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244 Cardio Diabetes Medicine 2017

Hypoglycemic Heart-

Cardiologist Perspective

Dr. Senthilkumar Nallusamy,

Dr. M. Shyamala Priya & Dr. A. Balaji

*Chief Cardiologist, Apollo Hospital, Trichy And Rana Hospital,
Trichy **&***Resident, Apollo Hospital, Trichy.

INTRODUCTION: epinephrine &norepinephrine may induce vasocon-
The risk of hypoglycemia associated with intensive striction and peptides such as endothelin have pro-
glucose control in acutely ill patients remains an nounced effects on intravascular coagulability and
important concern with an incidence of severe hy- viscosity.
poglycemia as high as 19% observed in the report- - Increased viscosity because of increase in eryth-
ed randomized trials. This concern maybe especially rocyte concentration coagulation is promoted by
important in the treatment of ACS,in which counter platelet activation increases P-selectin expres-
hormone response associated with hypoglycemia sion(marker of platelet activation),factor 8 lev-
may prove to be particularly deleterious to ischemic els,von-willebrand factor
and infarcting myocardium.
- Influence platelet aggregability and alter several
This article “HYPOGLYCEMIC HEART” will review the components of the inflammatory cascade
basic cardiac pathophysiological changes during hy-
poglycemia,the clinical cardiac events occurring due - Reduction in plasminogen activator inhibitor-1 in
to hypoglycemia and diabetic therapeutic modifica- patients with Type 1 DM
tions required to prevent adverse cardiac outcomes. - Endothelial functions may be compromised be-
cause of increase in CRP, mobilization and activa-
ADA’s DEFINITION OF HYPOGLYCEMIA: tion of neutrophils & platelets
-Symptoms consistent with hypoglycemia - Reduced systemic fibrinolytic balance and en-
-Low plasma glucose concentration measured with hanced platelet monocyte aggregation provide a
precise method (not a glucose monitor) biological rationale for the increased rates of acute
ischemic events seen in patients with DM& hypo-
-Relief of symptoms after the plasma glucose level glycemia
is raised
- Subjects with Type-II DM demonstrate greater
CARDIOVASCULAR CONSEQUENCES OF platelet aggregation despite treatment with aspirin
and adenosine diphosphate receptor antagonists
SEVERE HYPOGLYCEMIA: than their counterparts without DM
Hypoglycemia Causes:-
• Blood coagulation abnormalities INFLAMMATORY ABNORMALITIES:
-Increase in circulating inflammatory markers such
• Inflammation
as CD40,CD40 ligand,interleukin-6,high sensitivity
• Endothelial dysfunction CRP,oxidative stress and other proinflammatory and
atherothrombotic biomarkers such as VCAM-1,ICAM1,
• Sympathetic nervous system activation
E-SELECTIN,VEGF along with TNF-α
BLOOD COAGULATION ABNORMALITIES: ENDOTHELIAL DYSFUNCTION:
Increase in counterregulatory hormones such as
-Abnormal endothelial function remains as early

GCDC 2017