ATYPICAL AND UNUSUAL CLINICAL PRESENTATIONS OF PATIENTS WITH ISCHEMIC HEART DISEASE
Hanumanth K. Reddy, M.D., St. Louis University Medical School, St. Louis, Missouri, USA
Ischemic heart disease is the leading cause of death worldwide accounting for 7 million deaths annually. Chest pain is the cardinal symptom in patients with ischemic heart disease (IHD). This symptom also serves as a trigger for prompt investigation and treatment measures. However, up to 40 percent of patients with atypical symptoms seek medical attention and pose numerous missed opportunities for the best care. These atypical and unusual symptoms in IHD patients include fatigue, dyspnea, diaphoresis, nausea, vomiting, dizziness, vertigo, interscapular and epigastric pain. These atypical symptoms are more common in the elderly, diabetic and female patients.Myocardial infarction patients presenting with atypical symptoms may not receive prompt EKG and reperfusion treatment thereby leading to higher mortality and morbidity in this group of patients. These IHD patients with atypical presentation have not been studied adequately. One study has showed a 2 fold increase of in-hospital mortality in myocardial infarction patients with atypical symptoms. As people age, diabetes and hypertension becoming more prevalent, we would expect to see far greater number of IHD patients with atypical and unusual presentations. Therefore, a high index of suspicion for MI is essential in these patients presenting with unusual symptoms to avoid excess mortality and morbidity. There has been an ongoing research exploring newer techniques of detecting the pre-myocardial infarction state in high risk patients.