Today is the last of the twenty-four solar terms, "Great Cold", which also means that the weather is extremely cold. At the same time, in recent times, more and more patients with cardiovascular diseases have been treated in the ward, including acute myocardial infarction, acute hypertension, arrhythmias, etc., and it has been found that nearly 50% of these patients are accompanied by metabolic disorders such as diabetes. Why are so many cardiovascular patients with diabetes?
Twenty years ago, the American Heart Association (AHA) proposed that "diabetes is a cardiovascular disease." Diabetes has been officially listed as a major risk factor for coronary heart disease, alongside dyslipidemia, hypertension, smoking, etc. And elevated to the concept that diabetes is an equally critical condition of coronary heart disease, it means that "patients with diabetes without coronary heart disease" and "patients with coronary heart disease without diabetes" have the same risk of coronary heart disease, that is, within 10 years, diabetics and patients with coronary heart disease have the same risk of new cardiovascular events (such as myocardial infarction or death from coronary heart disease).
More broadly, diabetic heart disease ("diabetic heart disease") is a lesion of the large blood vessels, microvascular, myocardium and nerve fibers of the heart that occurs on the basis of diabetes. There are 3 common clinical manifestations, each with different manifestations.
(1) Diabetic coronary heart disease
Coronary heart disease is the most common type of "sugar heart disease", accounting for about 80% of the incidence of "sugar heart disease". Features include:
1. Early age of onset and high prevalence.
According to statistics, the age of diabetic patients with coronary heart disease is 5 years earlier than that of non-diabetics, and the probability of coronary heart disease in diabetic patients is 2 to 4 times higher than that of non-diabetic patients.
2. Symptoms are atypical, painless angina and myocardial infarction are more common.
Although many "sugar friends" show that myocardial ischemia is very serious, they often have no self-conscious symptoms or only appear as dizziness or fatigue, even if acute myocardial infarction occurs, there is no obvious chest pain, or heart failure, shock or arrhythmia as a prominent manifestation, therefore, it is easy to be missed or misdiagnosed, thereby delaying the condition. This may be related to damage to the patient's sensory nerves.
3. Severe lesions and poor prognosis.
Diabetic coronary heart disease often has multiple or multi-segment coronary artery involvement, higher degree of vascular stenosis, poor thrombolytic effect, difficult treatment, rapid progression, higher recurrence rate and mortality rate of myocardial infarction, and a worse prognosis than non-diabetic people.
4. Prone to sudden death.
Patients with diabetic heart disease can cause sudden death under various stresses, infections, or surgical anesthesia. Clinically, it is a severe arrhythmia or cardiogenic shock, with a sudden onset, and some patients can quickly develop into severe shock or coma after brief chest tightness and palpitations.
(2) Diabetic cardiomyopathy
Diabetic cardiomyopathy is a specific lesion of diabetes. Early patients have no obvious symptoms in the resting state, and after exertion, symptoms such as chest tightness, shortness of breath or palpitations may occur, and 75% of patients have different degrees of left cardiac insufficiency; in advanced patients, self-conscious symptoms and cardiac insufficiency are further aggravated, manifested by chest tightness or dyspnea, and cannot lie flat. ECG is normal or has nonspecific ST-T changes, and ultrasound ecG shows enlarged heart and cardiac insufficiency, and negative coronary angiography (this is different from coronary heart disease). Endocardial biopsy may reveal characteristic microvascular lesions and/or interstitial lesions.
(3) Diabetic cardiac autonomic neuropathy
1. Tachycardia and fixed heart rate at rest.
In the early stage of the disease, the vagus nerve that mainly innervates the heart is damaged, so that the excitability of the sympathetic nerve is relatively enhanced, and the patient can manifest as a heart rate in a rest state, often more than 90 times / min, or even as high as 130 times / min; and in the late stage, the vagus nerve and sympathetic nerve that innervate the heart are damaged, and the heart is almost completely lost innervated, which is often manifested as a relatively fixed heart rate. Therefore, the patient's heart rate changes can be judged whether the patient has autonomic neuropathy of the heart.
2. Orthostatic hypotension.
When the normal human position changes, the body can maintain normal blood pressure by increasing blood vessel tension and heart output. Diabetic patients due to the autonomic nerves that innervate the blood vessels (especially the sympathetic nerves) are damaged, can not effectively regulate vascular tone, when suddenly erected from the recumbent position, prone to postural hypotension, manifested as dizziness, dizziness, palpitations, sweating, standing instability and even syncope (orthostatic hypotension diagnostic criteria: when the patient rises from the recumbent position, the systolic blood pressure drops >30 mm Hg, and the diastolic blood pressure drops >20 mm Hg).
3 . Painless myocardial infarction.
Due to autonomic neuropathy of the heart, diabetic patients have no pain or very mild pain in the occurrence of acute myocardial infarction, and only manifest as epigastric discomfort, nausea, arrhythmia, heart failure, shock and even sudden death. Because the symptoms are not typical, it is easy to be missed or misdiagnosed, and the harm is even greater.
In short, diabetic patients even if there are no symptoms of high blood sugar is also in need of treatment, control of blood sugar, but also protect the heart muscle, of course, control of blood sugar should also have a degree, should vary from person to person. In addition, patients with coronary heart disease implanted a stent, not the end of treatment, it is precisely the beginning of treatment, we must adhere to lifestyle intervention and drug treatment, so that we can enjoy the "sweet life" of diabetes.