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414 Cardio Diabetes Medicine 2017

Cardiac Emergencies in Diabetes Mellitus

Dr. Arvinth Soundarrajan

Registrar, Institute of Emergency Medicine,
Meenakshi Mission Hospital & Research Centre, Madurai.
Dr. Narendra Nath Jena
Director & Head, Institute of Emergency Medicine,
Meenakshi Mission Hospital & Research Centre, Madurai.

Introduction: Mechanism of Sudden Death in DM:
Sudden cardiac death (SCD) is an event that can oc- In diabetic population, in addition to thee above fac-
cur in asymptomatic individuals, as well as in those tors several other mechanisms have been proposed
with advanced cardiovascular (CV) disease. SCD typ- to account for the excess of SCD observed. They are
ically manifests as a structural abnormality coupled silent myocardial ischemia, autonomic dysfunction,
with a disturbance in cardiac electrical activity that QT interval prolongation, hypoglycemia, a hyperco-
leads to fatal arrhythmias. Sudden cardiac death agulable state associated with DM, diabetic cardio-
(SCD) has been associated with diabetes, although myopathy and decreased ventilator response to hy-
it is unclear whether diabetes is a risk factor for SCD. poxia and hypercapnea.
Diabetes is a risk factor for common preventable co-
morbidities associated with SCD, including coronary Acute Myocardial Infarction in Diabetes:
artery disease (CAD), myocardial infarction, and heart Heart disease, particularly coronary heart disease
failure [13-14] .
(CHD), is a major cause of morbidity and mortality
among patients with diabetes mellitus. Compared
Sudden Cardiac Arrest in Diabetes: with nondiabetics, diabetics are more likely to have
The reduction of mortality from sudden cardiac ar- CHD, to have multivessel disease when it occurs, and
rest (SCA) in the setting of coronary heart disease to have episodes of silent ischemia. As a result of
(CHD) remains a major challenge, especially among these and other factors, diabetics with CHD have a
patients with type 2 diabetes . There is mounting ev- worse outcome and poorer long-term survival com-
idence that type 2 diabetes is associated with an in- pared to nondiabetics with CHD. Glycemic control is
creased risk of mortality from coronary heart disease a powerful predictor of survival and in-hospital com-
and SCA. The increased risk of CHD mortality and plications [1,3] .
SCA among patients with diabetes likely results, at
least in part, from the increased presence and extent Effect of Hyperglycemia on AMI [2,3] :
of coronary atherosclerosis (macrovascular disease) • Endothelial dysfunction
due to abnormalities of glucose/insulin homeostasis
and/or other risk factors, such as dyslipidemia, high • Platelet hyper reactivity
blood pressure, and renal disease. • Increased cytokine activation
• Increased lipolysis and FFA levels
Diabetes also is associated with micro-vascular dis-
ease and autonomic neuropathy; and, these non-cor- • Reduced glycolysis and glucose oxidation
onary atherosclerotic pathophysiologic processes • Increased oxidative stress
also have the potential to influence CHD mortality • Impaired microcirculatory function.
and SCA among patients with diabetes. However, • Impaired ischemic preconditioning
few prior studies have assessed the risk of CHD mor-
tality and SCA associated with clinically-recognized • Impaired insulin secretion and insulin stimulated
and subclinical micro-vascular disease or diabetic glucose uptake.
autonomic neuropathy [11-13] .

GCDC 2017