Cardiovascular disease is considered to be one of the main causes of death worldwide. The most common cardiovascular disease is ischemic heart disease (IHD). The cause of IHD is coronary blood flow reduction therefore also known as “coronary heart disease”.
Incidence of IHD has been increase worldwide.  IHD symptoms and sign range from typical classic chest pain to atypical e.g., epigastric discomfort and seizure. Patients present with atypical picture been misdiagnosed, this lead in delay of providing the appropriate care and treatment which will lead to worse outcomes and even death.
In this review we are aiming to study the different clinical pictures of IHD mainly atypical presentation so patient can be treated earlier. Also, we are studying risk factors associated with IHD so can be managed as long as possible.
 

In order to preserve the constant physiology missions of the heart such as blood supplying to other oragans, adequately perfusion of tissues with oxygen.the cardiac muscle continues working like a living machaine for power production that reflected in the form of hear rate, different stages of cardiac cycle.etc [1-2].

_One of the most serious problems of modern times are cardiovascular diseases. Different studies was done in poland show increase age of population along with increase incidence of risk factors for ischemic heart disease, so ischemic heart disease is considered the most common cause of death in poland.According to the World Health Organization (WHO), the number of deaths due to ischemic heart disease will increase from  7,200, 000 in 2002 to 11, 000, 000 in 2020 (3).The incidence of angina pectoris in men between 45 and 54 increases from 2% up to 5% and in 56-74 year-olds grow from 11 to 20%. In women, they are at the level of 0.5-1% and 10-14%, respectively. After the age of 75, the frequency of diagnosing ischemic heart disease is comparable in both genders [3-4]. 

_Epidemiological studies show that the elimination of harmful risk factors such as smoking, alcohol abuse, lack of physical activity, unhealthy and irregular nutrition, stress, lack of sleep, influences the behavior of health to a greater extent than genetic factors, quality of medical care or environmental conditions [5].

_Sex differences exist in the presentation of IHD. Women less often report chest pain and diaphoresis and more often complain of back pain, jaw pain, epigastric pain, palpitations, and lightheadedness; the additional, nonspecific symptoms can mislead both patients and providers. The National Registry of Myocardial Infarction demonstrated that 42% of men vs 31% of women presented with chest pain in the setting of myocardial infarction(6)، the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) trial, the poorer 1-year outcomes among middle-aged women (age <55>

_ Age-standardized acute myocardial infarction (AMI) incidence and angina prevalence decreased globally between 1990 and 2010; ischemic heart failure prevalence increased slightly [8]. The global burden of IHD increased by 29 million disability-adjusted life-years (29% increase) between 1990 and 2010. About 32.4% of the growth in global IHD disability-adjusted life-years between 1990 and 2010 was attributable to aging of the world population. 22.1% was attributable to population growth, and the total disability-adjusted life-years were attenuated by a 25.3

The cause of ischemic heart disease (IHD) is a restricted blood flow to the heart muscle. Because coronary blood flow loss from coronary artery atherosclerosis accounts for about 95% of IHD cases, this illness is sometimes referred to as "coronary heart disease"[35].

-The study's most significant finding is that both young and old patients, particularly those with co-occurring conditions like diabetes and hypertension, frequently have unusual symptoms.The primary merit of this study is in demonstrating that unusual symptoms are frequently observed in both young and elderly patients, particularly in those with co-occurring conditions such as diabetes and hypertension.It is typical for these individuals to arrive without experiencing chest pain or with ambiguous symptoms, which can mislead clinicians and postpone the proper diagnosis. This may lead to a rise in ischemic heart disease morbidity and mortality rates [36]

-Ischemic heart disease, nonspecific chest discomfort, gastrointestinal disorders, musculoskeletal pain, and arrhythmias were the most frequently misdiagnosed initial conditions that were later shown to be AMI.Rather than an unusual presentation, misdiagnosis may be caused by improper interpretation of an ECG or by neglecting to request the necessary diagnostic testing. Hospitals with a low percentage of patients with classical chest pain who later developed AMI and those located in rural areas were more likely to overlook AMI cases (37).

-Unfortunately, misdiagnosed AMI occurs often in clinical practice. However, the number of misdiagnosed IHD may be decreased with improved training in ECG interpretation and awareness of unusual IHD presentations (37).

-Therefore, despite extensive prevention, there is a conflict between the patient's continued recommendations and the current guidelines. Effective communication between healthcare professionals and patients suffering from ischemic heart disease. coupled with an emphasis on education, serves as a fundamental assurance of therapeutic success, ultimately impacting health, social, and economic domains (35).