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416 Cardio Diabetes Medicine 2017

heart failure. The probable mechanisms are intersti- pacity and symptoms of HF without an effect on
tial fibrosis, glycation of collagen leading to impaired mortality.
contractility , changes in calcium homeostasis and • Angiotensin II is considered to be a major player
autonomic dysfunction. Although a range of diagnos- in the development of cardiac dysfunction.ARBs
tic methods may help to characterize alterations in (angiotensin II type 1 receptor blockers) have been
cardiac function in general, none are specific for the proposed to have additive effects on haemody-
alterations in diabetes [7,8] .
namic measurements, neurohumoral activity and
LV remodelling when added to ACE inhibitors in
The principles of managing HF are as patients with chronic HF.
follows:
• Statins (hydroxymethylglutaryl CoA reductase in-
• Rapid diagnosis to determine the cause ofsymptos hibitors): The ability of statins to lower serum cho-
or excerbations.
lesterol and reduce CHD end points has confirmed
• BNP estimation. portions of the lipid hypothesis. However, the time
to benefit and increased benefit in overlapping
• Detect the cardiovascular related conditions : MI, populations, in particular diabetic patients, have
Arrythmia, HTN, Pulmonary Embolus, Infection, suggested that they induce pleiotropic effects.
Renal Failure
• TZDs are a new class of compounds for treating
• Medical or Dietary adherence
patients with Type II diabetes mellitus, which act
• Oxygen therapy : Pulse oximetry by increasing insulin sensitivity in skeletal muscle
and adipose tissue through binding and activa-
• Monitoring : Cardiac, Including ECGG, Central pres- tion of PPAR-δ, a nuclear receptor that has a reg-
sures if available, Vital signs
ulatory role in differentiation of cells. Additionally
• Intake and output they also act on PPAR-α and increase serum HDL
(high-density lipoprotein)-cholesterol, decrease
• Daily weight
serum triacylglycerols (triglycerides) and increase
LDL-cholesterol levels marginally (pioglitazone to
The principles of inpatient management of a lesser extent).
HF are as follows [7,9] :
• Clinical signs of perfusion and congestion Prevention of SCD in DM:

• Intravenous (IV) fluids or medications • Controlling the risk factors by slowing the pro-
gression or development of CV diseases should
• Loop diuretics if significant fluid overload
indirectly reduce SCD incidence.Controlling the co-
• Vasodilators : Nitroprusside, Nitroglycerin, Nesir- morbid conditions associated with diabetes such
itide as CAD, hypercholesterolemia and hypertension
lessen the risk of SCD in diabetes patients.
• Thromboembolic prophylaxis
• Pharmacologic agents that improve CV longevity
• Inotropes : Dopamine, Dobutamine, Milrinone
are ACE inhibitors, beta bloackers, and antiplatelet
• IV fluids limitation. agents.
• Class I antiarrhythmics are not recommended for
Treatment of Heart Failure: SCD prevention.
• Glycaemic control: Poor glycaemic control has • Non pharmacologic prevention strategies of help
been associated with an increased risk of cardio- are weight reduction, dietary education, smoking
vascular mortality, with an increase of 11% for ev- sessation, stress management, and physical ac-
ery 1% rise in HbA levels, and a recent study has tivity [11 – 13] .
1c
shown a link between HbA and HF. Thus it has
1c
been assumed that improving glycaemic control
should have a beneficial effect on cardiovascular Conclusion:
morbidity and mortality . There are insufficient data to define the individual
contributions that any of these changes exert on the
• ACE inhibitors form the cornerstone for treatment risk of SCD in patients with diabetes. We are in need
of HF. The captopril multi-centre study demon- of future studies on SCD and DM to establish the
strated a significant improvement in exercise ca-
relationship between DM and SCD. Early recognition

GCDC 2017