This review addresses clinical picture of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM), the corre- sponding epidemiology data, morphological characteristics and prognosis. ACS in patients with T2DM features fulminant development, and its high lethality is due to chronic ischemic alterations in myocardium (the so-called ?metabolic ischemia?), as well as concomitant microangiopathy. It is more common for patients with T2DM to develop such complications of ACS as cardiogenic shock, acute left ventricular failure and arrhythmia that result in increased lethality during early hours of hospital admission when myocardial necrosis is yet to occur. Percutaneous translumenal intervention is by far the most effective method of ACS management in patients with T2DM. Whenever it is not available, a thrombolytic approach is indicated.
2 diabetes mellitus (T2DM). Dyspnea during physical exertion should be considered an anginal equivalent in patients with T2DM, and suffocation causing admission to ICU ? as a possible sign of myocardial infarction. Proximal and distal coronary lesions combined with diabetic microangiopathy compromising collateral circulation are a frequent finding in these patients. Therefore an infusion of nitroglycerine may yield a rapid improvement in their condition. Treatment with low-molecular-weight heparin (LMWH) should be administered for a longer period due to rheological disturbances in T2DM. Diabetic patients with a history of myocardial infarction (MI) should receive a life-long therapeutic combination of two different antiplatelet agents. Carvedilol, a non-selective beta blocker/ alpha-1 blocker, and selective beta-1 blockers (e.g. nebivolol, bisoprolol) have better safety profile than other beta blockers concerning neurological aspects of hypoglycemic events.
Influence of carbohydrate metabolism disturbance depending on expressiveness, degree of severity and type of glucose lowering therapy to current of ischemic heart disease are presented in article. Acute coronary syndrome outcomes to Q-forming and non-Q-forming myocardial infarction, unstable stenocardia, and complications to acute left ventricular aneurysm, frequency of progress pulmonary edema were analyzed in patients with normal and impaired carbohydrate metabolism.
The article presents a literature review of prevalence, prognosis and treatment of overt tactics of chronic heart failure (CHF) in patients with type 2 diabetes mellitus (T2DM). Diabetes and heart failure acquire the status of the epidemic of the XXI century and require health care costs for prevention and treatment of these diseases. Application of modern pharmacological preparations and instrumental treatment of cardiovascular disease (CVD) increases life expectancy and improves the quality of life of patients with CHF as with normal carbohydrate metabolism (UO), and with type 2 diabetes. However, the risk of cardiovascular mortality (CAS) in patients with type 2 diabetes, compared to having a normal carbohydrate metabolism remains unchanged. The rapidly growing population of patients with type 2 diabetes will soon change this in recent years to improve representation treatment prognosis of cardiovascular disease. Violation of myocardial remodeling in type 2 diabetes is caused by a combination of factors associated with diabetic cardiomyopathy. Reduction of the metabolic activity of cardiomyocytes insufficient glucose transport into cells, endothelial dysfunction, diabetic macro and microangiopathy myocardial fibrosis leading to disruption of filling the left ventricle (LV) and the development of chronic heart failure.Insulin resistance (IR) and compensatory hyperinsulinemia (GI) play a key role in the pathogenesis of type 2 diabetes. With effective treatment of chronic heart failure by cardiologists in patients with type 2 diabetes, affecting therapy with insulin resistance should be mandatory.
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