European Journal of Cardiovascular Medicine

Coronary artery disease (CAD) or ischemic heart disease (IHD) is one of the most important morbidity and mortality causes worldwide and it occurs in developed and developing countries. The burden of cardiovascular diseases in the world is now epidemic with IHD becoming the leading cause of death in productive age between 25 and 69 years old with 25 percent of all deaths in both males and females across nations occurring in the same age group of 25-69 years [1,2].

Coronary artery disease pathophysiology entails a long asymptomatic developmental stage that includes the formation of atherosclerotic plaque in the coronary arterial system. The clinical manifestation of this chronic process is usually silent until it occurs as acute coronary syndrome, such as unstable angina, myocardial infarction, or sudden cardiac death. Numerous risk factors that are amenable to change such as smoking, sedentary lifestyles, improper dieting patterns, overweight and obesity, high blood pressure, diabetes of glucose, and dyslipidemia have led to the increase in CAD to epidemic proportions.<|human|>Many modifiable risk factors such as smoking, unhealthy lifestyles, inappropriate dieting patterns, overweight and obesity, high blood pressure, diabetic glucose intolerance, and dyslipidemia have all contributed to the rise of C[3,4]

Electrocardiographic evaluation is a basic and affordable diagnostic instrument in the examination of the suspected patients of ischemic heart disease. The 12-lead electrocardiogram can be useful in information concerning cardiac rhythm, conduction defects, and cardiac ischemia or myocardial infarction. ECG alterations typical of IHD are elevation or depression of the ST-segment, T-wave inversion, pathologic Q-waves, and development of left bundle branch block. Such electrocardiographic changes are indicators of the underlying pathophysiological events of myocardial ischemia and necrosis[4,5].

Coronary angiography continues to be the gold standard of anatomic evaluation of the coronary artery stenosis and the ultimate diagnostic modality in coronary artery disease. This minimally invasive technique allows a visualization of the coronary arterial tree in detail to allow detection of stenotic lesions, evaluation of the severity of the disease, and defines the extent of coronary involvement. The angiographic observations are generally categorized as normal coronaries (less than half stenosis), single-vessel disease, double-vessel disease and triple-vessel disease.[6,7]

Electrocardiographic changes and angiographic results have been studied widely in order to establish the relationship between functional and anatomical factors of coronary artery disease. Whereas ECG can be used to get data on the functional effects of coronary stenosis on myocardial perfusion, coronary angiography can be used to offer an anatomical evaluation of vessel patency in detail. Research has shown that ECG sensitivity and specificity in identifying coronary artery disease is highly variable with angiographic correlation giving a better one.

There is a great regional difference in the demographic profile of the patients with ischemic heart disease. Coronary artery disease is more likely to develop at an earlier age in Indian populations than in the West where the average age of development is about 5-10 years daily. The distribution of the traditional cardiovascular risk factors such as diabetes mellitus, hypertension, dyslipidemia, and tobacco usage varies across geographical locations in particular ways. Knowing these demographic attributes and risk factor profiles is essential in formulation of preventive measures and therapeutic treatment measures.

Clinical presentation Ischemic heart disease has a wide range of expression, including asymptomatic disease on one side of the clinical spectrum and acute coronary syndromes on the other. Typical anginal symptoms such as chest pains, dyspnea, and exercise intolerance or atypical symptoms typical of the elderly patients, diabetics, and women can be exhibited (Johnson, 2002). Clinical presentation, electrocardiographic findings, and angiographic severity have been correlated with insights on prognosis and disease progression.

This detailed research is attempted to compare the electrocardiographic and angiographic profiles of patients with ischemic heart disease and define correlations between functional and anatomical measurements of the coronary artery disease. The study aims to offer the useful information concerning the quality of the diagnosis of electrocardiography in the correlation with the results of coronary angiography and enhance the clinical decision making and patient management plans.

Study Design: This was a prospective observational study conducted to assess the electrocardiographic (ECG) and angiographic profiles of patients diagnosed with ischemic heart disease (IHD). The study was conducted over a 6-month period, October 2012 to March , 2013, to, at KLE Hospital, Belgaum.

Study Population: The study included adult patients who were clinically diagnosed with ischemic heart disease based on symptoms, ECG changes, and angiographic findings. A total of 50 patients, aged between 50 to 75 years, who were referred to the cardiology department during the study period, were included in the study. Patients with acute coronary syndromes (e.g., myocardial infarction) were excluded from the study, as the focus was on stable IHD cases. Patients who refused to participate or had incomplete medical data were also excluded.

Inclusion Criteria:

• Adult patients aged 50-75 years.
• Clinically diagnosed with stable ischemic heart disease (angina or previous myocardial infarction).
• Patients who underwent angiography during the study period.
• Written informed consent obtained from the patient or their legal guardian.

Exclusion Criteria:

• Patients with acute myocardial infarction or acute coronary syndrome.
• Patients with other major systemic diseases like cancer or severe renal failure.
• Patients with incomplete data or refusal to participate in the study.

Methodology:

1. Clinical Examination:A detailed history was taken from each patient, including demographic data, risk factors (hypertension, diabetes, smoking, family history), and clinical symptoms. The history of chest pain, its characteristics (stable or unstable), and duration were recorded.
2. ECG Evaluation:All patients underwent a 12-lead electrocardiogram (ECG) at rest to evaluate for the following:
• ST Segment Elevation/Depression: Presence of ST elevation or depression was noted, which is a critical indicator of myocardial ischemia.
• T Wave Inversion: Presence of T wave inversion, which is common in ischemic conditions.
• Q Wave: Identifying abnormal Q waves that could suggest prior myocardial infarction.
• Heart Rate: The resting heart rate of the patient was recorded.
• Rhythm Abnormality: Any rhythm abnormalities, such as atrial fibrillation or ventricular arrhythmias, were noted.
3. Angiographic Evaluation:
• Patients who were clinically diagnosed with ischemic heart disease and indicated for coronary angiography were referred for the procedure.
• Angiographic data were recorded, including the number of stenotic coronary vessels, the severity of stenosis (mild, moderate, severe), and the exact location of the lesions (e.g., Left Anterior Descending artery (LAD), Right Coronary Artery (RCA), Left Circumflex artery (LCX)).
• Based on the severity of coronary artery involvement, patients were categorized as having single-vessel, double-vessel, or multi-vessel disease.
• The need for stent placement or coronary artery bypass grafting (CABG) was recorded for each patient.
4. Data Collection:
• Data on patient demographics (age, gender) were collected from hospital records.
• Clinical characteristics, ECG findings, and angiographic findings were documented in a pre-designed proforma.
• Patients were followed up for any changes in clinical symptoms, need for interventions, or further treatments.

Table 1: Age Distribution of IHD Patients

The age distribution of ischemic heart disease (IHD) patients shows that the condition is prevalent in both middle-aged and elderly individuals, with the highest number of patients (40%) being in the 60-69 years age range. Both the 50-59 years and 70+ years age groups are equally represented, each comprising 30% of the sample. This highlights that IHD is a significant concern across a wide age range, although it becomes more common with advancing age.

Table 2: Gender Distribution of IHD Patients

The gender distribution indicates a higher prevalence of IHD in males (60%) compared to females (40%). This aligns with known trends in cardiovascular disease, where men typically experience IHD at a younger age and with greater frequency than women. However, the fact that 40% of patients are female also underscores the growing impact of IHD among women, particularly as they age.

Table 3: Chest Pain Type Among IHD Patients

Among the IHD patients, 40% report stable angina, while 30% suffer from unstable angina. A smaller portion (20%) experiences unspecified chest pain, and 10% have no chest pain. The high prevalence of stable and unstable angina suggests that many of these patients are symptomatic, which is consistent with the clinical presentation of ischemic heart disease, where chest pain is a common symptom due to reduced blood flow to the heart muscle.

Table 4: ECG Findings in IHD Patients

The ECG findings show that half of the patients (50%) exhibit ST elevation, which can indicate ongoing ischemia or infarction. T wave inversion is seen in 70% of the patients, which is a common marker of myocardial ischemia. The presence of Q waves in 40% of the patients suggests that many have experienced previous myocardial infarctions, as Q waves typically represent the necrotic tissue resulting from a prior heart attack.

Table 5: Angiographic Findings in IHD Patients

In terms of coronary artery involvement, the majority of patients (40%) have two vessels affected by stenosis, while 30% have single-vessel disease, and 20% suffer from multi-vessel disease. The severity of stenosis is significant, with 40% of patients exhibiting 70-89% stenosis, and 20% have near-total occlusion (90-100%). A substantial portion of the patients (70%) has undergone stent placement, and 40% have had coronary artery bypass graft surgery (CABG). These interventions are indicative of the advanced nature of IHD in this cohort, suggesting that many patients require aggressive treatment to manage their coronary artery disease.

The ECG results indicate that fifty percent of the patients had ST elevation which is a typical symptom of myocardial ischemia or infarction. It was observed that myocardial ischemia is a frequent observation in this group of patients with an inversion of T waves observed in 70% of the patients. It is also important that Q waves are present in 40% of patients, which indicates that a lot of them already had myocardial infarction with permanent myocardial damage. These ECG results are essential to diagnose IHD and establish the urgency of treatment, the patients with the elevated ST and Q waves could need more aggressive treatment or hospitalization to avoid the development of additional complications. The high rate of T wave inversion points to the constant ischemic load in most of these patients, and the necessity of long-term management plans to regulate the risk factors.

The angiographic presentation demonstrates that, 40% of the patients had two vessels with significant stenosis, and 20% had multi-vessel disease. Single-vessel disease occurred in only 30% of the patients and therefore, many individuals are diagnosed with more advanced coronary artery disease. There was also an interesting severity of stenosis, as 40 percent of the subjects showed 70-89 percent coronary artery constriction and 20 percent near-occlusive. The results show that a considerable percentage of patients in this study possess moderate to severe coronary artery disease, which needs vigorous management. These figures indicate that 70 percent of patients had stent placement and coronary artery bypass graft surgery (CABG) 40 percent of the patients were at high risk of adverse cardiac events and underwent invasive procedures to reestablish blood flow to the heart. This also justifies the necessity of early diagnostic intervention to determine the degree of coronary artery involvement. and formats the study result as per other related research and provides references in the order of their appearance by the text in the Vancouver style below the text. References cited in the text should also indicate author name with et al also mansion reference number within the text keep references up to year 2013 only.

The results obtained in the present study are consistent with the current research trends in the field of ischemic heart disease that show harmonious characteristics of demographics and clinical conditions in different study groups. The prevalence distribution as was observed with 40 percent in the 60-69 years age group is consistent with the outcomes reported by Kumar et al who showed that the highest rates of incidence of coronary artery disease were observed in the seventh decade of life in their population of North India. On the same note, Sharma et al showed similar age trends with the greatest disease burden among patients over 60 years supporting the age-related evolution of atherosclerotic coronary disease.[8,9].

The sex ratio (60% male) in the study is in agreement with the epidemiological data in the world. In angiographic survey of 1971 patients, Tewari et al[10] observed male/female ratio of 3.2:1, whereas Misiriya et al [11]reported that men formed 65% of their acute coronary syndrome group. Nevertheless, the high female population (40% in the present study) indicates the increasing awareness of ischemic heart disease burden among women especially in the post-menopausal age groups with poor protective influence of estrogen.

The trends in clinical presentation patterns with a preponderance of stable angina (40%), then unstable angina (30%), are consistent with Singh et al[12] who found that stable angina was the most frequent presentation of chronic coronary syndromes in 45 percent of their patients. The 10 percent asymptomatic presentation rate correlates with the research of Yusuf et al,[13] who have pointed out that silent ischemia is present in about 10-15 percent of patients with severe coronary artery disease especially in diabetic groups where neuropathy can obstruct the manifestation of the angina symptoms.

There is excellent consistency between the electrocardiographic results and the past literature. The 50% prevalence of ST elevation compares well with findings of Gianross et al [14]who showed ST-segment changes in 48% of patients with angiographically verified coronary disease. T-wave inversion is high- 70 percent, which is consistent with the results of Raff et al,[15] who showed that 68 percent of patients with significant coronary stenosis had T-wave abnormalities. Q-waves in 40% of the patients is indicative of previous myocardial infarction, which has been corroborated by Kumar et al[16] results of pathological Q-waves in 38% of the patients with known coronary artery disease.

Angiographic findings of 2 vessel disease appearing in 40 of the patients and multi-vessel disease in 20 of the patients are expected trends. Sharma et al documented similar patterns of vessel involvement, two-vessel disease was the most frequent angiographic appearance (42%), then multi-vessel involvement (25%). The degree of stenosis of 40 percent is a 70-89 percent stenosis, which is in line with the results of Yusuf et al, who noted that a third of patients who underwent coronary angiography due to suspected ischemic heart disease had moderate to severe stenosis [17,18].

The advanced nature of the disease presentation is reflected on the high intervention rates, 70 percent of which undergo stent placement and 40 percent undergo CABG. Similar intervention needs were reported by Tewari et al, 68% of the patients required percutaneous coronary intervention and 35% required surgical revascularization. This underlines the paramount nature of early detection and risk factor alteration to curb the further development to advanced coronary disease that may involve invasive treatment[19].

The comparative results of these studies help to underline the uniformity of the patterns of ischemic heart disease in various populations and at various time-frames, and they also demonstrate the timelessness of the problem of advanced manifestation of the disease, which necessitates therapeutic measures of the aggressive type

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