Heart disease is a complication that can affect people with diabetes if their disease develops.

Cause of death for 80% of people with diabetes, but the NHS says heart attacks are largely preventable.

How are heart disease and diabetes related?

People suffering from type 2 are most at risk from heart attacks, stroke and high blood pressure.

Vascular problems, such as poor circulation to the legs and feet, are also more likely to affect those with diabetes.

Like diabetes itself, symptoms of cardiovascular disease can go undetected for many years.

The Russian Diabetes Association believes that the risk of cardiovascular disease is 5 times higher in middle-aged men with diabetes and 8 times higher in women with diabetes. More than half showed signs of complications of cardiovascular disease.

Who does heart disease affect?

Many people think that heart disease only affects middle-aged and elderly people.

However, serious cardiovascular disease can develop in diabetics before the age of 30.

Both type 1 diabetics and type 2 diabetics are at greater risk of developing heart disease.

What is the cause of heart disease among diabetics?

Diabetes can change the composition of blood vessels, and this can lead to cardiovascular disease.

The walls of blood vessels may become thicker, and this in turn may reduce blood flow. Because of this, heart problems and possibly a stroke may occur.

What signs can identify heart disease?

The following are common symptoms of heart disease, although they may differ from person to person.

• Chest pain
• Holding your breath
• Irregular heartbeat
• Swollen ankles

Angina (chest pain)

Angina is a symptom of coronary heart disease and has two forms, stable angina and unstable angina.

A person with stable angina may notice pain or discomfort in the chest, a dull, monotonous and severe pain that goes away within a few minutes. This pain may be a sign of angina, after physical activity, overexertion, or from cold weather.

Tell your doctor if you experience symptoms of stable angina.

The symptom of unstable angina is that the symptoms persist for more than 5 minutes and no angina triggers are present.

If you or someone else is experiencing symptoms of unstable angina, call an ambulance immediately.

Heart attack (myocardial infarction)

A heart attack is usually caused by a blockage in the blood supply to the heart.

Symptoms of a heart attack include severe pain or tightness in the center of the chest, shortness of breath, coughing, and severe anxiety.

If these symptoms occur, call an ambulance immediately.

Treatment of coronary heart disease

Today, coronary heart disease is one of the leading causes of death worldwide, which can be prevented with surgery, coronary artery bypass grafting (CABG). Bypass surgery in different countries is carried out according to their own standards; in Israel, for example, bypass surgery is performed if a blood vessel is blocked by more than fifty percent.

For diabetics in general or with signs of coronary heart disease, doctors advise making lifestyle changes such as quitting smoking, eating healthy foods, eating a balanced diet and eating daily.

Treatment may also be prescribed. Common medications for treating heart disease include:

• FIRST CLASS inhibitors
• Calcium channel blockers
• Statins
• Low dose of aspirin (I personally take thrombo ass, daily, at night, for a month, then rest for two months and repeat the course again)

What you need know before surgery CABG for type 2 diabetes?
Do you know thatmortality rate in diabetics after bypass surgerybelow Compared to stenting?
What are the features of shunting for second diabetes?

Are diabetes and atherosclerosis inseparable friends?

In fact, this is true. The saddest complication caused by diabetes is the effect on blood vessels. All blood vessels are affected. They are exposed to excess glucose in what one heart surgeon described as being like being sanded. Small scratches on the inner walls of the arteries left by abrasives ultimately lead to inflammation and thinning. Gradually, the affected areas begin to become covered with a layer of cholesterol.
The body, as it were, is trying to patch up the damaged surface in order to avoid a big disaster - rupture of the vascular wall and internal bleeding. This is how atherosclerosis appears. A disease in which the walls of the arteries become covered with cholesterol plaques. Plaques tend to gradually calcify, and the flexibility of the vessel and its conductivity noticeably deteriorate.
The blood flow becomes noticeably more difficult, the blood supply to organs deteriorates, in our case we are talking about the coronary vessels and the supply to the heart. Then diseases of the cardiovascular system occur. Ischemia, angina and ultimately heart attack.
That is why among patients who have undergone CABG about 40% have type 2 diabetes, and this figure is growing. The question leaves no ambiguous answer. But diabetes still brings its own peculiarities to the operation.

Features of bypass surgery for type 2 diabetes.

I am writing for you because I myself already underwent such an operation in 2013. Everything went well, as you can see, and I sincerely wish the same for you!

The peculiarity of bypass surgery for type 2 diabetes lies in two main factors:

• The first thing we are more or less ready for is longer healing of wounds after surgery.
• Second, this sharp increase in blood glucose levels may come as a “surprise” to many.

Prolonged wound healing.

A sharp increase in blood sugar after bypass surgery.

You may not be warned about this, but this is a very important episode. I was not warned, but it turned out at the most inopportune moment. Therefore, I want to warn you.

After bypass surgery, your blood sugar levels may rise sharply. For example, before the operation my diabetes was well compensated for more than two years. The average morning fasting sugar level before surgery was 6.1-6.3. After the operation, on the third or fourth day, I measured my sugar and was shocked. Glucose level is more than 14 mmol/l! This is actually dangerous, the level is from 13 to 18 mmol/l. is considered a borderline state before a diabetic coma.
Quite a sharp jump occurs. I had to take insulin because the pills that they urgently gave me didn’t help.

Looking ahead, I will say that gradually, as the body was rehabilitated, within about a month, diabetes returned to a compensated form.

Why am I writing all this, of course, to remind you once again so that you have with you there must have been a glucometer. Despite the fact that blood is constantly taken for analysis after surgery, for some reason it was I myself who found out about the increase in sugar, and not the staff.
It is advisable to “synchronize” the glucometer with the hospital laboratory. It's easy to do. When your blood is taken for analysis, simply take your measurement with your device and write down the result. Then, when the lab test is ready, simply write it down next to your value.
Why is this necessary? Because you will be sure that doctors see the same picture of changes in glucose as you.

Why does blood sugar rise sharply after CABG?

Most likely, after surgery, two factors play a role in the increase in sugar:

1. General stress for the body.
2. A decrease in total blood volume while the liver continues to produce glucose at its normal level.

These factors are just my assumptions, but I couldn’t find any official information on this matter.

Subsequently, as I progressed through rehabilitation at the sanatorium, my sugar levels were brought back to normal; it took three or four weeks. The sanatorium doctors said that after surgery this was a normal phenomenon. All the “sores” are getting worse. Of course, it would be better if they said this in advance. Because not everything that is obvious to some is as natural and understandable to others.

Stenting or bypass? What is better for diabetes?

According to research conducted in the UK The new England journal of medicine article Strategies for Multivessel Revascularization in Patients with Diabetes The mortality rate is lower among diabetics who undergo CABG compared with those who undergo stenting.

About compensation for diabetes in a hospital.

If you are taking sugar-lowering medications, the hospital will give you the same or corresponding analogues. It is strictly not recommended to take medications you bring with you.

If you adhere to a strict diet or engage in physical activity to lower blood sugar levels, then the hospital will not offer you any alternative. The ninth table is probably all you can count on. Ninth table, this is something for which those who invented it should be executed, but this separate topic.

In general, be prepared for the fact that your sugar levels may rise, it all depends on how different your lifestyle in the hospital will be from everyday life. If a person usually moves little, then perhaps stationary immobility will go unnoticed. And if, to lower your glucose level, you take 10 thousand steps a day, or run, or something like that, then, alas, the possibility of a hospital corridor is limited.

What to do with diabetes after CABG?

You probably don’t care about your diabetes right now, but most likely it is, since you read about the operation, all your thoughts are about it. But after the bypass there will be plenty of time, I invite you to read the blog, I will slowly fill it, including telling you, how to say goodbye to diabetes. That is, to achieve long-term, sustainable compensation without taking medications or dietary supplements.

And everything turned out to be quite simple. And I learned it myself choose a diet, and managed to give up the pills, and after bypass surgery I started move actively(the operation still spurred it on!), the body has changed so that there is nothing left on it not an ounce of excess weight. The long-awaited compensation has arrived. It took about 8 years to complete this. 3 would be enough for the same result if I knew right away what to do with diabetes.

Conclusion.

• The peculiarity of bypass surgery for type 2 diabetes is the relatively slow healing of surgical sutures. Help your body as much as you can. Use proven tools that you trust. It is especially important to increase your immunity.
• Immediately after surgery, diabetes control may decrease dramatically and overall blood glucose levels may increase. Pay attention to self-control. Be sure to take a sugar measuring device to the hospital that you use regularly.
• Death rate in diabetics after bypass surgerybelowcompared to stenting. Therefore, CABG for diabetes is more promising.

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Diabetes mellitus is a disease that is associated with hormone dysfunction pancreas - insulin. Diabetes mellitus causes metabolic disorders, especially carbohydrate metabolism.
It is believed that about 3-4% of the population has diabetes. More often in older people.

Types of disease

There are two main types of diabetes - diabetes 1 (insulin-dependent diabetes) and type 2 (non-insulin-dependent diabetes). There are also other specific types of diabetes, such as diabetes in pregnancy, latent autoimmune diabetes and other, rarer forms.

Causes and development of the disease

Diabetes is caused by a lack of insulin. Depending on the mechanism of occurrence of this pathological condition, there are two main forms of diabetes mellitus - diabetes mellitus type I and type II. In the first case, they speak of absolute insulin deficiency. In the second - about the relative.

Diabetes type I associated with impaired production of insulin by the pancreas. Pancreatic cells can be destroyed due to the action of any pathogenic factors. For example, due to a viral infection (measles, rubella virus, chickenpox), strong medications (some antitumor drugs) or other toxic substances (vacor - a means for exterminating rodents). Severe psycho-emotional stress can also be the initiator of this pathological condition.

Diabetes mellitus type II characterized by relative insulin deficiency. In this case, the synthesis and secretion of the hormone are not impaired. Changes occur in the mechanism of action of insulin on target cells. The main role of this hormone is to participate in glucose metabolism. The hormone is involved in the transport of this molecule. When a person eats carbohydrates, the pancreatic gland secretes insulin, which, by connecting with the receptors of target cells, opens special channels so that glucose can enter the cells of tissues and organs from the blood. In type II diabetes mellitus, it is the mechanism of communication between target cells and insulin that is disrupted (the receptors lose sensitivity to the hormone) and, consequently, the transport of glucose into the cells is disrupted. The amount of the hormone in this pathological condition may be normal, often higher than normal, but it does not perform its main function. Type 2 diabetes mellitus is common in obese people. This happens because insulin receptors wear out and become unusable due to the large intake of glucose from food. If we often use something, it soon becomes unusable, and the same thing happens with receptors. If you do not overindulge in sweets and stick to a healthy diet, the likelihood of developing diabetes is significantly reduced.

The cause of relative insulin deficiency may also be the effect of liver enzymes on insulin or the effect of antagonist hormones, for example, thyroid hormones, adrenal hormones, growth hormone and glucagon.

Most of all, insulin deficiency affects carbohydrate metabolism, but protein and fat metabolism are also affected. Since the body tries to make up for the lack of glucose in the cells at the expense of other substances, this leads to pathological conditions affecting almost all processes in the cells. Insulin affects the permeability of membranes to glucose only in insulin-independent tissues. These tissues include muscle and fat, as well as the liver. For example, the brain does not depend on insulin, so its function is not impaired in patients with diabetes.

What happens in the tissues? Since glucose is the main source of energy in the body, when there is a lack of it, the body tries to get energy from other sources. The mechanism of gluconeogenesis is triggered - the production of glucose by cells from storage substances or other substrates (fats and proteins). Firstly, liver glycogen is consumed; adipose tissue can also be a source of energy. To eliminate energy hunger, amino acids that are part of the muscles are used. Therefore, one of the symptoms of diabetes is weight loss.

Violation of fat metabolism. Obtaining energy from fats and protein leads to the formation of harmful products. The breakdown of fats leads to an increase in the level of ketone bodies in the blood (acetone is especially dangerous), which have a strong toxic effect on the body. With increased breakdown of fats, many triglycerides are released, which are involved in the formation of cholesterol, therefore, the risk of atherosclerosis increases.

Protein metabolism disorder. Protein performs many important functions in the body. For example, blood cells, which play an important function in maintaining immunity, are of protein nature. However, when cells lack glucose (the main energy substrate), amino acids are used by the body first for energy and only then for other functions. Consequently, in diabetic patients, the synthesis of blood globulins and albumins is impaired. The patient's body becomes susceptible to infectious diseases.

Diabetes mellitus, symptoms

There are three main symptom of diabetes. Since glucose does not enter the cells, the tissues “feel hungry” and send a signal to the brain. The patient appears to “wake up” increased appetite- polyphagia is the first sign. Against this background, polydipsia occurs - increased feeling of thirst, and as a consequence - polyuria ( increased urination). Nutrients leave the body in large quantities with urine.
Other important symptoms to watch out for:

• pain in the heart area;
• weight loss;
• dry mouth;
• headache;
• pain in the calf muscles;
• skin itching;
• irritability;
• sleep disturbance;
• increased fatigue and weakness.

Symptoms vary from person to person, but if you notice such signs, you should see a doctor as soon as possible.

In type 1 diabetes, symptoms develop very quickly and occur in young people under 30 years of age. The amount of ketone bodies in the blood sharply increases - ketoacidosis, and the balance of proteins is also disturbed - hypoglycemia. If you do not provide assistance to the patient, a diabetic coma may develop (first confusion occurs, and then loss of consciousness).

Type 2 diabetes is also called diabetes of the elderly. Develops most often after 40 years. However, type 2 diabetes is getting younger every year. The onset of symptoms in this case is gradual, rather slow. The signs are mild. It is very difficult to determine the onset of the disease. Complications may not appear for years, however, the later a person goes to the doctor, the worse it is for his health. What you need to pay attention to. Most often, type 2 diabetes occurs in people with excess body weight - more than 80% of patients are obese people. Decreased vision may also be a symptom. Heart and kidney diseases can result from this pathological condition. Sometimes a patient learns about diabetes only after a myocardial infarction or stroke.

Complications of diabetes

Diabetes mellitus is dangerous due to its complications. As mentioned above, all types of metabolism are affected: carbohydrate, protein and fat. Everything in the body is aimed at eliminating energy hunger. Therefore, other functions of the body fade into the background. Increased breakdown of fats and proteins leads to the accumulation of harmful byproducts.
The cardiovascular system suffers greatly. First, small vessels are affected (in the eyes - angioretinopathy, kidneys - nephropathy, and other organs that have a network of small blood vessels). Vascular damage is associated with the release of products of increased fat breakdown into the bloodstream. Due to atherosclerosis, the walls of blood vessels thicken and their lumen decreases. As a result of blood obstruction, tissue hypoxia occurs, as well as microhemorrhages, which are clearly visible in retinopathy during examination of the retina. In addition to small vessels, large vessels are also susceptible to atherosclerotic changes: main vessels (aorta, arteries of the extremities, renal arteries) and vessels of the heart (coronary arteries). Damages to the cardiovascular system in diabetes are called diabetic angiopathy and lead to serious complications: coronary heart disease, circulatory disorders in the brain, stroke, circulatory disorders in the extremities, and renal failure. Gangrene of the limbs may develop, and due to retinopathy, blindness.

Diagnosis and treatment of diabetes mellitus

If a patient has type 1 diabetes, treatment is aimed at eliminating the symptoms and complications of this pathological condition. Insulin preparations are mandatory. One of the methods for eliminating insulin-dependent diabetes is pancreas transplantation.

The earlier the disease is diagnosed, the easier it will be for the patient. If you detect type 2 diabetes in a person in time, you can do without insulin medications. The main thing is to monitor your health and pay attention to any changes.
It is important to monitor your blood glucose levels. Its increase may indicate the development of diabetes mellitus. Diabetes patients need to be aware of this parameter at all times. Glucometers are used for this.

It is also necessary to monitor the functioning of the cardiovascular system, since it is one of the first to be affected in this pathological condition. Even the smallest changes in the functioning of the heart and blood vessels will allow us to identify disorders associated with diabetes in the early stages. Monitoring your heart function allows you to avoid serious complications. At this stage, the Cardiovisor device can help. Its use allows you to notice the smallest changes in the functioning of the cardiovascular system. makes it possible not only to detect the onset of pathology, but also to prevent it, thanks to the modern method of analyzing ECG microalternations. The Cardiovisor device is not difficult to use. It is easy to use at home. Now you can always be aware of the work of your heart, which will allow you to avoid irreversible disorders that usually begin against the background of apparent health.

It is impossible to completely get rid of diabetes, since diabetes is a chronic pathological condition. However, even with it you can lead a normal, full life.

How to live with diabetes

Patients with diabetes need a specially selected diet, which is aimed at normalizing metabolic processes in the body. After an accurate diagnosis is made, a number of medications are prescribed.

Diet therapy consists of a balanced diet. People with diabetes should eat less fatty foods. Food should be rich in vitamins and complex carbohydrates. In order to avoid complications, physical therapy is also necessary, which is aimed not only at maintaining normal body weight, but also at preventing cardiovascular diseases. To prevent the disease from progressing, it is necessary to avoid stressful situations.

Constant monitoring of blood glucose levels, as well as monitoring of heart function, will allow you to lead a full life, rich in joyful moments.

Rostislav Zhadeiko, especially for the project.

Heart rhythm disturbances in diabetes mellitus can develop both as a result of diabetes itself and in connection with other concomitant diseases: coronary heart disease, arterial hypertension and other reasons.

The nature of rhythm and conduction disturbances in diabetes mellitus is also very different.

Not all heart rhythm disturbances require immediate medical intervention. Many of these rhythm or conduction disturbances persist throughout a person's life. However, some of them can progress and lead to severe complications, while others require emergency medical intervention.

An important role is played by patient awareness of behavioral tactics for various rhythm disturbances.

After all, not all disturbances of heart rhythm and conduction can manifest themselves clinically, that is, cause corresponding sensations. Many of these disorders can only be detected by electrocardiographic examination.

At the same time, heart rhythm disturbances can manifest themselves with various symptoms, which a person does not always associate with arrhythmias.

In addition to the typical sensations of an irregular heartbeat, which are called interruptions, Other rhythm disturbances may also occur clinical manifestations:

• heartbeat,
• dizziness,
• fainting states,
• rare heartbeat,
• alternation of rare and frequent heart rhythms,
• feeling of a sinking heart,
• sensation of a lump or rolling over behind the sternum,
• increased shortness of breath.

In some cases, rhythm disturbances are detected when counting the pulse in the complete absence of subjective sensations.

In all of the above cases It is necessary to consult a doctor. Only a thorough examination and qualified assessment of the results will allow your doctor to choose rational treatment tactics.

A number of symptoms, more often in young people with long-term diabetes mellitus, may be due to diabetic autonomic neuropathy. This is a complication of diabetes, in which, due to long-term elevated blood sugar, the nerves of the heart itself are damaged. It is with the damage to these nerves that heart rhythm disturbances are associated. Symptoms of diabetic heart disease are as follows:

• sinus tachycardia even at rest with a fixed heart rate of up to 90-100, and sometimes up to 130 beats per minute;
• no effect of breathing on the heart rate (normally, when a person takes a deep breath, the heart rate slows down). This indicates a weakening of the function of the parasympathetic nerves, which reduce the heart rate.

This condition requires conducting a special examination with performing functional tests to assess the state of the nervous regulation of the heart and the prophylactic use of medications that prevent the progression of neuropathy and reduce the influence of the sympathetic nervous system on the heart.

The regulation of heart activity is carried out by the autonomic nervous system, consisting of sympathetic and parasympathetic nerves.

Parasympathetic nerves - slow down the heart rate.

Sympathetic nerves - strengthen and increase heart rate.

In diabetes, the parasympathetic nerves are primarily affected, causing the heart rate to increase. Subsequently, changes occur in the sympathetic department of the autonomic nervous system.

Damage to sensory nerve fibers leads not only to tachycardia, but also to atypical course of coronary heart disease in these patients. A variant of the course of coronary artery disease occurs with a sharp weakening of pain, up to the complete absence of pain (painless ischemia) and even myocardial infarction becomes painless. This symptom of diabetic heart disease is dangerous because it creates the impression of imaginary well-being.

Hence, If stable tachycardia occurs in diabetes mellitus, you should definitely consult a doctor for timely prevention of progression of diabetic autonomic cardiac neuropathy.

In the later period of the disease in diabetes mellitus with diabetic autonomic neuropathy, a change in the sympathetic nervous system occurs. These changes are characterized by signs of orthostatic hypotension - dizziness, darkening of the eyes, flashing "spots". These sensations occur when there is a sudden change in body position, for example, when suddenly getting out of bed. They can go away on their own or lead to the need to return to 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, atrioventricular block, and paroxysmal rhythm disturbances. Only a qualified specialist can determine the cause of the described clinical conditions, which sometimes require rapid preventive and therapeutic measures.

The appearance of dizziness, darkening of the eyes, and fainting requires immediate medical attention.

It should be noted that cardiovascular neuropathy in diabetes mellitus is dangerous for another reason. This complication of diabetes increases the risk of sudden death and cardiopulmonary arrest when narcotics are administered during surgery. Therefore, prevention of neuropathy is at the same time prevention of this risk.

Another cause of heart rhythm disturbances in diabetes mellitus is diabetic myocardial dystrophy. It is caused by metabolic disorders caused by insulin deficiency and impaired flow of glucose through the cell membrane into the heart muscle cells. As a result, most of the energy expenditure in the heart muscle comes from the use of free fatty acids. In this case, an accumulation of under-oxidized fatty acids occurs in the cell, which has a particularly negative effect when coronary heart disease is added to diabetes mellitus. As a result, myocardial dystrophy can cause various focal rhythm disturbances (extrasystole, parasystole), adduction disorders, atrial fibrillation, etc. However, the nature of these rhythm disturbances will require slightly different treatment tactics than for diabetic neuropathy.

Diabetic microangiopathy in diabetes mellitus It also affects the smallest vessels that supply the heart muscle. It can also cause various heart rhythm disturbances. For its prevention, as well as for the prevention of neuropathy and diabetic myocardial dystrophy, first of all, maximum compensation for diabetes mellitus is required.

Strict diabetes compensation helps prevent the occurrence of complications of the disease, including diabetic cardiac neuropathy, diabetic myocardial dystrophy and microangiopathy.

Blood sugar levels should not exceed:

• 5.5-6 mmol/l on an empty stomach and
• 7.5-8 mmol/l 2 hours after meals.

Of course, the most common cause of heart rhythm disturbances in diabetes mellitus is frequent concomitant coronary heart disease, in which any of the listed rhythm disturbances can be observed.

Thus, we can conclude that Heart rhythm disturbances can have a wide variety of clinical manifestations, which are not always correctly and adequately assessed by the patient himself. In addition, rhythm disturbances can have different causes. Therefore, independent treatment of heart rhythm disturbances is unacceptable. You should not listen to the advice of your friends or other patients who were previously effectively treated with any drug. This drug may not only not help you, but also worsen the course of the disease. Despite the presence of a large arsenal of antiarrhythmic drugs, we deliberately do not talk about them and do not give any recommendations for drug therapy. Only a qualified doctor in each specific case, after an appropriate examination, can determine the nature and cause of heart rhythm disturbances, and only a doctor can give recommendations on antiarrhythmic therapy.

It should be remembered that Heart disease often accompanies diabetes. Therefore, every patient with diabetes, even if he does not have any symptoms from the cardiovascular system, should be periodically examined by a cardiologist. If you experience any of the symptoms listed in this article, You should contact not only an endocrinologist, but also a cardiologist.

Violetta MKRTCHAH

Endocrinology: diseases, symptoms, diagnosis, treatment,

The risk of angina pectoris in diabetics is extremely high. After 45 years, this combination leads to a heart attack, severe arrhythmia, and heart failure 11 times more often than in patients with normal carbohydrate metabolism. Read further in our article about the relationship between diabetes and angina, symptoms of heart problems, the danger they pose for patients, as well as treatment and prevention.

📌 Read in this article

Diabetes and angina: relationship between diseases

It is important that not only an attack of angina pectoris can occur in this form, but also. Due to late diagnosis, coronary blood flow disorders are often accompanied by complications and death.

Why does the heart hurt slightly with diabetes?

Elevated blood sugar leads to damage to the bloodstream. Small vessels that supply blood to nerve fibers also lose their patency. Due to insufficient nutrition, the outer sheath of the nerve is destroyed.

In addition, high sugar levels contribute to the accumulation of sorbitol inside the cells, which retains water, causing tissue swelling. Free radicals are formed quickly and in large quantities, destroying nerve cells. As a result of such changes, the nerve endings in the myocardium are lost.

With physical and psychological stress, patients with angina pectoris without diabetes experience pain. It occurs due to the fact that a sufficient amount of blood cannot flow through narrowed vessels. When the patient feels pressure and pain in the chest, he stops, sits down, tries to relax, and takes Nitroglycerin.

Diabetics do not feel such a threat to the heart and continue their normal activities. Lack of oxygen and disturbances in myocardial nutrition increase.

“Silent”, “silent” ischemia is much more dangerous, the risk of sudden cardiac arrest is 3 times higher than with ordinary angina. Patients with a latent course of the disease turn to a cardiologist only in case of an extensive heart attack, when complete recovery is almost impossible.

The danger of type 2 diabetes mellitus

In this variant of the disease, increased glucose levels are combined with a special condition - insulin resistance. This means that the pancreas produces, but the cells do not respond to it. Such insensitivity to the hormone is considered an independent risk factor for severe consequences of myocardial infarction:

• rhythm disturbances, cardiac impulse conduction;
• resumption of angina in the post-infarction period;
• addition of heart failure (edema, tachycardia, shortness of breath, liver enlargement);
• long-term complications one year after a heart attack (blood stagnation in the lungs, liver, arrhythmia), relapse with fatal outcome.

These conditions are found 7 times more often in patients with type 2 diabetes who take sugar-lowering pills than in the rest of the population.

The causes of such severe myocardial ischemia are:

• increased levels of cholesterol and triglycerides, free fatty acids;
• multiple unstable (collapsing) atherosclerotic plaques, blockage of arteries by forming blood clots;
• high activity of the inflammatory process;
• insufficient formation of additional blood flow paths that bypass the area of ​​narrowing of the artery.

Myocardial ischemia

Features of the course of heart rhythm disturbances

In type 2 diabetes, arrhythmia often occurs against the background of angina or heart attack. She is provoked by:

• lack of nutrition of the heart muscle;
• accumulation of toxic compounds due to improper carbohydrate metabolism;
• high oxygen demand;
• sudden changes in blood glucose concentration;
• imbalance between calcium, potassium, sodium inside and outside the cell.

Diagnosis of the condition

If for most patients it is enough to conduct an ECG to detect ischemia, even in a painless form, then for a patient with diabetes a more in-depth diagnosis is required. A regular cardiogram is normal. Therefore, daily Holter monitoring (registration over a long period of time), as well as stress tests, is prescribed.

Functional tests in diabetics have their own characteristics. Under standard conditions, the criterion for sufficient load is the appearance of an attack or changes in the ECG.

Spirometry

In case of diabetes mellitus, it is recommended to first determine the maximum tolerated level of stress using spirometry (breathing tests) and, when it is reached, take an ECG. Stress echocardiography (ultrasound of the heart) is performed similarly.

To clarify the extent of heart damage, the following methods are indicated:

• coronary angiography– helps to find areas of narrowing of the arteries, the possibility of bypass routes of blood flow, usually used in determining indications for surgery;
• single photon emission CT– shows the degree of impact of nutritional deficiency on heart function;
• PET-CT of the heart– reflects areas potentially dangerous for a heart attack.

Carrying out PET CT scan of the heart

Patients with diabetes and angina pectoris are advised to undergo regular laboratory blood tests - general analysis, lipid profile, coagulogram, glucose content, glycated hemoglobin.

Treatment of angina complicated by diabetes

Achieving compensation for diabetes mellitus is the most important direction of therapy. In the first type of disease, it may be recommended to change the dose, frequency of insulin administration, and add long-acting drugs.

In type 2 diabetes, if there is a high risk of heart attack, patients are prescribed a combination of long-acting insulin and tablets to lower blood sugar. The group of glucose-lowering drugs is changed less frequently. Actos and Avandia have a protective effect on the heart muscle.

To improve metabolism and blood circulation in the myocardium, use:

• beta blockers (selective action only) – Nebivolol, Nebilet;
• angiotensin-converting enzyme inhibitors – Prenesa, Ampril;
• cholesterol-lowering – Vasilip, Crestor;
• cardioprotectors (protect heart cells from damage) – Preductal, Thiotriazolin;
• blood thinners – Aspirin cardio, Plavix;
• potassium and magnesium salts - Panangin, Kalipoz prolongatum.

The goal of therapy is to normalize the levels of sugar, cholesterol, triglycerides, and lipoprotein complexes. Patients are recommended to maintain blood pressure no more than 130/80 mm Hg. Art., visit a cardiologist at least once a month, undergo instrumental and laboratory diagnostics.

Prevention measures

To slow down the progression of atherosclerosis, angina pectoris, diabetes, it is necessary to strictly follow the nutritional rules:

• Sugar, foods with a high glycemic index (quickly increase blood glucose), fatty meat, offal, semi-finished products, margarine, store-bought sauces, butter, cottage cheese, cream above 10% fat content are excluded from the diet;
• Every day the menu should include vegetable salads dressed with vegetable oil, fresh fruits, berries (unsweetened);
• Whole grain porridge, low-fat cottage cheese, fermented milk drinks, boiled and baked vegetables, and herbs are allowed.

Alcohol and smoking, stress and lack of physical activity have an adverse effect on the course of coronary disease.

Therefore, it is vital for patients to reconsider their lifestyle in order to promptly stop damage to the heart and blood vessels. A minimum of 30 minutes per day should be allocated for physical therapy, walking, and swimming. To prevent blockage of the coronary arteries, aspirin 100 mg is prescribed for a long period of time, alone or in combination with clopidogrel.

Angina pectoris occurs in diabetes against the background of damage to blood vessels and nerve fibers of the myocardium. Its course is often hidden, symptoms are absent or atypical, and an ECG at rest also does not show any abnormalities. High glucose levels cause rhythm disturbances, cardiac muscle contractility, rapid progression of ischemia, and the appearance of a heart attack with complications.

To identify the disease, stress tests, coronary angiography, and CT are needed. Treatment is aimed at compensating for diabetes, reducing the load on the heart, normalizing the fat composition of the blood and the coagulation system. For prevention, it is important to adhere to dietary nutrition, dosed physical activity, and give up bad habits.

Useful video

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