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130 Cardio Diabetes Medicine 2017

FLOW CHART OF EVAUATION OF SILENT REFERENCES:
MYOCARDIAL ISCHAEMIA 1. Hadi AR Hadi Khafaji et.al; Atypical presentation of Acute and Chronic
coronary artery disease in diabetics. World journal of cardiology 2014
August 26; 6(8): 802 – 813.
2. Hyun Kuk Kim et.al; Atypical presentation in patients with Acute cor-
DIABETES onary syndrome; Acute coronary syndrome – Dr.Mariano Brizzio,ISBN:
978-953-307-827-4.
3. Brieger D et.al; Acute coronary syndromes without chestpain , an un-
Long standing Diabetes derdiagnosed and undertreated high risk group : Insights from the Global
Diabetic complication >2 Registry of Acute Coronary Events. Chest 2004: 126:461-469.
Risk Factors 4. Canto et.al, Prevalence, clinical characteristics and mortality among
patients with myocardial infarction presenting without chest pain.
YES No JAMA,283,3223-3229.

Control of Diabetes
Stress ECG & CV risk of factors

Non -Diagnostics /
Submaximal

Myocardial Perfusion
Scan / Dobutamine
Stess ECHO

LARGE ISCHEMIA >
20-25%

Cornorary Angiogram

CONCLUSION:
All diabetics do not have the same risk of coronary
events. Hence it is reasonable to identify patients who
require additional investigations to diagnose associ-
ated CAD. This strategy will help to adopt therapeutic
measures like tight glycaemic control, antiplatelets,
statins, ACE/ARB and also invasive interventions to
improve prognosis in high risk individuals. Future
studies are needed to identify the patient subgroups
who will benefit from screening.

GCDC 2017