Ischemic heart disease and diabetes
Jul 06, 2018
It has long been known that cardiovascular diseases are a scourge of our century. They are the main cause of disability and mortality in the developed countries of the world. It has also been noted for a long time that diabetes mellitus makes a significant contribution to the development of diseases of the heart and blood vessels. The defeat of coronary, cerebral and peripheral vessels is one of the main late complications in all types of diabetes mellitus. It is established that at the age of 30 to 55 years, 35% of diabetic patients die from it, while in the general population, coronary heart disease causes death in only 8% of men and 4% of women of the same age group. More information about ischemic heart disease see here.
The reason for this high prevalence of coronary sclerosis in diabetic patients is that, in addition to the usual circumstances of the risk of developing coronary disease, there are additional specific adverse factors. The development of the sclerotic process in diabetes mellitus is noted in the blood vessels of the lower limbs, heart, kidneys and the retina of the eye. If diabetes mellitus is combined with hypertension, sclerotic changes are often observed in coronary vessels feeding the heart, as well as in the vessels of the lower extremities.
Control measures and prevention of complications from the cardiovascular system in diabetes mellitus are reduced to bringing to normal or normalize disturbed metabolic processes. The food of the patients must be complete and meet the physiological needs of the body. Particular care is needed to monitor the restriction of fat in the diet and not consume it in larger quantities than the body requires. In patients with diabetes, the need for vitamins, in particular vitamin C., increases.
It is known that a certain amount of sugar( glucose) is needed to feed the heart and brain tissue. In this regard, in patients with diabetes with vascular changes( heart, brain) should not seek a rapid reduction in blood sugar and strive for the complete disappearance of sugar in the urine. Such therapeutic tactics are usually accompanied by a worsening of the heart and the phenomena of vasospasm.
In this case, rational treatment of patients with a physiological diet and in the cases shown by insulin is of great importance. Care should be taken in the appointment of insulin to patients in old age, in whom sclerotic changes are combined with hypertension. The hypoglycemic state that can result from insulin treatment is dangerous in such cases, since it can cause severe vascular reactions with unpleasant consequences.
One of the features of the course of ischemic disease in diabetics is that angina often manifests not as painful attacks, but a feeling of discomfort in the chest, shortness of breath, nausea, weakness, increased fatigue. If you have such symptoms, you need to urgently go to the cardiologist and undergo a cardiovascular examination! To date, a clear link has been established between high blood sugar levels and the development of microvascular complications of diabetes.
In diabetes mellitus, various disorders of the heart rhythm are often observed. They can develop both as a result of diabetes itself and in connection with other concomitant diseases: coronary heart disease, arterial hypertension and other causes. Some of them may progress and lead to serious complications, while others require emergency medical intervention. At the same time, heart rhythm disturbances can manifest themselves with various symptoms that a person does not always associate with arrhythmias.
Rhythm disturbances can have other clinical manifestations: palpitations, dizziness, fainting, rare heartbeat, alternation of rare and frequent heart rhythms, feelings of cardiac fading, a feeling of coma or overturning of the sternum, an increase in dyspnea.
Due to prolonged high blood sugar, neuropathy often affects the nerves of the heart. Symptoms of diabetic heart failure are as follows: sinus tachycardia even in a state of rest with a fixed heart rate of up to 90-100, and sometimes up to 130 beats per minute;absence of the influence of breathing on the heart rate( normal with a deep inspiration, the heart rate in a person is reduced).This indicates the weakening of the function of parasympathetic nerves, which reduce the heart beat frequency. This condition requires a special examination with the performance of functional tests to assess the state of nervous regulation of the heart and the preventive use of drugs that prevent the progression of neuropathy and reduce the influence of the sympathetic nervous system on the heart. Regulation of the heart is carried out by the autonomic nervous system, consisting of sympathetic and parasympathetic nerves. Parasympathetic nerves reduce the heart rate. Sympathetic nerves increase and increase the heart rate.
In diabetics, parasympathetic nerves are primarily affected, so the heart rate increases. Later, changes occur in the sympathetic department of the autonomic nervous system. The defeat of sensitive nerve fibers leads not only to tachycardia, but also to an atypical course of ischemic heart disease. There is a variant of the course of ischemic disease with a sharp easing of pain, up to the complete absence of pain( painless ischemia) and even myocardial infarction acquires a painless course. This symptom of diabetic heart damage is dangerous, because it creates the impression of imaginary well-being. If stable tachycardia occurs, you should always consult your doctor to prevent the progression of diabetic vegetative cardiac neuropathy in a timely manner.
In a later period of the disease in diabetes mellitus with diabetic autonomic neuropathy, changes in the sympathetic nervous system occur. They are characterized by signs of orthostatic hypotension - dizziness, darkening in the eyes, flashing "flies".These sensations arise with a sharp change in the position of the body, for example, with a sharp rise from the bed. They can pass independently or lead to the need to take the original position of the body. On the other hand, similar clinical manifestations, up to loss of consciousness, can occur with weakness of the sinus node, atrio-ventricular blockade, paroxysmal rhythm disturbances. Only a qualified specialist can determine the cause of the described clinical conditions, sometimes requiring rapid preventive and curative measures.
The appearance of dizziness, darkening in the eyes, fainting states requires immediate contact with a doctor.
In diabetes mellitus, atherosclerosis develops very rapidly, the incidence of myocardial infarction is very high. Given the defeat of nerve endings in diabetes mellitus, very often heart attacks occur without severe pain. At any unpleasant sensations in the field of heart it is necessary to address to the doctor and to make an electrocardiogram. In addition, you need to regularly monitor blood pressure.