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Cardio Diabetes Medicine 2017 167

PREVENTION PET Scan is used to establish an association be-
tween myocardial metabolic derangement and early
Careful diabetic management of the mother may re-
duce severity of hypertrophic cardiomyopathy in the manifestation of diastolic dysfunction.
7
infant . However a routine use of these methods is imprac-
tical.
EVALUATION OF CARDIOMEGALY IN A
DIABETIC PATIENT PREVENTION OF CARDIOMEGALY ,
There are three main interlinked characteristics of CARDIOMYOPATHY AND HEART FAILURE
diabetes mellitus. IN DIABETES

1. Patients with diabetes develop more severe cor- There is no totally certain way to avoid heart disease
onary artery disease at a younger age and more in diabetes. The best way is to prevent diabetes itself.
micro angiopathy than in individuals without di- People with increased risk of diabetes can be iden-
abetes. tified and the following recommendations can be
2. Increased frequency of heart failure (diastolic made on the basis of The Diabetes Prevention Pro-
dysfunction in earlier stages and systolic dys- gram, which is an NIH (National Institutes of Health)
funtion, later on) in general, is the second main sponsored study.
manifestation of diabetic cardiomyopathy. 1. Modest weight reduction by a 30 min. exercise,
3. The third, often unappreciated, but important fea- 5 days a week can reduce the development of
ture of diabetic heart disease is a disproportion- diabetes by 50% over a 3 year period.
ate increase in LV mass. 2. Abnormalities in BP and lipid levels in prediabet-
Framingham study showed LV mass, was on an av- ics should be corrected, to prevent cardiovascu-
erage, 22% higher in females with diabetes and hy- lar disease. The goal for LDL cholesterol is less
pertension increases the risk of left ventricular hy- than 100mg% in diabetics and less than 70mg%
pertrophy (LVH). in diabetics with heart disease. This is the recom-
Diabetes with LVH causes LV dysfunction and coro- mendation of the American Heart Association.
nary artery disease. Long standing LVH with left ven- 3. Smoking cessation
tricular dysfunction will lead on to LV fibrosis.
4. Blood sugar control with a HbA1c of less than 7,
However, in the initial stages, diabetic cardiomyopa- along with a low dose aspirin.
thy is an asymptomatic disease. So far, there are no
diagnostic biochemical or imaging methods to detect CONCLUSION
subclinical manifestations of the disease. Diabetic cardiomegaly and cardiomyopathy progress
There is current evidence to propose circulating mi- slowly and silently, and is diagnosed with current de-
croRNA as promising biomarkers for early detection tection procedures like ECHO only when the heart
8
of diabetic cardiomyopathy. manifests a certain degree of dysfunction. So before
this subclinical state of the illness becomes critical
Micro RNAs are small non coding RNA molecules, following an ischaemic episode, adequate preventive
which down regulate gene expression by a post tran- measures need to be taken. In the present scenario,
scriptional mechanism. there is no other option to rescue the heart.
Cardiac hypertrophy measured by Tissue Doppler,
ECHO ( in the absence of coronary artery disease REFERENCES
and hypertension ), have been considered as the 2 1. Fonarrow GC, Srikanthan P Diabetic Cardiomyopathy; Endocrinol Metab
principal hallmarks, to propose a diagnosis of DCM Clin North Am sep 2006,: 35 (3); 575 -99;
in asymptomatic diabetic patients. 2. Peter Sa, Huxley RR, Sattar N, Woodwart M, Sex differences in the excess
risk of cardiovascular diseases associated with Type 2 diabetes. Potential
Imaging diagnostic techniques used for explanations and clinical implications. Curr CV Risk Rep; 2015; 9 (7):36.
detecting myocardial metabolic changes in 3. Ballotari P Ranieri SC, Luberto F, Caroli S, Greci M, Giorgi Rossi P, Mani-
cardi V, Sex differences in CV mortality in diabetic and nondiabetic
diabetic patients subjects : A population based study (Italy) Int J Endocrinol; 2015; 2015:
Protein magnetic Resonance Spectroscopy : detects 914057.
excessive storage of lipid in the myocardium of pa- 4. Recarti C, Stehower CDA, Unger T. Excess CV riskin diabetes mellitus in
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