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Published on: April 25, 2014
Patterns of presentation of chronic ischemic heart disease with and without previous myocardial infarction
Rehan Ahmad1, Aftab Rabbani, Zahid Aslam Awan
1Department of Medicine, Ayub Medical College, Abbottabad, Pakistan. reehhan@hotmail.com
Insights
Chronic ischemic heart disease (IHD) patients with a prior myocardial infarction (MI) showed increased left ventricular (LV) dysfunction and wall motion abnormalities. These findings highlight the significant impact of previous heart attacks on cardiac health.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Echocardiography
Background:
- Ischemic Heart Disease (IHD) prevalence is increasing due to longer lifespans and improved medical care.
- Chronic IHD cases in Hazara, Pakistan, were analyzed to understand left ventricular (LV) dysfunction and complications.
- The study focused on differentiating outcomes in patients with and without a history of myocardial infarction (MI).
Purpose of the Study:
- To evaluate left ventricular (LV) dysfunction in chronic IHD patients.
- To assess wall motion abnormalities in patients with and without previous MI.
- To identify the complications of IHD, comparing those with and without a history of MI.
Main Methods:
- 183 chronic IHD patients were studied from June 2004 to May 2005.
- Exclusion criteria included non-cardiac chest pain, acute MI, unstable angina, and other heart conditions.
- Echocardiography assessed LV function (ejection fraction, LA size, E/A ratio), wall motion, and complications like mitral regurgitation and LV clots.
Main Results:
- Patients with previous MI (n=60) had lower ejection fraction (35% vs 45%) and larger LA size (39mm vs 35mm) compared to those without (n=123).
- Regional Wall Motion Abnormality (RWMA) was significantly higher in patients with prior MI (58% vs 12%).
- Complications such as mitral regurgitation (20% vs 10%), LV clots, VSD, and LV aneurysm were more prevalent in the previous MI group.
Conclusions:
- Previous myocardial infarction is associated with increased left ventricular dysfunction.
- Patients with a history of heart attack exhibit more significant wall motion abnormalities.
- Mitral regurgitation and other severe LV complications are more common in IHD patients with a prior MI.
Background:
The prevalence of Ischemic Heart Disease (IHD) is on the rise, from increasing lifespan 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 Abrormality (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.
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