PATTERNS OF PRESENTATION OF CHRONIC ISCHEMIC HEART DISEASE WITH AND WITHOUT PREVIOUS MYOCARDIAL INFARCTION
Abstract
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 cases
with and without previous myocardial infarction, in Hazara, NWFP, Pakistan to evaluate left
ventricular (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-cardiac
chest 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 or
without myocardial infarction (MI) were studied for left ventricular dysfunction (ejection
fraction, left atrial size, E/A ratio), wall motion abnormalities and complications of IHD (Mitral
regurgitation, Ventricular Septal Defect (VSD), LV aneurysm, LV clot). Clinical and
echocardiographic 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) was
45%±15 in the group without MI and 35±11% in cases with MI. Left Atrium (LA) size was
35±6 mm and 39±4 mm in the two groups respectively. LV diastolic dysfunction was seen in
17% 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) was
observed in 12% in patients without MI and in 58% cases with MI. Mitral regurgitation was
seen in 10 and 20% in the 2 groups respectively LV clots, VSD, LV and aneurysm were seen in
8.4, 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 with
previous heart attack.
Keywords: Ischemic heart disease, left ventricular dysfunction, Wall motion abnormalities, Mitral
regurgitation
References
American Heart Association, Heart disease and stroke,
Statistics 2006,-Update, Dallas; TX:, AHA, 2006. Available at:
http://www.americanheart.org/downloadable/heart/113535864
-1026_HS_Stats06book.pdf.
Kannel WB, Feinleib N. Natural history of angina pectoris in
Frammingham study. Prognosis and survival, Am J Cardiol
,29:154-63.
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
:107:149-58.
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
:4:215-33.
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
;344:1840-5.
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
;95:1686-744.
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
:49:1110-9.
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
;67:233-44.
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
;84:592-5.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
