Purpose: The objective of the study is to determine the direct cost of treatment of ischemic heart disease patient in tertiary care hospital in Karachi. Methods: This is a retrospective cost of illness study conducted in tertiary care hospital in Karachi between May 2015 to October 2015. All patients were included in the study diagnosed with IHD during admission at hospital between a period of August 2014 to June 2015. The research study conducted in a 100 beds tertiary care hospital attached with a medical university located in Karachi. All in patients were included in the study with an age group of (>18 years old) who were diagnosed, or suffered from IHD (Ischemic heart disease) (with respect to the patient file) were included in the study. Over all we evaluated 700 files of cardiovascular disease patients from which we separated the IHD patients’ files. From separated IHD files we selected the most relevant 75 IHD patient files. Patient clinical information were obtained from the patients ‘medical file, and added with the unit cost of services to determine expense. Results: Overall most relevant 75 patient files were selected for the study purpose from the 700 files of cardiovascular disease patients’ files. Most of the patients were male, aged from 30 to 85 years. Co morbidity was found in 60 (80%) patients, a single co morbid condition consist of 26 (43.3%) patients and two or more consist of 31(51.6%) patients. Hypertension and diabetes were most commonly found co morbid condition in ischemic heart disease patients. Chest pain, Shortness of breath were the most commonly symptoms found in ischemic heart disease patients. Most commonly prescribed medication were aspirin 77 (61.60%), clopidogrel 73 (58.40%), nitro-glycerine 35 (28%), Enoxaparin 38 (30.40%) and Atorvastatin 41 (32.80%). The mean total direct cost was Rs. 359975. The cost component included were length of stay cost Rs. 27697; laboratory and diagnosis cost Rs. 37684; medication cost Rs. 21019 and surgical procedure cost Rs. 273574. The percentage of the total expense according to the each component was as follows: length of stay expense (7.69%), laboratory and diagnosis cost (10.47%), hospital stay cost (7.69%), surgical procedures (75.99%). Surgical procedure was main component of cost of treatment of Ischemic heart disease patients. The median hospital stay was 2 days in ischemic heart disease patients. Conclusion: IHD is associated with high economic burden on society. Among different component of direct cost of treatment of IHD, surgical procedure was the main component of cost of treatment of ischemic heart disease patients.