We generally believe ischemia and it’s clinical counterpart angina would go together .It is not true .Most patients with ischemic cardiomyopathy do not have any significant angina in spite of having one or more critically narrowed coronary arteries.
The reasons could be many ,
- Little viable tissue to generate Ischemia.
- Less contractile elements and less MVO2 consumption.
- Severe LV dysfunction makes these patients adopt a very restrictive lifestyle.
- Loss of nerve fibers along with myocyte necrosis and apoptosis.
- Post CABG patients often have no angina due to denervation..
The benefits of revascularisation in ischemic DCM is not clear. As the cardiomyopathy progresses , intensity of angina regresses and dyspnea dominates .Presence of angina makes the decision to revascularise easy .To consider dyspnea as an anginal equivalent in ischemic DCM and advising revascularisation can not be justified .