Diabetes Complications: Heart
The heart is a muscular pump. Diabetes can affect the heart in many ways. The coronary arteries which supply blood to the heart are rarely occluded in premenopausal women. But this advantage of being a female is lost in diabetic women. Atherosclerosis occurs earlier and faster in diabetics than in the normal. Diabetes confers same risk as that of a non-diabetic, who had an heart attack. The risk of coronary heart disease in 3-5 times higher in diabetic individuals, especially diabetic women compared to non-diabetic individuals. Coronary heart disease accounts for upto 70% deaths and 80% hospitalizations in diabetic. Death due to coronary heart disease occurs with greater frequency before the diabetic individual reaches hospital. Compared to non-diabetic, more diabetics die within one year of a heart attack. Occlusion of more than one artery and multiple blocks are common in diabetes. Besides these large blood vessels, fine blood vessels may also be affected in long standing diabetes. The heart muscle, itself may be affected; the nerves which control the heart function may also be involved in diabetes, increasing the risk of abnormal heart rhythm.
An admission to and a longer period of management in an intensive coronary care unit ( ICCU ) is essential in diabetics. The outcome is much worse in diabetics than in nondiabetics.
A reduction of the blood supply to the heart may give rise to breathlessness or discomfort or heaviness in front of the chest, or arms or jaws or shoulders, on walking or climbing stairs. These complaints disappear with rest. A part of the heart muscle may be destroyed if its blood supply is totally or drastically cut off. Such a localized destruction (infarction) of heart muscle gives rise to a severe and prolonged chest pain even at rest, sweating, breathlessness, vomiting or fainting, or sudden death. The pain may be absent or minimal in diabetics. Some drugs given for heart problems can blunt the warning signals of hypoglycaemia.
A diabetic should report to his/her doctor he/she gets breathlessness, chest pain or discomfort at rest or after accustomed exertion.
Unless contraindicated, aspirin in a dose of at least 75 mg once a day after meals, is given to diabetics, to reduce platelet stickiness and occlusion of arteries.
An electrocardiogram is an essential test in a young person with long standing diabetes or in middle aged or elderly persons with diabetes. Exercise testing that is, recording an electrocardiogram during and after exercise is useful in detecting latent coronary artery disease and in assessing its severity. With noninvasive techniques (which do not involve inserting a needle or a tube inside the body) it is possible to see the structure and the function of different parts of the heart. It is now possible to get pictures of the coronary arteries and to detect sites and the extent of their obstruction.
By passing an instrument ( angioplasty ) and putting a stent in the obstructed coronary artery, blood supply to heart is restored. The mortality and the post-procedural hospital stay is much less with coronary angioplasty, than with the more formidable and expensive coronary artery bypass graft (CABG). CABG is considered in multiple, difficult arterial blocks and in reocclusion after angioplasty.
It should be clearly understood that these procedures tackle the mechanical problem of occlusion of the coronary arteries and do not address the basic mechanism of the disease. The patient should continue to be vigilant about control of diabetes and avoiding other risk factors like consumption of tobacco and unhealthy life style after these procedures.