Heart and diabetes. Diabetes Heart Damage: Causes and Signs Diabetic Heart

The problem of heart damage in diabetes mellitus (DM) remains relevant, since the main cause of disability and mortality in patients with diabetes remains ischemic disease heart (IHD) and other cardiovascular complications. The development of cardiovascular pathology is based on secondary metabolic disturbances arising from prolonged de- or subcompensation of diabetes mellitus (hyperglycemia). There are 3 main histopathological types of heart damage in diabetes mellitus.

1. Diabetic angiopathy with arterial disease (microangiopathia) and coronary arteries (macroangiopathy).The predominant lesion of large coronary arteries is expressed in the form of atherosclerotic plaques, thrombosis and is a histomorphological sign of various variants of the course of coronary artery disease.

2. Myocardial dystrophycharacterized by the occurrence of dystrophic changes in myocardial fibers and a gradual increase in signs of myocardial insufficiency.

manifests itself in a decrease in the number of nerve fibers, their demyelination and degenerative changes in axons and is accompanied by clinical signs of impaired cardiac conduction, etc.

These types of heart damage in diabetes can develop independently and / or in combination (in any combination).

Damage to the coronary arteries.Most researchers testify about a significant dependence of the increase in the frequency of ischemic heart disease in diabetes. It has been proven that in similar age groups without diabetes, coronary artery disease occurs 2 times less often in men and 3 times less often in women. According to a 7-year study conducted in Finland, insulin-dependent diabetes mellitus (IDDM) increases the risk of coronary artery disease 3-4 times in men, and 8-11 times in women. In this case, atherosclerotic changes develop 10-12 years earlier than in individuals with normal carbohydrate metabolism. The same relationship applies to patients with impaired glucose tolerance.

According to numerous literature data, up to 75% of all deaths of patients with diabetes are caused by acute cardiovascular pathology. Clinical studiesJoslin (USA), show that 35% of diabetics die from cardiovascular disease at the age of 30-55 (compared with 8% of patients without diabetes). Most researchers note that IDDM contributes to a more rapid progression of coronary artery disease, which is explained by the initial dyslipidemia characteristic of this group of patients. It is believed that the type of diabetes does not affect the development of coronary atherosclerosis. However, there is no doubt that diabetes decompensation and its duration determine the progression of coronary artery disease.

Thus, along with the generally recognized risk factors for the development and progression of atherosclerosis of the coronary vessels, diabetes mellitus can be distinguished as a regular and independent risk factor for this pathology.

What contributes to the development of the atherosclerotic process in diabetes? First, insulin deficiency in tissues leads to hyperglyca- miia, activation of lipolysis, ketogenesis and lipid peroxidation. Secondly, dyslipoproteinemia develops, accompanied by hypertriglyceridemia and hypercholesterolemia. This process is based on the activation of 3-hydroxy-3-methylglutaryl-CoA synthetase, which catalyzes the processes of biosynthesis of cholesterol and triglycerides in the liver and endothelial cells and an increased intake of free fatty acids due to the activation of lipolysis. Thirdly, a certain role is played by the violation of intravascular blood coagulation and a tendency to thrombus formation. Hypercoagulable syndrome is a consequence of a change in the ratio of thromboxane prostaglandins A2, B2 towards the latter. In addition, platelets secrete other biologically active substances that are atherogenic (for example, β-thromboglobulin). Fourthly, hyperglycemia is accompanied by increased formation of glycosaminoglycans infiltrating the vascular wall, and activation of protein glycosylation. As a result of glycosylation of hemoglobin, its affinity for oxygen is disrupted, which contributes to the aggravation of tissue hypoxia. But, despite hyperglycemia, non-insulin-dependent diabetes mellitus (NIDDM) is characterized by hyperinsulinemia, which causes an increased formation of insulin antagonists, in particular somatotropin. It is somatotropin that stimulates the proliferation of smooth muscle cells and the penetration of lipids into them. In addition, smoking, arterial hypertension, and obesity contribute to the progression of atherosclerosis. There is evidence that IHD can be predicted by detecting microalbuminuria.

Therefore, in diabetes, there are a number of factors that can contribute to the premature onset and progression of atherosclerosis, and the more they are detected in a patient, the higher the threat of disease. But this assumption is not supported by all authors.

The diagnosis of ischemic heart disease in diabetes is not always easy, since the course of the disease is often atypical. The most common atypical form of ischemic heart disease in Diabetes mellitus is a "quiet", painless course of the disease, when there are no typical angina pain in history, and the diagnosis is made after a myocardial infarction or sudden death is detected. In the absence of characteristic clinical symptoms, special examination methods become important, which make it possible to establish coronary artery disease before serious complications. The following methods can be used as such methods: ECG monitoring; exercise test; myocardial scintigraphy with thallium-201; atrial stimulation; coronary angiography; pharmacological tests.

ECG monitoring(holter monitoring) allows you to fix signs of myocardial ischemia (segment displacementST, change: T, etc.) at the time of a painful attack and outside it. This technique is not invasive, easily tolerated by patients, but requires long-term observation and special equipment. The importance of ECG monitoring increases when it is necessary to verify painless attacks of myocardial ischemia.

ECG tests with dosed physical activity(veloergometry, treadmill, etc.) provoke the development of myocardial ischemia during the period of exercise and allow it to be documented. These tests are also of particular importance in atypical and (or) painless course of coronary artery disease. Sometimes bicycle ergometry and other exercise tests are difficult due to the pathology of the vessels of the legs and distal neuropathy. In addition, veloergometry is contraindicated in progressive angina pectoris, thrombophlebitis, pulmonary heart failure, arterial hypertension over 220/130 mm Hg. Art.

Scintigraphymyocardium with thallium-201 is based on the selective accumulation of the drug by the myocardium. Violation of myocardial perfusion with blood is expressed in the form of "cold foci" on scintigrams. Identification of "cold foci" at rest indicates the presence of an ischemic zone, acute myocardial infarction or cicatricial changes. To detect zones of "mute" ischemia, it is possible to conduct scintigraphy against the background of tests with physical activity.

Transesophageal electrical stimulation -one of the most frequently used methods of atrial stimulation in clinical practice. The method is based on imposing the rhythm of contractions from the step a figurative increase in their frequency to 160-170 beats / min and registration of electrocardiographic signs of myocardial ischemia in the form of horizontal or oblique depression of the T segment by 1 mm or more. Atrial stimulation is contraindicated in case of esophageal diseases with stable course of angina pectoris FCIII-IV, atrial fibrillation at the time of examination, failure blood circulation IIb -III degree, heart aneurysm, intracardiac thrombosis, valve prostheses, acute infectious diseases.

Coronary angiography -an invasive method requiring special equipment, which allows you to visually assess the condition of the coronary arteries: degree, localization and prevalence pathological process. Given the difficulties in performing coronary angiography, this method is used relatively rarely.

Pharmacological testswith dipyridamole and isoproterenol allow documenting latent manifestations of myocardial ischemia using ECG or radionuclide scintigraphy. These tests are easily tolerated by patients and have fewer contraindications than exercise tests.

A few studies on the screening of coronary artery disease in diabetes confirm the latent, asymptomatic course of ischemic heart disease in approximately 50% of patients. An in-depth examination allows you to start treatment, prevent the development of complications of coronary artery disease and thereby reduce the mortality of patients with diabetes.

One of the most serious complications of ischemic heart disease is myocardial infarction, which with diabetes increases the likelihood of death. The causes of mortality in the combination of myocardial infarction with diabetes mellitus are as follows: decompensation of diabetes, accompanied by the development of ketoacidosis, sharply worsens the patient's condition due to water-electrolyte changes; a sharp decrease in glycemia (up to hypoglycemia) aggravates myocardial ischemia; hypercoagulable syndrome leads to more frequent thromboembolic complications; arrhythmias develop more often; hyperglycemia, accompanied by an increased formation of glycosylated hemoglobin, aggravates tissue hypoxia.

Diabetic myocardial dystrophy (DM)implies diabetes-specific degenerative changes in the myocardium due to long-term metabolic disorders. DM is subdivided into primary ny and secondary. Primaryis the result of the accumulation of glycoprotein complexes, glucuronates and abnormal collagen in the interstitial tissue of the myocardium. Secondarydevelops as a result of extensive damage to the capillary bed of the myocardium by a microangiopathic process. As a rule, these two processes develop in parallel. Histological examination reveals a thickening of the basement membrane of capillaries, proliferation of endothelial cells, microaneurysms, as well as myocardial fibrosis and degenerative changes in muscle fibers.

The main causes of DM are impaired redox reactions due to insufficient supply of energy substrates under conditions of hyperglycemia. The mechanism of this pathology can be represented as follows: absolute or relative insulin deficiency leads to a sharp decrease in glucose utilization in target cells. In such conditions, the need for energy costs is replenished due to the activation of lipolysis and proteolysis. The basis for replenishing the energy needs of the myocardium is the utilization of free fatty acids and amino acids. In parallel, the accumulation of triglycerides, fructose-6-phosphate, glycogen and other polysaccharides in the heart muscle is noted. Liver dysfunction due to the development of diabetic hepatosis aggravates metabolic disorders in the myocardium and accelerates the development of DM.

Since the pathogenetic basis of DM is deep decompensation of DM, it usually develops in patients with IDDM with frequent ketoacidosis.

The clinical manifestations of DM are caused by impaired myocardial contractility due to a decrease in the mass of myocardial cells. At the same time, patients note aching, diffuse pain in the heart area without a clear connection with physical exertion. These pains, as a rule, do not have irradiation characteristic of ischemic heart disease and go away on their own, without the use of coronary artery disease. Signs of heart failure (shortness of breath, edema, etc.) gradually increase. At the same time, patients almost always show other late complications of diabetes, such as retinopathy, nephroangiopathy, etc. DM progression depends on the duration and degree of DM decompensation, as well as on the severity of arterial hypertension.

Since the clinical signs of DM are very nonspecific, instrumental methods are used to verify the diagnosis: phonocardiography and electrocardiography; echocardiography; myocardial scintigraphy with thallium-201.

The most informative methods are echocardiography and scintigraphy, which make it possible to reliably assess changes in heart mass and a decrease in myocardial contractility. The development of heart hypodynamia syndrome is accompanied by a decrease in stroke and minute volume.

Diabetic autonomic cardiac neuropathy (DICN)it is verified relatively rarely, since it does not have characteristic and specific clinical manifestations. However, it should be remembered that the diagnosis of DIC is very important, since this pathology is often associated with cases of sudden death. Available literature data do not allow us to reliably talk about frequency of development of DICS, although there is undoubted evidence of the dependence of DICS on the duration of DM decompensation and the presence of other neuropathic signs.

The development of DVSN is due to the increase in denervation phenomena heart with involvement in the pathological process, first parasympathetic, and then sympathetic nerve fibers. Since the heart is richly innervated, the initial damage to the autonomic nerve fibers does not affect cardiac activity. The progression of DVSN is accompanied by a violation of the motor function of the heart, cardiac conduction and sensitivity.

Morphological changes in DICN are characterized by a decrease in the number of nerve fibers, their demyelination, degeneration by axons. Nerve fibers become denser, empty due to the appearance of vacuoles in them.

There is no doubt that metabolic disorders in nerve fibers prevail in the pathogenesis of DFS, accompanied by the accumulation of sorbitol and glycosylated proteins in them, which rye change the structure of the neuron. In addition, due to microangiopathy,vasa nervorum, which aggravates the violation of the trophism of the nervous tissue.

Clinical manifestations of DICN include tachycardia, orthostatic hypotension, and painless course of coronary artery disease. Tachycardia occurs at rest (up to 130 beats / min), is not accompanied by an increase in heart rate during physical exertion, and practically cannot be corrected with medications. This symptom of DVSN is due to vagal denervation of the heart.

Orthostatic hypotension, which develops as a result of sympathetic denervation of the heart, is sometimes an early symptom of DICN. ... Orthostatic hypotension is characterized by a decrease in blood pressure to 30 mm Hg. Art. with a change in body position from orthostasis to clinostasis. Patients have dizziness, darkening of the eyes, severe weakness, and possible short-term loss of consciousness.

In addition to the characteristic clinical symptoms, functional tests are used to diagnose DIC. The main and generally accepted test is the registration of changes in the R — R intervals on the ECG against the background of forced breathing, in the supine position and after assuming an upright position. At the same time, a decrease in the variability of the R — R intervals is recorded, which serves as an indicator of the severity of the DVSN. To assess the degree of DVSN, the calculated indicators (indices) "E-I" (Expiratio / Inspiratio (inhalation / exhalation)) and "I-E" - vagal-sympathetic index are used. A pharmacodynamic test with atropine is rarely used, in which an increase in heart rate is not recorded.

Heart damage in diabetes mellitus can be isolated or combined. To determine the incidence of these lesions, an active targeted cardiological examination of patients is required using the above techniques for the differential diagnosis of heart lesions in diabetes.

Literature

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Medical news. - 1995. - No. 7. - S. 7-15.

Attention! The article is addressed to medical specialists. Reprinting this article or parts of it on the Internet without a hyperlink to the original source is considered a violation of copyright.

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

Disease types

There are two main types of diabetes mellitus - diabetes type 1 (insulin-dependent diabetes mellitus) and type 2 (non-insulin-dependent diabetes mellitus). There are other specific types of diabetes, for example, diabetes mellitus during pregnancy, latent autoimmune diabetes, and other, more rare forms.

Causes and development of the disease

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

Diabetes mellitus type I associated with a violation of the formation 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, chickenpox virus), strong medications (some anticancer drugs) or other poisonous substances (vacor is a means for destroying rodents). Severe psycho-emotional stress can also initiate this pathological condition.

Type II diabetes mellitus characterized by a relative lack of insulin. In this case, the synthesis and secretion of the hormone are not disturbed. Changes occur in the mechanism of action of insulin on target cells. The main role of this hormone is participation 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 get from the blood into the cells of tissues and organs. In type II diabetes mellitus, it is the mechanism of communication of target cells with insulin that is disrupted (receptors lose sensitivity to the hormone) and, therefore, the transport of glucose into cells is disrupted. The amount of the hormone in this pathological condition may be normal, often higher than normal, but at the same time it does not perform its main function. Type 2 diabetes is common in obese people. This is because insulin receptors wear out and become unusable due to the high intake of glucose from food. If we often use a thing, it soon falls into disrepair, the same happens with receptors. If you do not abuse sweets and stick to a healthy diet, then the likelihood of developing diabetes is significantly reduced.

Relative insulin deficiency can also be caused by the action of liver enzymes on insulin or by the action of hormone antagonists, for example, thyroid hormones, adrenal hormones, growth hormone and glucagon.

Most of all, insulin deficiency affects carbohydrate metabolism, but protein and fat metabolism is 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 membrane permeability to glucose only in non-insulin dependent tissues. These tissues include muscle and fat, as well as the liver. For example, the brain does not depend on insulin, so its work is not impaired in patients with diabetes mellitus.

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

Fat metabolism disorders. Getting energy from fats and protein goes with the formation 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 the increased breakdown of fats, many triglycerides are released, which are involved in the formation of cholesterol, therefore, the risk of atherosclerosis increases.

Violation of protein metabolism. Protein has 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 in the first place for energy and only then for other functions. Consequently, in patients with diabetes, the synthesis of globulins and blood albumin is disrupted. The patient's body becomes susceptible to infectious diseases.

Diabetes mellitus, symptoms

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

• pain in the region of the heart;
• losing weight;
• dry mouth;
• headache;
• pain in the calf muscles;
• itchy skin;
• irritability;
• sleep disturbance;
• increased fatigue and weakness.

Symptoms depend on the individual, but if you notice such signs, you should see a doctor as soon as possible.

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

Type 2 diabetes, also called elderly diabetes. It 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. Signs are weak. It is very difficult to determine the onset of the disease. Complications may not appear for years, however, the later a person seeks a doctor, the worse for his health. What you need to pay attention to. Most often, type 2 diabetes manifests itself in people with overweight - more than 80% of patients are obese people. Decreased vision can also be a symptom. Diseases of the heart and kidneys may result from this pathological condition. Sometimes the patient learns about diabetes only after a heart attack or stroke.

Complications of diabetes mellitus

Diabetes mellitus is dangerous for 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, the rest of the body's functions fade into the background. The increased breakdown of fats and proteins leads to the accumulation of harmful by-products.
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 the vessels thicken, their lumen decreases. As a result of blood obstruction, tissue hypoxia occurs, as well as microbleeds, which are clearly visible in retinopathies during examination of the retina. In addition to small vessels, large vessels are also subject to atherosclerotic changes: main vessels (aorta, arteries of the extremities, renal arteries) and heart vessels (coronary arteries). Damage to the cardiovascular system in diabetes is called diabetic angiopathy and leads to serious complications: coronary heart disease, circulatory disorders in the brain, stroke, circulatory disorders in the extremities, renal failure. Gangrene of the extremities may develop, and due to retinopathy - blindness.

Diagnosis and treatment of diabetes mellitus

If the patient has type 1 diabetes mellitus, then treatment is aimed at eliminating the symptoms and complications of this pathological condition. Insulin preparations are required. 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 find type 2 diabetes in a person in time, you can do without insulin preparations. 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. Patients with diabetes need to be aware of this parameter at all times. For this, glucometers are used.

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

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

How to live with diabetes

Patients with diabetes mellitus 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 a normal body weight, but also for the prevention of cardiovascular diseases. In order for the disease not to progress, stressful situations must be avoided.

Constant monitoring of blood glucose levels, as well as monitoring of the work of the heart with the help, will allow you to lead a fulfilling life rich in joyful moments.

Rostislav Zhadeikospecially for the project.

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Palpitations and tachycardia, regardless of the severity or relative safety of the causes causing them, give patients many unpleasant minutes and experiences. If a similar problem occurs, you must contact a cardiologist in order to:

1. Find out the cause of palpitations and tachycardia.
2. Get rid of painful symptoms and return to a normal active life.

Palpitations - a feeling of a rapid or increased heartbeat. It is often combined with tachycardia - an increase in heart rate over 90 beats per minute.

Palpitation is a subjective symptom. Some people periodically feel even normal heart contractions, while others may not feel serious rhythm disturbances. Therefore, the very sensation of palpitations is not a sign of heart disease.

Strengthening and increasing heart rate is a normal reaction of the body to physical activity, stress, which is felt like palpitations and tachycardia. Only in combination with other symptoms can the heartbeat indicate abnormalities. The symptoms accompanying the palpitations depend on the disease of which they are present.

Causes of palpitations and tachycardia

Palpitations and tachycardia occur with the following diseases:

1. Arrhythmias (cardiac arrhythmias),
2. Endocarditis. myocarditis.
3. Myocardial dystrophy, cardiosclerosis.
4. Arterial hypertension.
5. Heart glands.
6. Anemia.
7. Neurosis.
8. Vegeto-vascular dystonia.
9. Endocrine diseases (thyrotoxicosis, pheochromocytoma, hypoglycemic conditions in diabetes mellitus).
10. Feverish states.
11. Climax.

Sometimes, a sudden heartbeat scares the person, causing excitement and, accordingly, increasing the heartbeat and tachycardia. This creates a vicious circle that can greatly impair the quality of life.

In some cases, a combination of palpitations and tachycardia with high anxiety, additional autonomic reactions (sweating, feeling short of breath, tremors of the extremities, nausea) cause the patient to fear death and a false belief that he has a serious, life-threatening disease. In such cases, the participation of a psychotherapist in the treatment is effective. An objective picture of the state of the cardiovascular system will be given by such studies as daily Holter ECG monitoring and stress tests (treadmill, bicycle ergometry - stress ECG).

Heart and diabetes

Heart rhythm disorders in diabetes mellitus can develop as a result of diabetes itself, and in connection with other concomitant diseases: ischemic 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 attention. Many of these rhythm or conduction disturbances persist throughout a person's life. However, some of them can progress and lead to serious complications, while others require urgent medical attention.

Awareness of patients about the tactics of behavior in various rhythm disturbances plays an important role.

Indeed, not all violations of the heart rhythm and conduction can manifest themselves clinically, that is, cause the corresponding sensations. Many of these abnormalities can only be detected by electrocardiographic examination.

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

In addition to the typical sensations of irregular heartbeat, which are called interruptions, rhythm disturbances can have other clinical manifestations:

• heartbeat
• dizziness,
• fainting conditions
• rare heartbeat,
• alternation of a rare and frequent heart rhythm,
• feeling of sinking heart,
• feeling of coma or rolling over behind the breastbone,
• increased shortness of breath.

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

In all these cases a mandatory visit to a doctor is necessary. Only a thorough examination and a qualified assessment of the results obtained will allow your doctor to choose a 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 the nerves of the heart itself are damaged due to long-term elevated blood sugar. It is with the defeat of these nerves that the violation of the heart rhythm is associated. The symptoms of diabetic heart disease are as follows:

• sinus tachycardia even at rest with a fixed heart rate up to 90-100, and sometimes up to 130 beats per minute;
• lack of influence of breathing on the heart rate (normally, with a deep breath, a person's heart rate decreases). This indicates a weakening of the function of the parasympathetic nerves, which reduce the heart rate.

This state requires conducting a special survey with the performance of functional tests to assess the state of the nervous regulation of the heart and prophylactic use medicinespreventing the progression of neuropathy and reducing the effect of the sympathetic nervous system on the heart.

The regulation of the activity 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 - amplify and speed up the heart rate.

In diabetes mellitus, the parasympathetic nerves are primarily affected, so the heart rate increases. Subsequently, changes occur in the sympathetic division of the autonomic nervous system.

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

Consequently, if a stable tachycardia appears in diabetes mellitus, you should definitely consult a doctor for the timely prevention of the 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 in the eyes, flickering "flies". These sensations arise with a sharp change in body position, for example, when suddenly getting out of bed. They can pass on their own or lead to the need to take the original body position.

On the other hand, similar clinical manifestations, up to loss of consciousness, can occur with weakness of the sinus node, atrioventricular block, paroxysmal rhythm disturbances. Only a qualified specialist can determine the cause of the described clinical conditions, sometimes requiring rapid preventive and therapeutic measures.

The appearance of dizziness, darkening in the eyes, fainting conditions requires an urgent visit to a doctor.

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 drugs are injected during surgery. Therefore, prevention of neuropathy is also 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 glucose entry through the cell membrane into the heart muscle cells. As a result, most of the energy expenditure in the heart muscle is carried out through the use of free fatty acids. At the same time, there is an accumulation of under-oxidized fatty acids 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), reducibility disorders, atrial fibrillation, etc. However, the nature of these rhythm disturbances will require a slightly different treatment strategy than in diabetic neuropathy.

Diabetic microangiopathy in diabetes mellitus also affects the smallest vessels that feed 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 of diabetes mellitus is required.

Strict compensation of diabetes allows to prevent the appearance 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 eating.

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

Thus, we can conclude that heart rhythm disorders 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, self-treatment of heart rhythm disturbances is unacceptable. You should not listen to the advice of your friends or other patients who have previously been 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 establish the nature and cause of cardiac arrhythmias, 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, if he does not have any symptoms from the cardiovascular system, should periodically undergo examination 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 MCRTCHAH

Endocrinology: diseases, symptoms, diagnosis, treatment, more details

Heart damage in diabetes: causes and symptoms.

In diabetes mellitus, against the background of an increase in blood sugar levels (chronic hyperglycemia), a number of adverse changes occur in the peripheral nervous system.

In diabetes mellitus, against the background of an increase in blood sugar levels (chronic hyperglycemia), a number of adverse changes occur in the peripheral nervous system. The heart "obeys" the wrong commands and begins to work intermittently. Heart damage in diabetes mellitus is caused by a number of metabolic disorders in the heart muscle and its conduction system.

Cardiovascular form diabetic autonomic neuropathy manifests itself in the form of the following symptoms: heart palpitations occur (sinus tachycardia at rest), disturbed by interruptions (heart rate variability), myocardial infarction can proceed in a painless form, with a sharp rise, blood pressure drops (orthostatic arterial hypotension in), less often pain is present areas of the heart (cardialgia). Let us examine in detail these clinical signs of heart trouble.

Rapid heartbeat (sinus tachycardia) occurs normally when a person is nervous or has intense physical activity. In these cases, an accelerated heart rate is needed in order to provide organs and tissues with oxygen and nutrients. But with prolonged and / or poorly compensated diabetes mellitus, the heart is forced, for various reasons, to work constantly - day and night in an emergency mode. Normal heart rate is 60 - 70 beats per minute, i.e. every second the heart works, and with sinus tachycardia it works two or more times more intensively - the heart rate is sometimes 120 or more beats per minute. Even at night, when all organs and tissues are resting, the work of the heart continues at the same rhythm. If there is diabetic damage, then the heart is not able to increase the frequency of contractions, so that the organs and tissues involved in intensive work receive oxygen and nutrients in an increased volume.

Heart rate variability

In the cardiovascular form of diabetic autonomic neuropathy, arrhythmia can be observed, which is caused by fluctuations in the resistance of the peripheral vascular system - after all, it is controlled primarily by the nervous system.

Painless myocardial infarction

Any organ, if "it feels bad", gives its owner a "SOS" signal in the form of pain. Pain shows that something has happened to the organ and urgent help is needed. Myocardial infarction is a serious problem for the heart, it is not by chance that it is called a vascular catastrophe. With myocardial infarction, one of the most important manifestations that help a doctor make a correct diagnosis and start treatment in a timely manner is pain. It occurs both at rest (even during sleep) and during exercise. The pain builds up quickly and lasts 30 minutes or more. With diabetic autonomic neuropathy, pain does not manifest itself, so a person lives the same life: he performs normal, and sometimes increased physical activity, is nervous, rejoices. At the same time, the heart already has serious problems, which are very dangerous, because can end in sudden death.

Orthostatic arterial hypotension - hypotension (lowering the level of blood pressure). The human body is designed very intelligently, when organs and systems try to compensate or take on the load in case of "temporary disability" of the sick. This is clearly demonstrated with orthostatics, i.e. a sharp change in body position (transition from the "lying" position to the vertical). During this time, the blood vessels constrict, which would help lower blood pressure levels. But at the same time, the activity of a special - sympathetic - part of the nervous system increases and blood pressure does not decrease. Unfortunately, with long-term poorly compensated diabetes mellitus, the activity of this part of the nervous system is blocked.

How does orthostatic hypotension manifest?

Its symptoms are general weakness, fainting, dizziness. This is especially evident with a rapid transition from horizontal to vertical. In some cases, orthostatic hypotension is accompanied by prolonged headache and a sharp decrease in working capacity in morning hours... The intensity of the headache decreases after the transition to a horizontal position; a forced position when the head is below or at the level of the torso often relieves (many patients do not use a pillow).

The use of a standard set of drugs for the treatment of headaches (analgesics - analgin, spazgan, paracetamol, etc.) is ineffective.

In this regard, in addition to medications, some caution should be observed:

- avoid abrupt changes in body position;

- going to get out of bed, you need to sit and breathe deeply for a few seconds;

- when getting out of bed, stand quietly near her for a few seconds;

- carefully take diuretics and antihypertensive drugs (especially modern "two in one",

which have both hypotensive and diuretic effects);

- getting up from the chair, the chair also does not need to rush.

What can accelerate the development of lesions of the autonomic nervous system, including the cardiovascular form of diabetic autonomic neuropathy?

2. The duration of diabetes.

3. The presence of other complications of diabetes.

4. Overweight.

5. Arterial hypertension.

6. Smoking.

1. Of course, first of all, consultations of a neurologist and a cardiologist.

2. Questionnaires - the use of special questionnaires allows you to better understand and identify

the main signs of neuropathy.

3. It is very important to do an ECG: this study can identify or suspect painless

myocardial infarction or cardiac arrhythmias (sinus tachycardia and / or arrhythmia).

4. ECHO-cardiogram will allow to evaluate a number of necessary parameters of the functional state

heart muscle.

5. Conducting specific tests - a test using adrenergic blockers, a test with insulin, tests with physical activity.

These tests assess the role of the autonomic nervous system in maintaining homeostasis.

6. Electroneuromyographic research. This method includes a set of relatively independent techniques aimed at diagnosing a still preclinical form of diabetic neuropathy.

7. Carrying out cardiovascular tests - with deep breathing, orthostatic test (Shelong test), Valsalva's test, etc.

What should be done so that the cardiovascular form of diabetic autonomic neuropathy manifests itself as late as possible and what treatment is prescribed?

1. First of all, you need to achieve stable compensation for diabetes.

2. Self-monitoring of glucose levels on a regular basis is very important.

3. Constant relationship with the attending physician, under whose supervision the treatment of diabetes mellitus is carried out.

In the arsenal of modern medicines there are a number of drugs that are used in the treatment of diabetic neuropathy. These include antioxidants, alpha-reductase inhibitors, vasodilators, antiplatelet agents, anticoagulants, lipoic acid preparations, etc. Only the attending physician can choose a drug, prescribe a course of treatment - do not self-medicate!

Heart lesions are frequent and unfavorable in terms of prognosis complications of diabetes mellitus. In such patients, coronary insufficiency comes to the fore. Let's consider the main features of heart lesions in diabetes and methods of their treatment.

Impact of diabetes on the heart and blood vessels

Heart damage in diabetes mellitus is observed in many patients. About half of patients develop a heart attack. Moreover, with diabetes, this disease occurs in persons of relatively young age.

Disturbances in the work of the heart, pain are primarily associated with the fact that large amounts of sugar in the body lead to the deposition of cholesterol on the walls of blood vessels. There is a gradual narrowing of the vascular lumen. This is how atherosclerosis develops.

Under the influence of atherosclerosis, the patient develops ischemic heart disease. Patients are often worried about pain in the heart. I must say that against the background of diabetes, it is much more difficult. And as the blood gets thicker, there is an increased risk of blood clots.

People with diabetes are much more likely to have high blood pressure. It causes complications after myocardial infarction, the most common of which is aortic aneurysm. With impaired healing of postinfarction scar in patients, the risk of sudden death increases significantly. The risk of repeated heart attacks also increases.

What is a "diabetic heart"

Diabetic cardiopathy is a condition of dysfunction of the heart muscle in patients with impaired diabetes compensation. Often, the disease has no pronounced symptoms, and the patient feels only aching pain.

There are cardiac arrhythmias, in particular, tachycardia, bradycardia. The heart cannot pump blood normally. From increased loads, it gradually grows in size.

The manifestations of this disease are as follows:

exercise-related heart pain; an increase in edema and shortness of breath; patients are worried about pain that does not have a clear localization.

In young people, diabetic cardiopathy is often asymptomatic.

Risk factors in people with diabetes

If a person develops diabetes, then under the influence of negative factors, the risk of developing cardiovascular diseases increases markedly. These factors are:

if among the relatives of a diabetic someone has a heart attack; with increased body weight; if the waist circumference is increased, this indicates the so-called central obesity, which occurs as a result of an increase in the amount of cholesterol in the blood; an increase in the level of triglycerides in the blood; frequent increase in blood pressure; smoking; drinking a lot of alcoholic beverages.

Myocardial infarction in diabetes mellitus

Ischemic disease in diabetes mellitus threatens the patient's life with many dangerous complications. And myocardial infarction is no exception: among patients with diabetes mellitus, a high frequency of death has been observed.

Features of myocardial infarction in diabetic patients are as follows.

Pain radiating to the neck, shoulder, shoulder blade, jaw. It is not stopped by taking nitroglycerin. Nausea, sometimes vomiting. Be careful: these signs are often mistaken for food poisoning. Heartbeat disorder. Near chest and a sharp pain of a constricting character appears in the heart. Pulmonary edema.

Angina pectoris in diabetes mellitus

With diabetes, the risk of angina pectoris doubles. This disease is manifested by shortness of breath, palpitations, weakness. The patient is also worried about increased sweating. All these symptoms are relieved by nitroglycerin.

Angina pectoris in diabetes mellitus has such features.

The development of this disease depends not so much on the severity of diabetes as on its duration. Angina pectoris in diabetics occurs much earlier than in individuals who do not have abnormalities in the level of glucose in the body. Pain with angina pectoris is usually less severe. In some patients, it may not appear at all. In many cases, patients develop heart rhythm dysfunctions that are often life-threatening.

Development of heart failure

Against the background of diabetes mellitus, patients may develop heart failure. It has many flow features. For a doctor, the treatment of such patients is always associated with certain difficulties.

Heart failure in diabetic patients manifests itself at a much younger age. Women are more susceptible to disease than men. The high prevalence of heart failure has been proven by many researchers.

The clinical picture of the disease is characterized by the following symptoms:

an increase in the size of the heart; the development of edema with blue limbs; shortness of breath caused by fluid congestion in the lungs; dizziness and increased fatigue; cough; increased urge to urinate; weight gain caused by fluid retention in the body.

Medication for the heart in diabetes mellitus

For the treatment of heart diseases caused by diabetes mellitus, drugs of such groups are used.

Antihypertensive drugs. The goal of treatment is to achieve blood pressure values \u200b\u200bless than 130/90 mm. However, if heart failure is complicated by renal impairment, even lower blood pressure is recommended. ACE inhibitors. A significant improvement in the prognosis of the course of heart disease has been proven with the regular use of such funds. Angiotensin receptor blockers are able to stop the hypertrophy of the heart muscle. They are prescribed for all groups of patients with heart disorders. Beta blockers can decrease the heart rate and lower blood pressure. Nitrates are used to relieve a heart attack. Cardiac glycosides are used to treat atrial fibrillation and severe edema. However, at present, the area of \u200b\u200btheir application is significantly narrowing. Anticoagulants are given to reduce the viscosity of the blood. Diuretics - prescribed to eliminate edema.

Operative treatment

Many patients are interested in whether bypass surgery is performed as a treatment for heart failure. Yes, it is carried out, because bypass surgery gives a real chance to eliminate obstacles in the blood flow and improve the functioning of the heart.

The indications for surgery are:

chest pain; arrhythmia attack; progressive angina; increased edema; suspicion of a heart attack; abrupt changes in the cardiogram.

Radical elimination of heart disease in diabetes mellitus is possible with prompt treatment. The operation (including bypass surgery) is performed using modern methods of treatment.

Surgery for heart failure includes these.

Balloon vasodilation. It removes the narrowed area of \u200b\u200bthe artery that feeds the heart. For this, a catheter is inserted into the arterial lumen, through which a special balloon is brought to the narrowed area of \u200b\u200bthe artery. Coronary artery stenting. A special mesh construction is inserted into the lumen of the coronary artery. It prevents the formation of cholesterol plaques. This operation does not lead to significant trauma to the patient. Coronary artery bypass grafting allows you to create an additional path for blood and significantly reduces the likelihood of recurrence. The implantation of a pacemaker is used for diabetic cardiac dystrophy. The device reacts to all changes in cardiac activity and corrects it. The risk of arrhythmias is significantly reduced.

The goal of treating any violation of heart activity is to bring its indicators to the physiological norm as much as possible. This can prolong the patient's life and reduce the risk of further complications.

Many patients with diabetes mellitus have heart damage. Therefore, almost 50% of people have a heart attack. Moreover, such complications can develop even at an early age.

Heart failure in diabetes mellitus is associated with a high glucose content in the body, due to which cholesterol is deposited on the vascular walls. This leads to a slow narrowing of their lumen and the appearance of atherosclerosis.

Against the background of atherosclerosis, many diabetics develop coronary heart disease. Moreover, with an elevated glucose level, pain in the area of \u200b\u200bthe organ is more difficult to tolerate. Also, due to thickening of the blood, the likelihood of thrombosis increases.

In addition, blood pressure can often rise in diabetics, which contributes to complications after a heart attack (aortic aneurysm). In the case of poor regeneration of the post-infarction scar, the likelihood of repeated heart attacks or even death increases significantly. Therefore, it is extremely important to know what heart disease is in diabetes mellitus and how to treat such a complication.

Causes of heart complications and risk factors

Life expectancy in diabetes is shortened due to persistently high blood glucose levels. This condition is called hyperglycemia, which directly affects the formation of atherosclerotic plaques. The latter narrow or block the lumen of the vessels, which leads to ischemia of the heart muscle.

Most doctors are convinced that an excess of sugar provokes dysfunction of the endothelium - an area of \u200b\u200baccumulation of lipids. As a result, the walls of the vessels become more permeable and plaques are formed.

Hyperglycemia also contributes to the activation of oxidative stress and the formation of free radicals, which also have a negative effect on the endothelium.

After a number of studies, a relationship was established between the likelihood of coronary heart disease in diabetes mellitus and an increase in glycated hemoglobin. Therefore, if HbA1c increases by 1%, then the risk of ischemia increases by 10%.

Diabetes mellitus and cardiovascular diseases will become interrelated concepts if the patient is exposed to adverse factors:

obesity; if any of the relatives of the diabetic had a heart attack; often elevated blood pressure; smoking; alcohol abuse; the presence of cholesterol and triglycerides in the blood.

What kind of heart diseases can complicate diabetes?

Sugar level

Most often, with hyperglycemia, diabetic cardiomyopathy develops. The disease appears when the myocardium malfunctions in patients with impaired diabetes compensation.

Often, the disease is almost asymptomatic. But sometimes the patient is worried about aching pain and arrhythmic heartbeat (tachycardia, bradycardia).

In this case, the main organ stops pumping blood and functions in an intensive mode, which is why its size increases. Therefore, this condition is called diabetic heart. Pathology in adulthood can be manifested by wandering painful sensations, swelling, shortness of breath and chest discomfort that occurs after exercise.

Ischemic heart disease in diabetes mellitus develops 3-5 times more often than in healthy people. It is noteworthy that the risk of CHD does not depend on the severity of the underlying disease, but on its duration.

Ischemia in diabetics often proceeds without pronounced signs, which often leads to the development of painless heart attack. Moreover, the disease proceeds in waves, when acute attacks are replaced by a chronic course.

The peculiarities of ischemic heart disease are that after hemorrhage in the myocardium, against the background of chronic hyperglycemia, cardiac syndrome, heart failure and damage to the coronary arteries begin to develop rapidly. The clinical picture of ischemia in diabetics:

dyspnea; arrhythmia; labored breathing; pressing pains in the heart; anxiety associated with fear of death.

The combination of ischemia with diabetes can lead to the development of myocardial infarction. Moreover, such a complication has some features, such as disturbed heartbeat, pulmonary edema, heart pain, radiating to the collarbone, neck, jaw or scapula. Sometimes the patient has acute squeezing pain in the breasts, nausea and vomiting.

Unfortunately, many patients have a heart attack because they are unaware of diabetes. Meanwhile, the effects of hyperglycemia lead to fatal complications.

Diabetics are twice as likely to develop angina. Its main manifestations are rapid heartbeat, malaise, sweating, and shortness of breath.

Angina pectoris associated with diabetes mellitus has its own characteristics. So, its development is influenced not by the severity of the underlying disease, but by the duration of heart damage. In addition, in patients with high blood sugar, insufficient blood supply to the myocardium develops much more rapidly than in healthy people.

Many diabetics have little or no angina symptoms. At the same time, they often have heart rhythm disruptions, which often ends in death.

Another consequence of type 2 diabetes mellitus is heart failure, which, like other cardiac complications arising from hyperglycemia, has its own specifics. So, CHF with high sugar often develops at an early age, especially in men. The characteristic symptoms of the disease include:

swelling and blue discoloration of the limbs; enlargement of the heart in size; frequent urination; fast fatiguability; an increase in body weight, which is explained by fluid retention in the body; dizziness; dyspnea; cough.

Diabetic myocardial dystrophy also leads to an irregular heartbeat. Pathology arises from a malfunction in metabolic processes provoked by insulin deficiency, which makes it difficult for glucose to pass through the myocardial cells. As a result, oxidized fatty acids accumulate in the heart muscle.

The course of myocardial dystrophy leads to the occurrence of foci of conduction disturbances, flickering arrhythmias, extrasystole or parasystole. Also, microangiopathy in diabetes contributes to the defeat of small vessels that feed the myocardium.

Sinus tachycardia occurs with nervous or physical strain. After all, the accelerated work of the heart is necessary to provide the organ with nutrients and oxygen. But if blood sugar continues to rise, then the heart is forced to work in an enhanced mode.

However, in diabetics, the myocardium cannot rapidly contract. As a result, oxygen and nutrients are not supplied to the heart, which often leads to heart attack and death.

Heart rate variability can develop in diabetic neuropathy. For such a state of nature, arrhythmia arising from fluctuations in the resistance of the peripheral vascular system, which must be controlled by the NS.

Orthostatic hypotension is another diabetic complication. They are manifested by a decrease in blood pressure. Signs of hypertension are dizziness, faintness, and fainting. It is also characterized by weakness upon awakening and a constant headache.

Since with a chronic increase in blood sugar there are a lot of complications, it is important to know how to strengthen the heart in diabetes and what treatment to choose if the disease has already developed.

Drug therapy for heart disease in diabetics

The basis of treatment is to prevent the development of possible consequences and stop the progression of existing complications. To do this, it is important to normalize fasting glycemia, control sugar levels and prevent them from rising even 2 hours after eating.

For this purpose, in type 2 diabetes, agents from the biguanide group are prescribed. These are Metformin and Siofor.

The influence of Metformin is due to its ability to inhibit gluconeogenesis, activate glycolysis, which improves the secretion of pyruvate and lactate in muscle and adipose tissues. Also, the drug prevents the development of smooth muscle proliferation of the vascular walls and has a beneficial effect on the heart.

The initial dosage of the drug is 100 mg per day. However, there are a number of contraindications to taking the medication, especially those who have liver damage should be careful.

Also, with type 2 diabetes, Siofor is often prescribed, which is especially effective when diet food and exercise is not conducive to weight loss. The daily dose is selected individually depending on the glucose concentration.

In order for Siofor to be effective, its amount is constantly evaded - from 1 to 3 tablets. But the maximum dose of the drug should be no more than three grams.

Siofor is contraindicated in insulin-dependent type 1 diabetes, myocardial infarction, pregnancy, heart failure and severe lung disease. Also, the drug is not taken if the liver, kidneys are poorly functioning and in a state of diabetic coma. In addition, Siofor should not be drunk if children or patients over 65 years of age are being treated.

To get rid of angina pectoris, ischemia, to prevent the development of myocardial infarction and other cardiac complications that occur in diabetes, it is necessary to take various groups of drugs:

Antihypertensive drugs. ARBs - preventing myocardial hypertrophy. Beta-blockers - normalizing the frequency of heart contractions and normalizing blood pressure. Diuretics - reduce swelling. Nitrates - stop a heart attack. ACE inhibitors - have a general strengthening effect on the heart; Anticoagulants - make the blood less viscous. Glycosides - indicated for edema and atrial fibrillation.

Increasingly, with type 2 diabetes, accompanied by heart problems, the attending physician prescribes Dibikor. It activates metabolic processes in tissues, providing them with energy.

Dibikor has a beneficial effect on the liver, heart and blood vessels. In addition, after 14 days from the start of taking the drug, there is a decrease in blood sugar concentration.

Treatment with the drug for heart failure consists in taking tablets (250-500 mg) 2 r. per day. Moreover, it is recommended to drink Dibikor in 20 minutes. before eating. The maximum amount of a daily dose of the drug is 3000 mg.

Dibikor is contraindicated in childhood during pregnancy, lactation and in case of taurine intolerance. In addition, Dibikor should not be taken with cardiac glycosides and CCBs.

Surgical treatments

Many diabetics are concerned about how to treat heart failure with surgery. Radical treatment is performed when strengthening the cardiovascular system with drugs has not brought the desired results. The indications for surgical procedures are:

changes in the cardiogram; if the chest area constantly hurts; swelling; arrhythmia; suspicion of a heart attack; progressive angina pectoris.

Surgery for heart failure includes balloon vasodilation. With its help, the area of \u200b\u200bnarrowing of the artery, which feeds the heart, is eliminated. During the procedure, a catheter is inserted into the artery, through which a balloon is brought to the problem area.

Coronary stenting is often done, when a mesh structure is inserted into the artery, which prevents the formation of cholesterol plaques. And with coronary artery bypass grafting, additional conditions are created for free blood flow, which significantly reduces the risk of recurrence.

In the case of diabetic cardiac dystrophy, surgical treatment with the implantation of a pacemaker is indicated. This device records any changes in the work of the heart and instantly corrects them, which reduces the likelihood of arrhythmias.

However, before carrying out these operations, it is important not only to normalize the glucose concentration, but also to compensate for diabetes. Since even a minor intervention (for example, opening an abscess, removing a nail), which is performed in the treatment of healthy people on an outpatient basis, for diabetics is performed in a surgical hospital.

Moreover, before significant surgical intervention, patients with hyperglycemia are transferred to insulin. In this case, the introduction of simple insulin (3-5 doses) is indicated. And during the day, it is important to control glycosuria and blood sugar.

Since heart disease and diabetes are compatible concepts, people with glycemia need to regularly monitor the functioning of the cardiovascular system. It is equally important to control how much blood sugar has increased, because with severe hyperglycemia, a heart attack can occur, leading to death.

The video in this article continues the topic of heart disease in diabetes.

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The term "diabetic cardiomyopathy" was first proposed in 1954 to denote cardiac changes preceding coronary heart disease.

Pathogenesis

The pathogenesis of metabolic cardiomyopathy in diabetes mellitus is multifactorial; damage to the cardiovascular system is caused by complex metabolic disorders arising from absolute or relative insulin deficiency and impaired glucose tolerance.

The pathogenesis of myocardial disorders includes several main mechanisms: damage to cardiomyocytes, microcirculatory and neurovegetative disorders. The first mechanism is associated with a violation of the metabolism of cardiomyocytes, a decrease in the efficiency of energy, plastic processes and a change in ionic metabolism, as a result of which the compensatory capabilities of the cardiovascular system are reduced, the contractile function of the myocardium is impaired, and tolerance to physical activity decreases. The second mechanism is based on microcirculatory disorders in small myocardial arteries as a local manifestation of generalized microangiopathy. The third mechanism includes damage to the autonomic nervous system as a result of the formation of neurovegetodystrophy.

Cardiomyopathy, not caused by impaired coronary circulation, occurs in young patients with juvenile diabetes mellitus, for whom the development of severe atherosclerosis is uncharacteristic, or in older patients without concomitant coronary artery disease.

Insulin has a direct effect on the heart, which is to increase the supply and stimulate the oxidation of glucose and lactate, increase the formation of glycogen in the myocardium. The indirect effect of insulin is to reduce the content of fatty acids in the blood plasma, reducing their supply to the heart.

Insulin deficiency causes impaired glucose utilization by tissues and enhances the breakdown of lipids and proteins, and also leads to pronounced changes in the composition of the internal environment of the body - hyperglycemia, hyperketonemia, hyperlipidemia with accumulation of fatty acids in the blood, dysproteinemia, metabolic acidosis, oxidative stress causes apoptosis of myocytes. These disorders are the determining factors in changes in the structure and function of the myocardium.

The pathogenesis and morphogenesis of diabetic heart disease are caused not only by the influence of hyperinsulinemia on the vascular endothelium, energy and metabolic processes in the myocardium, but are also directly related to toxic-metabolic damage to cardiomyocytes.

It is believed that the cause of the destruction of the structures of cardiomyocytes, disruption of the structure of the sarcolemma and its derivatives, changes in ionic equilibrium and a decrease in the activity of the actomyosin complex of cardiomyocytes is direct glucose toxicity.

Tissue hypoxia plays an important role in the pathogenesis of cardiomyopathy. Of great importance in the development of hypoxia is the violation of oxygen transport by the blood, the function of respiratory enzymes under the influence of pronounced acidosis. With diabetes mellitus, the need for tissues, including the myocardium, for oxygen is increased.

An important factor in the development of myocardial dystrophy is a violation of the neuroendocrine regulation of the heart, associated with the predominance of the effects of counterinsular hormones. It has been proven that patients experience an increase in the production of adrenocorticotropic and somatotropic hormones, as well as glucocorticoids, catecholamines and glucagon, which leads to the initiation of a whole group of metabolic and ultrastructural processes that cause the development of metabolic cardiomyopathy.

The pathogenesis of increased myocardial stiffness is associated with impaired calcium transport, electromechanical imbalance, accompanied by asynchronous relaxation and mechanical factors.

Pathological anatomy

Characterized by myocardial fibrosis associated with impaired intracellular metabolism of nitric oxide and calcium, as well as proliferative processes caused by the action of insulin and IGF. The morphological basis of myocardial dystrophy in diabetes mellitus is microangiopathy, characterized by infiltration by mast cells and fibrinoid swelling of the walls of small vessels. Morphological examination reveals the development of apoptotic degeneration, the loss of synaptic vesicles, the appearance of large vacuoles in the cytoplasm of the cells of the sympathetic ganglia. During histochemical study, glycoprotein deposits are determined in the vessel walls. At the ultrastructural level, a thickening of the basement membrane of the vascular wall is determined. Great importance is attached to the disorganization of the muscle fibers of the hypertrophied myocardium.

Clinical presentation and diagnosis

Patients with juvenile diabetes mellitus occasionally notice stabbing pain in the region of the heart. The onset of rest tachycardia is associated with damage to the vagus nerve and the relative predominance of the tone of the sympathetic part of the autonomic nervous system. Tachycardia is accompanied by ineffective myocardial contractions, which leads to depletion of energy resources and ultimately to a decrease in myocardial contractile function and the development of heart failure.

The size of the heart is within normal limits. Some muffling of heart sounds and systolic murmur at the apex are more often noted in patients with diabetes mellitus for more than 5 years. Further, hyperglycemia and insulin resistance are associated with an increase in LV mass and the onset of HF symptoms.

On the ECG, sinus tachycardia or bradycardia, ventricular extrasystolic arrhythmia, disturbances in repolarization processes are noted: displacement of the BT segment, change in amplitude, inversion, flattening, smoothness or biphasicity of the T wave, violation of intraventricular conduction.

With echocardiography, the earliest sign of myocardial damage in diabetes mellitus is impaired diastolic function, which is noted in 27-69% of asymptomatic patients.

On a blood test, the fasting plasma glucose level is\u003e 7.0 mmol / L.

One of the main objectives of the treatment of patients with diabetic cardiomyopathy is the prevention of further progression of myocardial damage and the development of heart failure. It is important to combat risk factors: smoking, obesity, sedentary lifestyle, unbalanced diet. Lifestyle recommendations should include rationale for an appropriate low-calorie diet for weight loss, smoking cessation, regular physical exercise.

An important task is the normalization of metabolism, which includes the achievement of target levels of glucose, aglucosuria, normalization of the level of glycated hemoglobin. Regular physical activity can reduce insulin resistance, increase glucose tolerance, promote the utilization of blood glucose and free fatty acids in the muscles, and have a beneficial effect on the functioning of the cardiovascular system.

Pharmacotherapy of type II diabetes mellitus is aimed at increasing insulin secretion, reducing insulin resistance and is represented by drugs with various mechanisms of action: biguanides, sulfonylurea derivatives, glitazones, glinides, α-glucosidase inhibitors, insulin. The use of metformin improves blood glucose control in patients with diabetes mellitus and reduces overall mortality by 36%.

To restore metabolic disorders in the myocardium, preparations of a-lipoic acid are prescribed, which activates mitochondrial enzymes, increases glucose oxidation, slows down gluconeogenesis and ketogenesis, as an antioxidant protects cells from the damaging effects of free radicals. Also used drugs that help correct metabolic disorders in the myocardium: trimetazidine, trimethylhydrazinium propionate.