[Clinical features of ischemic heart disease and modes of subjective perception of illness].

The sample included 91 inpatients with different clinical forms of ischemic heart disease (IHD) and modes of subjective perception of illness (subjective meaning of illness). Prichard's Reaction to Illness Questionnaire, Hospital Anxiety and Depressive Scale, Rotter's Internal-External Control Scale and Illness Locus of Control Scale (Bevz I.A.,1998) were used on day 14 after admission for qualification of the patient's subjective perception of illness. The following clinical predictors of hypernosognia (inadequately high subjective significance of illness) were revealed: 1) the onset of IHD in midlife (<65 years) with its subsequent fast progression including high incidence of recurrent coronary events and/or congestive heart failure, 2) "typical" and protracted angina pectoris, 3) cardiac arrhythmias accompanying persistent high heart rate (sinus tachycardia, chronic atrial fibrillation, frequent extrasystoles) and defying any self-care, and 4) severe heart failure. On the other hand clinical predictors of hyponosognosia (inadequately low subjective significance of illness) included 1) the onset of IHD in elderly individuals (>65 years) and its subsequent slow progression without recurrent coronary events and/or congestive heart failure, 2) the socalled "anginal syndrome" (lack of angina's coupling with psychical exertion, atypical pain location, inconstant efficiency of nitroglycerin) and silent myocardial ischemia, 3) the paroxysmal cardiac arrhythmias (infrequent extrasystoles, paroxysmal atrial fibrillation, supraventricular tachyarrhythmias) with normal or slow heart rate between the paroxysms and high efficiency of self-care, and 4) mild to moderate heart failure. The findings are discussed in terms of prediction of specific modes of subjective perception of illness and its practical implications for correction of patient's attitude to his/her disease, correction of non-compliance, optimization of therapeutical alliance and use of heart care resources.