The Effects Of Ivabradine On Cardiac Function After Myocardial Infarction Are Weaker In Diabetic Rats
The Effects of Ivabradine on Cardiac Function after Myocardial Infarction are Weaker in Diabetic Rats Cao X.a Sun Z.b Zhang B.c Li X.a Xia H.a Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, 37 Yiyuan Street, Nangang District, Harbin, Heilongjiang Province, (China) Tel. +86 0451-85939362, E-Mail [email protected] Background/Aims: Plasma norepinephrine (NE) and brain natriuretic peptide (BNP, termed BNP-45 in rats) are considered as essential neurohormones indicating heart failure progression. The purposes of this study were to examine the effects of ivabradine (IBD) on cardiac function and plasma NE and BNP-45 after chronic ischemic heart failure (CHF) in non-diabetic rats and diabetic rats. We further determined if sympathetic NE uptake-1 (a major pathway to metabolize NE) mechanism is responsible for the role played by IBD. Methods: We ligated rat's coronary artery to induce CHF; and injected streptozotocin (STZ) to induce diabetic hyperglycemia. Echocardiography was employed to determine cardiac function. We used ELISA to examine plasma NE and BNP-45; and Western Blot analysis to examine the protein levels of NE uptake-1 in sympathetic nerves. Results: CHF increased the levels of NE and BNP-45 in non-STZ rats and STZ rats. Systemic injection of IBD significantly attenuated the augmented NE and BNP-45 and impaired left ventricular function induced by CHF in those rats. This effect appeared to be less in STZ rats. A liner relation was observed between the NE/BNP-45 levels and left ventricular function after administration of IBD. Also, IBD was observed to have a recovery effect on the downregulated NE uptake-1 evoked by CHF, but to a smaller degree in STZ rats. Conclusion: Our data revealed specific signaling mechanisms by Continue reading >>
Fasting Hyperglycemia Increases In-hospital Mortality Risk In Nondiabetic Female Patients With Acute Myocardial Infarction: A Retrospective Study
International Journal of Endocrinology Volume 2014 (2014), Article ID 745093, 8 pages Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China Academic Editor: Alexandra Kautzky-Willer Copyright © 2014 Guojing Luo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Previous studies had shown that elevated admission plasma glucose (APG) could increase mortality rate and serious complications of acute myocardial infarction (AMI), but whether fasting plasma glucose (FPG) had the same role remains controversial. In this retrospective study, 253 cases of AMI patients were divided into diabetic () and nondiabetic group (). Our results showed that: compared with the nondiabetic patients, diabetic patients had higher APG, FPG, higher plasma triglyceride, higher rates of painless AMI (), non-ST-segment elevation myocardial infarction (NSTEMI), and reinfraction (). They also had lower high density lipoprotein cholesterol and rate of malignant arrhythmia, but in-hospital mortality rate did not differ significantly (). While nondiabetic patients were subgrouped in terms of APG and FPG (cut points were 11.1 mmol/L and 7.0 mmol/L, resp.), the mortality rate had significant difference (), whereas glucose level lost significance in diabetic group. Multivariate logistic regression analysis showed that FPG (OR: 2.014; 95% confidence interval: 1.296–3.131; ) but not APG was independent predictor of in-hospital mortality for nondiabetic patients. These results indicate that FPG can be an independent predictor for mortality in nondiab Continue reading >>
:: Dmj :: Diabetes & Metabolism Journal
Korean Diabetes J. 2009 Jun;33(3):225-231. English. Published online Jun 30, 2009. Copyright 2009 Korean Diabetes Association Frequency of Silent Myocardial Ischemia Detected by Thallium-201 SPECT in Patients with Type 2 Diabetes Dong Woo Kim,1Eun Hee Jung,1Eun Hee Koh,1Min Seon Kim,1Joong Yeol Park,1Seung Whan Lee,2Seong Wook Park,2Jin Sook Ryu,3 and Ki Up Lee 1Department of Endocrinology and Metabolism, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 3Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Corresponding author (Email: [email protected] ) Kannel WB, McGee DL. Diabetes and cardiovascular disease: the Framingham Study. JAMA 1979;241:20352038. Jacoby RM, Nesto RW. Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. J Am Coll Cardiol 1992;20:736744. Cohn PF. Silent myocardial ischemia. Ann Intern Med 1988;109:312317. Koistinen MJ. Prevalence of asymptomatic myocardial ischaemia in diabetic subjects. BMJ 1990;301:9295. Milan Study on Atherosclerosis and Diabetes (MiSAD) Group. Prevalence of unrecognized silent myocardial ischemia and its association with atherosclerotic risk factors in noninsulin-dependent diabetes mellitus. Am J Cardiol 1997;79:134139. Chipkin SR, Frid D, Alpert JS, Baker SP, Dalen JE, Aronin N. Frequency of painless myocardial ischemia during exercise tolerance testing in patients with and without diabetes mellitus. Am J Cardiol 1987;59:6165. Callaham PR, Froelicher VF, Klein J, Risch M, Dubach P, Friis R. Exercise-induced silent ischemia: age, diabetes mellitus, previous myocardial infarction and prognosis. Continue reading >>
Cardiovascular Complications Of Ketoacidosis
US Pharm. 2016;41(2):39-42. ABSTRACT: Ketoacidosis is a serious medical emergency requiring hospitalization. It is most commonly associated with diabetes and alcoholism, but each type is treated differently. Some treatments for ketoacidosis, such as insulin and potassium, are considered high-alert medications, and others could result in electrolyte imbalances. Several cardiovascular complications are associated with ketoacidosis as a result of electrolyte imbalances, including arrhythmias, ECG changes, ventricular tachycardia, and cardiac arrest, which can be prevented with appropriate initial treatment. Acute myocardial infarction can predispose patients with diabetes to ketoacidosis and worsen their cardiovascular outcomes. Cardiopulmonary complications such as pulmonary edema and respiratory failure have also been seen with ketoacidosis. Overall, the mortality rate of ketoacidosis is low with proper and urgent medical treatment. Hospital pharmacists can help ensure standardization and improve the safety of pharmacotherapy for ketoacidosis. In the outpatient setting, pharmacists can educate patients on prevention of ketoacidosis and when to seek medical attention. Metabolic acidosis occurs as a result of increased endogenous acid production, a decrease in bicarbonate, or a buildup of endogenous acids.1 Ketoacidosis is a metabolic disorder in which regulation of ketones is disrupted, leading to excess secretion, accumulation, and ultimately a decrease in the blood pH.2 Acidosis is defined by a serum pH <7.35, while a pH <6.8 is considered incompatible with life.1,3 Ketone formation occurs by breakdown of fatty acids. Insulin inhibits beta-oxidation of fatty acids; thus, low levels of insulin accelerate ketone formation, which can be seen in patients with diabetes. Extr Continue reading >>
Myocardial Infarctionclinical Presentation
Myocardial InfarctionClinical Presentation Author: A Maziar Zafari, MD, PhD; Chief Editor: Eric H Yang, MD more... The patients history is critical in diagnosing myocardial infarction (MI) and sometimes may provide the only clues that lead to the diagnosis in the initial phases of the patient presentation. Patients with typical acute MI usually present with chest pain andmay have prodromal symptoms of fatigue, chest discomfort, or malaise in the days preceding the event; alternatively, typical ST-elevation MI (STEMI) may occur suddenly without warning. The typical chest pain of acute MI usually is intense and unremitting for 30-60 minutes. It is retrosternal and often radiates up to the neck, shoulder, and jaws, and down to the left arm. The chest pain is usually described as a substernal pressure sensation that is also perceived as squeezing, aching, burning, or even sharp. In some patients, the symptom is epigastric, with a feeling of indigestion or of fullness and gas. In some cases, patients do not recognize the chest pain, have an unusually high pain threshold, or have a disorder that impairs pain perception and results in a defective anginal warning system (eg, diabetes mellitus). In addition, some patients may have an altered mental status caused by medications or impaired cerebral perfusion. Elderly patients with preexisting altered mental status or dementia may have no recollection of recent symptoms and may have no complaints whatsoever. MI occurs most often in the early morning hours. Mechanisms that may explain this circadian variation include the morning increase in sympathetic tone leading to increases in blood pressure, heart rate, coronary vascular tone, and myocardial contractility; the morning increase in blood viscosity, coagulability, and platelet a Continue reading >>
Myocardial Infarction
"Heart attack" redirects here. For other uses, see Heart attack (disambiguation). Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle.[1] The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw.[1] Often it occurs in the center or left side of the chest and lasts for more than a few minutes.[1] The discomfort may occasionally feel like heartburn.[1] Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired.[1] About 30% of people have atypical symptoms.[7] Women more often have atypical symptoms than men.[10] Among those over 75 years old, about 5% have had an MI with little or no history of symptoms.[11] An MI may cause heart failure, an irregular heartbeat, cardiogenic shock, or cardiac arrest.[2][3] Most MIs occur due to coronary artery disease.[2] Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol intake, among others.[4][5] The complete blockage of a coronary artery caused by a rupture of an atherosclerotic plaque is usually the underlying mechanism of an MI.[2] MIs are less commonly caused by coronary artery spasms, which may be due to cocaine, significant emotional stress, and extreme cold, among others.[12][13] A number of tests are useful to help with diagnosis, including electrocardiograms (ECGs), blood tests, and coronary angiography.[6] An ECG, which is a recording of the heart's electrical activity, may confirm an ST elevation MI (STEMI) if ST elevation is present.[7][14] Commonly used blood tests include troponin and less often creatine kinase MB.[6] Treatm Continue reading >>
Jacoby, R.m. And Nesto, R.w. (1992) Acute Myocardial Infarction In The Diabetic Patient Pathophysiology, Clinical Course And Prognosis. Journal Of The American College Of Cardiology, 20, 736-744. - References - Scientific Research Publishing
JOURNAL NAME: World Journal of Cardiovascular Surgery , Vol.4 No.12 , December 2, 2014 ABSTRACT: Objectives: Diabetes is a well-established risk factor for cardiovascular disease, and diabetics have a threefold increase in risk of death from cardiovascular disease compared to non-diabetics. Following coronary artery bypass grafting, tight glycemic control improves short-term outcomes, however limited data exist for long-term outcomes. Here we examine these outcomes in diabetics using aggressive risk factor management. Methods: A retrospective review of all patients under-going coronary artery bypass between 1991 and 2000 at a single Veterans Affairs Medical Center was undertaken. 973 patients were included, 313 with diabetes and 660 without. Strict glucose control was maintained for all patients. Additional risk factor modification, including anti-platelets medications, statins, and beta blockers were also used. Survival analysis was performed. Results: The diabetic group was at higher risk, with age, BSA, and NYHA class all being greater (p Continue reading >>
Diabetes And Vascular Disease: Pathophysiology, Clinical Consequences, And Medical Therapy: Part Ii
Diabetes and vascular disease are intimately linked and share pathophysiological features as examined in Part I of this review. In this section, we review the epidemiology and clinical consequences of vascular disease in patients with diabetes, and discuss the efficacy of risk factor modification and antiplatelet treatment. Since the reviews published on this topic by the authors previously,1,2 contemporary trends in the incidence and outcomes of vascular disease in diabetes suggest that timely and effective implementation of therapies is making a favourable impact. In the late 1990's and early 2000s, there was a marked increase in the rate of obesity and diabetes across the globe.3 These changes were observed and reported in the United States,4 Europe,5,6 Africa,7 China,8,9 and India.10 In 1997, Amos et al.11 predicted the worldwide burden of diabetes would increase from 124 to 221 million people in 2010, with particular gains in Asia and Africa. In retrospect, these predictions now seem optimistic as the World Health Organization estimates a current worldwide prevalence of 346 million patients with diabetes12 (Figure 1). Evidence suggests that the rates of obesity and diabetes may be leveling off in Europe and the United States but continue to increase in Asia and Africa, making clear the global nature of the problem.13–16 Worldwide prevalence of diabetes mellitus in persons aged 20–79 years. The prevalence of diabetes is high. Colours indicate percent prevalence in respective nations. Source: Diabetes Atlas 5, International Diabetes Federation. Permission granted by the International Diabetes Federation. Recently, investigators have identified subsets of patients with diabetes at the highest risk. In a meta-analysis of 29 clinical trials that included at least 10 Continue reading >>
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Acute Myocardial Infarction (mi)
By James Wayne Warnica, MD, FRCPC , Professor Emeritus of Cardiac Sciences and Medicine, The University of Calgary Revascularization for Acute Coronary Syndromes Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of a coronary artery. Symptoms include chest discomfort with or without dyspnea, nausea, and diaphoresis. Diagnosis is by ECG and the presence or absence of serologic markers. Treatment is antiplatelet drugs, anticoagulants, nitrates, beta-blockers, statins, and reperfusion therapy. For ST-segment-elevation myocardial infarction, emergency reperfusion is via fibrinolytic drugs, percutaneous intervention, or, occasionally, coronary artery bypass graft surgery. For non-ST-segment-elevation MI, reperfusion is via percutaneous intervention or coronary artery bypass graft surgery. (See also Overview of Acute Coronary Syndromes .) In the US, about 1.5 million myocardial infarctions occur annually. MI results in death for 400,000 to 500,000 people, with about half dying before they reach the hospital (see Cardiac Arrest ). Acute myocardial infarction (MI), along with unstable angina, is considered an acute coronary syndrome . Acute MI includes both non ST segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI). Distinction between NSTEMI and STEMI is vital as treatment strategies are different for these two entities. Myocardial infarction is defined as myocardial necrosis in a clinical setting consistent with myocardial ischemia ( 1 ). These conditions can be satisfied by a rise of cardiac biomarkers (preferably cardiac troponin [cTn]) above the 99th percentile of the upper reference limit (URL) plus at least one of the following: ECG changes indicative of new ischemia (significant ST/T Continue reading >>
Ijcs - Intensive Glycemic Control In Patients With Acute Myocardial Infarction: Diabetes Time Duration Counts!
Original Article Intensive glycemic control in patients with acute myocardial infarction: diabetes time duration counts! Controle glicmico intensivo em pacientes com infarto agudo do miocrdio: tempo de durao do diabetes conta! Ana Rita Pereira Alves Ferreira; Sofia Lazaro Mendes; Francisco Gonalves; Pedro Monteiro; Silvia Monteiro; Mariano Pgo Universidade Centro Hospitalar e Universitrio de Coimbra - Hospitais de Universidade de Coimbra - Servio de Cardiologia A - Coimbra - Portugal 4770-454 - Vila Nova de Famalico, Portugal BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in patients with diabetes. The presence of type 2 diabetes mellitus (T2DM) puts the patients with and without history of myocardial infarction at risk for significant cardiovascular risk. OBJECTIVE: To evaluate the prognostic impact of the time of duration and metabolic control of T2DM in a population hospitalized for acute coronary syndrome. METHODS: Retrospective study of 731 consecutive patients admitted for acute coronary syndrome from May 2007 to August 2013. Patients were stratified into: Group 1 (n=297) with known diabetes mellitus (DM) (prior to hospitalization) and hemoglobin A1c (HbA1c) <6.5%; Group 2 (n=383) with known DM and HbA1c >6.5%; Group 3 (n=39), with recently diagnosed DM (during hospitalization) and HbA1c <6.5% and Group 4 (n=12) recently diagnosed with DM and HbA1c >6.5%. The primary endpoint was death from all causes (cardiovascular and non-cardiovascular) at one year, and the secondary endpoint at two years of follow-up. RESULTS: The distribution by sex and age was similar in both groups. In-hospital mortality was also higher in Group 2 (4.4%). Mortality from all causes over one year was higher in Groups 1 (8.3%) and 4 (8.3%), and at two years was higher Continue reading >>
Prevalence Of Diabetes In Patients With Myocardial Infarction: A Study In A Tertiary Care Centre | Mohanty | International Journal Of Advances In Medicine
Prevalence of diabetes in patients with myocardial infarction: a study in a tertiary care centre Lalatendu Mohanty, Debananda Sahoo, Dayanidhi Meher, Panchanan Sahoo Background:Diabetics experience a greater mortality during the acute phase of myocardial infarction (MI) and a higher morbidity in the postinfarction period. This study was conducted to assess the prevalence of diabetes as a risk factor for acute myocardial infarction. Methods: Detailed demographic details such as age, gender, weight, BMI, blood pressure, smoking and alcohol details, previous clinical and medical history were noted for all the patients. Blood was collected from the patients for random blood glucose levels and HbA1c levels. On the 2nd and the 5th days of admission, fasting blood glucose levels were measured. Results:63.5% patients were males and only 36.5% of them were females with the average age being around 66 years. Most of the patients who were admitted to the hospital with MI were obese or overweight with elevated cholesterol and triglyceride levels. Out of the 104 patients, 59 (56.7%) had no diabetics, 29 (27.9%) were known diabetics. 11 (10.6%) of them were identified as diabetic during the hospitalization. Conclusions:The chronic and acute hyperglycaemia associated to acute coronary syndromes, mainly in acute myocardial infarction is an independent and determinant factor in the outcome for patients with and without diabetes mellitus. Acute myocardial infarction, Diabetes mellitus, Prevalence, Risk factors Jacoby R, Nesto R. Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. J Am Coll Cardiol. 1992;20:736-44. Aronson D, Rayfield E, Cheseboro J. Mechanisms determining course and outcome of diabetic patients who have had acute myocardi Continue reading >>
Review Article Acute Myocardial Infarction In The Diabetic Patient: Pathophysiology, Clinical Course And Prognosis
Abstract Although there have been significant advances in the care of many of the extrapancreatic manifestations of diabetes, acute myocardial infarction continues to be a major cause of morbidity and mortality in diabetic patients. Factors unique to diabetes increase atherosclerotic plaque formation and thrombosis, thereby contributing to myocardial infarction. Autonomic neuropathy may predispose to infarction and result in atypical presenting symptoms in the diabetic patient, making diagnosis difficult and delaying treatment. The clinical course of myocardial infarction is frequently complicated and carries a higher mortality rate in the diabetic than in the nondiabelic patient. Although the course and pathophysiology of myocardial infarction differ to some degree in diabetic patients from those in patients without diabetes, much more remains to be known to formulate more effective treatment strategies in this high risk subgroup. Continue reading >>
A Review Of The Digami Study: Intensive Insulin Therapy During And After Myocardialinfarctions In Diabetic Patients
Despite many advances in modern medicine, diabetes mellitus continues to be associated with increased morbidity and mortality. The leading cause of death in people with diabetes continues to be myocardial infarction (MI). Although improvements have been made in the treatment of cardiac disease, diabetic patients with acute MI continue to have a poor prognosis. This increase in mortality is shown during both initial hospitalization and long-term follow up.1-4 The higher death and complication rates in these diabetic patients appear to be multifactorial. Diabetes may be associated with severe coronary artery disease, systolic left ventricular dysfunction, autonomic neuropathy, and larger infarct size. These processes not only leave these diabetic patients at higher risk of death when having an acute MI, but also increase their risk of recurrent cardiac events and other long-term complications.1-6 During an acute MI, multiple hormonal and physiological changes occur. Plasma catecholamines, glucagon, and cortisol increase, resulting in insulin resistance. Decreased insulin sensitivity causes impaired glucose utilization and increased free fatty acid turnover in cardiac muscle. People with diabetes are more sensitive to catacholamine stimulation, and thus they have a dramatic increase in plasma free fatty acids and a decrease in glucose utilization.1,7,8 As the blood levels of free fatty acids rise, the myocardium metabolizes more free fatty acids than glucose (up to 90% of energy supply in animal studies).9 Though the myocardium normally uses some free fatty acid (6070% of overall use), this metabolic process requires oxygen. Glucose does not require oxygen when metabolized (glycolysis), but this process, as described above, is impaired by the hormonal changes that take pl Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes
- Glycaemic control in people with type 2 diabetes mellitus during and after cancer treatment: A systematic review and meta-analysis
Acute Myocardial Infarction In The Diabetic Patient: Pathophysiology, Clinical Course And Prognosis.
Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. Institute for the Prevention of Cardiovascular Disease, New England Deaconess Hospital, Harvard Medical School, Boston, Massachusetts 02215. Although there have been significant advances in the care of many of the extrapancreatic manifestations of diabetes, acute myocardial infarction continues to be a major cause of morbidity and mortality in diabetic patients. Factors unique to diabetes increase atherosclerotic plaque formation and thrombosis, thereby contributing to myocardial infarction. Autonomic neuropathy may predispose to infarction and result in atypical presenting symptoms in the diabetic patient, making diagnosis difficult and delaying treatment. The clinical course of myocardial infarction is frequently complicated and carries a higher mortality rate in the diabetic than in the nondiabetic patient. Although the course and pathophysiology of myocardial infarction differ to some degree in diabetic patients from those in patients without diabetes, much more remains to be known to formulate more effective treatment strategies in this high risk subgroup. Continue reading >>
The Heart In Diabetes: Results Of Trials
It has been known for many years that diabetes has profound consequences on the cardiovascular system leading to increased morbidity and mortality in diabetic patients [1]. In the last years, the completion of several large trials allowed to gather critical information on the efficacy and safety of different drugs in patients with a variety of cardiovascular diseases. In most of these trials diabetic patients, generally identified on the basis of clinical history and with no distinction between type 1 and type 2 diabetes, represented an important proportion of the randomized population, ranging between 10 and 25 % in most cases. In this brief review, we will summarize how these trials helped in widening our knowledge of the pathophysiology, prognosis and pharmacological treatment of diabetic patients with cardiovascular disease. Table 61 shows the meaning of the acronyms of the trials quoted in this review, where three specific settings will be discussed: acute myocardial infarction (MI); congestive heart failure (CHF) and treatment of myocardial ischemia with coronary angioplasty (PTCA). Diabetic PatientAcute Myocardial InfarctionCongestive Heart Failure PatientScandinavian Simvastatin Survival StudyConcomitant Risk Factor These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves. This is a preview of subscription content, log in to check access. Unable to display preview. Download preview PDF. Jacoby RM, Nesto RW. Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis. J Am Coll Cardiol 1992; 20:73644. PubMed CrossRef Google Scholar Smith JW, Marcus FI, Serokman R, Multicenter Postinfarction Research Group. Prognosis of patie Continue reading >>
