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The primary problem is lack of microcirculation to the tissue, which is usually due to deposits narrowing the interior diameter of the blood vessel. Under normal cirsumstances the heart recieves enough oxygen, but under stress (exercise) the oxygen demands increase and the plumbing is not up to the job.
IIschemia means the tissue is not properly oxygenated, and generally there is some necrotic tissue, which may vary in surface area. Generally this diagnosis is obtained from observing the ST segment on the EKG, which will be abnormal (depressed).
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