Cardiovascular
complications of
Diabetes Mellitus
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By Ali Zoraiz, Ahmad Toqeer, Aawaiz Ahmad and Attib ur Rehman
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Prevalence of diabetes and it’s major
complications
1. Diabetes Is a chronic metabolic disorder characterized by high levels of
sugar (glucose) in the blood.
2. According to the International Diabetes Federation (IDF), approximately 463
million adults (aged 20-79 years) were living with diabetes worldwide in
Today. This number is expected to rise to 700 million by 2045 if current
trends continue.
3. Hyperglycemia causes lots of complications ranging from eye complications
to Kidney problems. Vascular complications such as Coronary Artery disease
due to atherosclerosis is leading cause of death in Diabetic patients .
4. Other cardiovascular problems include MI, Stroke and Peripheral artery
disease
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Coronary Artery disease
Coronary artery disease (CAD) is a prevalent and serious
condition characterized by the narrowing or blockage of the
coronary arteries, which supply oxygen-rich blood to the heart
muscle. CAD is primarily caused by atherosclerosis, a process
where plaque builds up inside the artery walls, leading to
reduced blood flow to the heart. This condition can result in
various complications, including angina (chest pain), myocardial
infarction (heart attack), and heart failure. Understanding the
pathophysiology of CAD is essential for developing effective
prevention and treatment strategies to mitigate its impact on
cardiovascular health.
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Patient
Presentation
Patient with coronary artery disease (CAD) may present with:
Angina Pectoris:Chest pain or discomfort, often described as
pressure or squeezing.Can radiate to the arms, shoulders, neck,
jaw, or back.Triggered by exertion or emotional stress, relieved
by rest or nitroglycerin
Shortness of Breath:Difficulty breathing, especially during
physical activity.May be accompanied by fatigue or weakness.
Other Symptoms:Nausea, vomiting, or indigestion.Sweating,
dizziness, or lightheadedness.Palpitations or anxiety.
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Chest pain
Clinical assessment
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History Taking: Obtain detailed medical history and assess CAD risk factors.
Vital Signs: Measure blood pressure, heart rate, respiratory rate, and temperature.
General Inspection: Observe overall appearance and signs of distress.
Cardiovascular Examination: Palpate chest for tenderness, listen for abnormal heart
sounds, and assess for signs of heart failure
Respiratory Examination: Check lungs for congestion or fluid accumulation
Peripheral Examination: Assess extremities for signs of vascular disease and
neuropathy
Skin Examination: Look for xanthomas or xanthelasmas indicating dyslipidemia
Abdominal Examination: Palpate for signs of organ enlargement or fluid accumulation
Neurological Examination: Assess mental status and signs of neuropathy.
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Investigations
Electrocardiogram (ECG): Records heart’s electrical activity at rest.
Echocardiogram: Ultrasound imaging of heart’s structure and function.
Coronary Angiography: X-ray imaging to visualize coronary arteries and
identify blockages.
Cardiac CT Angiography (CTA): Non-invasive imaging to visualize coronary
artery anatomy.
Myocardial Perfusion Imaging: Assess blood flow to the heart muscle.
Blood Tests: Assess cardiac enzymes, biomarkers, and lipid profile.
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Management via lifestyle modifications
Lifestyle Modifications
Healthy Diet: Encourage a diet rich in fruits, vegetables, whole grains, lean
proteins, and healthy fats. Limit saturated fats, trans fats, cholesterol,
sodium, and added sugars
Regular Exercise: Recommend at least 150 minutes of moderate-intensity
aerobic exercise or 75 minutes of vigorous-intensity exercise per week, as
tolerated
Smoking Cessation: Provide smoking cessation support and counseling to
patients who smoke
Weight Management: Encourage weight loss in overweight or obese
individuals to achieve and maintain a healthy body weight.
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Management via medication
Antiplatelet Therapy: Prescribe aspirin or other antiplatelet medications to
reduce the risk of blood clot formation and prevent heart attacks
Statins: Initiate statin therapy to lower cholesterol levels and reduce the risk of
cardiovascular events
Beta-Blockers: Use beta-blockers to reduce heart rate, blood pressure, and
myocardial oxygen demand
ACE Inhibitors or ARBs: Consider prescribing angiotensin-converting enzyme
(ACE) inhibitors or angiotensin receptor blockers (ARBs) for patients with heart
failure, hypertension, or diabetes
Nitrates: Use nitrates to relieve angina symptoms and improve exercise
tolerance.
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Management via surgery
Revascularization Procedures
Percutaneous Coronary Intervention (PCI): Perform PCI with
balloon angioplasty and stent placement to open narrowed or
blocked coronary arteries
Coronary Artery Bypass Grafting (CABG): Consider CABG
surgery for patients with complex CAD or significant coronary
artery blockages not amenable to PCI.
z Coronary artery bypass grafting
