). Clinical andechocardiographic evaluation was done in each case. Results: Out of 183 cases of chronic IHD,123 patients were without previous MI and 60 had had previous MI. Ejection fraction (EF) was45%±15 in the group without MI and 35±11% in cases with MI. Left Atrium (LA) size was35±6 mm and 39±4 mm in the two groups respectively. LV diastolic dysfunction was seen in17% in the first and 24% in the second group respectively. Global hypokinesia was seen in 8%and 17% in the 2 groups respectively. Regional Wall Motion Abnormality (RWMA) wasobserved in 12% in patients without MI and in 58% cases with MI. Mitral regurgitation wasseen in 10 and 20% in the 2 groups respectively LV clots, VSD, LV and aneurysm were seen in8.4, 5, and 6.5% respectively, only in cases with previous MI. Conclusion: LV dysfunction,wall motion abnormalities and mitral regurgitation were more common in IHD cases withprevious heart attack.Keywords: Ischemic heart disease, left ventricular dysfunction, Wall motion abnormalities, Mitralregurgitation


American Heart Association, Heart disease and stroke,

Statistics 2006,-Update, Dallas; TX:, AHA, 2006. Available at:


Kannel WB, Feinleib N. Natural history of angina pectoris in

Frammingham study. Prognosis and survival, Am J Cardiol


Acampa W, Petretta M, Cuocolo A. Nuclear medicine

procedure in Cardiovascular diseases: An vidence based

approach. Q J Nucl Med 2002;40: 323–30.

Mock MB, Ringquist I, Fisher LD, Davis KB, Chaitman BR,

Kouchoukos NT, et al. Survival of medically treated patients in

CASS registry. Circulation 1982;66:562–8.

Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC,

Douglas JS, et al. ACC/AHA-2002 Guidelines update for

management of patients with chronic stable angina. Circulation


Finkelho RS, Sun JP. Predicting Left ventricular failure after

MI. A preliminary study of echocardiographic measurements

of LV filling and wall motion. Am J Soc Echocardiogr


de Zwaan C, Cheriex EC, Braat SH, Stappers JL, Wellens HJ.

Improvement of systolic and diastolic left ventricular wall

motion by serial echocardiograms in selected patients treated

for unstable angina. Am Heart J 1991;121:789–97.

Lee TH , Boucher CA., Clinical practice. Noninvasive tests in

patients with stable coronary artery disease. N Engl J Med


Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP,

Beller GA, Bierman FZ, et al. ACC/AHA Guidelines for the

Clinical Application of Echocardiography. A report of the

American College of Cardiology/American Heart Association

Task Force on Practice Guidelines (Committee on Clinical

Application of Echocardiography). Developed in collaboration

with the American Society of Echocardiography. Circulation


Gibson RS, Bishop HL, Stamm RB, Crampton RS, Beller GA,

Martin RP. Value of early two dimensional echocardiography

in patients with acute myocardial infarction. Am J Cardiol


Macedo F, Martins L, Maciel MJ, Gonçalves R, Ramalhão C,

Van Zeller P, et al. Evaluation of left ventricular function after

acute myocardial infarction. Two-dimensional

echocardiography versus radionuclide angiography. Study of

patients. Acta Cardiol 1991;46:39–42.

Stanum RB, Gibson RS. Echocardiographic detection of infarct

localizes synergy during acute myocardial infarction

Correlation with extent of angiographic disease. Circulation


Shen Z, Palma A, Prediction of single and multiple CAD in

patients after myocardial infarction according to quantitative

ultrasound wall motion analysis. Am Heart J 1993;125:949–57.

Feigenbaum, Willium F Armstrong. Coronary artery disease.

In: Feigenbaum Echocardiography 6th Ed. Philedelphia:

Lippincott Williums & Wilkins; 2005.p.437–48,

Buda A. The role of echocardiography in evaluation of

Mechanical complications of acute myocardial infarction.

Circulation 1991;84(3 Suppl):I109–21.

Stratton JR, Lighty GW, Pearlman AS, Ritchie JL. Detection of

left ventricular thrombus by two-dimensional

echocardiography: sensitivity, specificity and causes of

uncertainty. Circulation 1982;66:156–66.

Prieto A, Eisenberg J, Thakur RK. Nonarrhythmic

complications of acute myocardial infarction. Emerg Med Clin

North Am 2001;19:397–415.

Yeo TC, Malouf JF, Reeder GS, Oh JK. Clinical characteristics

and outcome in postinfarction pseudoaneurysm. Am J Cardiol




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