Skip to Main Content

KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Diabetes mellitus type 2

  • Unexplained heart failure without hypertension, valvular disease, or large epicardial coronary artery disease

  • Left ventricular hypertrophy with predominantly diastolic dysfunction by echocardiography

GENERAL CONSIDERATIONS

  • In addition to being a risk factor for macrovascular atherosclerosis, diabetes (especially type 2 diabetes) produces a microvascular disease that can involve the heart, leading to left ventricular hypertrophy and heart failure with preserved left ventricular systolic function

  • Microvascular disease is associated with endothelial dysfunction

  • Insulin sensitivity, lipid-lowering agents, and angiotensin-modulating drugs may improve endothelial function

  • Because diabetics can have painless myocardial infarction, macrovascular coronary artery disease must be excluded in diabetics with heart failure

  • Diabetes frequently coexists with hypertension, which can lead to left ventricular hypertrophy and heart failure

  • Type 1 diabetes is associated with autoimmune myocyte death, which can lead to heart failure with reduced left ventricular systolic function

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Dyspnea, fatigue

  • Chest pain

PHYSICAL EXAM FINDINGS

  • Hypertension in some

  • Left ventricular lift

  • S3 or S4

DIFFERENTIAL DIAGNOSIS

  • Atherosclerotic cardiovascular disease with silent infarction

  • Hypertensive heart disease

  • Other causes of heart failure

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • Glucose, hemoglobin A1c

  • Lipid panel

  • Liver function tests

  • Creatinine, electrolytes

  • B-type natriuretic peptide, troponin

ELECTROCARDIOGRAPHY

  • ECG findings:

    • – Left ventricular hypertrophy

    • – Left atrial abnormality

IMAGING STUDIES

  • Echocardiogram:

    • – Left ventricular, left atrial enlargement

    • – Systolic and diastolic dysfunction may be seen

DIAGNOSTIC PROCEDURES

  • Coronary angiography may be necessary to exclude macrovascular coronary artery disease

TREATMENT

CARDIOLOGY REFERRAL

  • Suspected cardiac disease

HOSPITALIZATION CRITERIA

  • Heart failure

  • Significant tachyarrhythmias

MEDICATIONS

  • Tight control of blood glucose (hemoglobin A1c < 7.0%)

  • Angiotensin-converting enzyme inhibitors titrated to achieve blood pressure < 130/85 mm Hg

  • Correction of dyslipidemia

  • Diuretics as needed

  • Other heart failure treatment as required

  • Aspirin 81 mg/day PO

THERAPEUTIC PROCEDURES

  • Percutaneous coronary revascularization may be indicated in some

SURGERY

  • Coronary bypass surgery may be required

MONITORING

  • ECG monitoring in hospital

DIET AND ACTIVITY

  • Diabetic diet plus low-sodium diet

  • Exercise as tolerated

ONGOING MANAGEMENT

HOSPITAL DISCHARGE CRITERIA

  • Resolution of problem

  • After successful procedure or surgery

FOLLOW-UP

  • Careful management of diabetes is important

COMPLICATIONS

  • Heart failure

  • Serious arrhythmias

  • Myocardial ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.