L3: Macrovascular Complications of DM Flashcards
People with diabetes have a significantly ……. of macrovascular complication than that of the non diabetic population
greater risk
Diabetes is a …….. in the development of atherosclerosis
risk factor
Macrovascular complications of DM (Table)
Overlap of Atherosclerotic Disease
Patients with one manifestation often have coexisted disease in other vascular beds
Macrovascular complications of DM
Diabetic Risk Factors of macrovascular complications
Introduction to atherosclerosis
nature of atherometous lesions in DM
Athermanous lesion tend to be more sever, extensive and run more aggressive in diabetes than non-diabetic people
Pathogenesis of atherosclerosis in DM
(Very Important)
Myocardial infarction is …… times more among diabetic people
three to five
Women with diabetes …… their premenopausal protection from coronary artery disease.
lose
Angina in patients with DM
- Painless angina and myocardial infarction may be due to neuropathic damage to the autonomic nerves serving the myocardium.
- Atypical presentation of angina and myocardial infarction (malaise, sweating, dyspnea and syncope which may be confused with hypoglycemia).
Long term mortality from MI are increased in diabetes may be due to increased risk of HF in diabetes
..
Management of MI is similar to non-diabetic population with more caution with usage of thrombolytic therapy because of the risk of intraocular hemorrhage in the patient with retinopathy
..
Cardiomyopathy in Diabetic Patients
Hypertension in Diabetic Patients
Investigastions in patients with CHD & DM
TTT in patients with CHD & DM
What is the first line TTT in patients with CHD & DM?
ACE inhibitors
SE of thiazides & Beta-Blockers in TTT of DM & HTN
- Thiazide should be used at low dose to avoid worsening of glycemic control and aggravation of dyslipidemia
- Beta-Blockers can aggravate hyperglycemia, dyslipidemia and impotence.
Prevelance of PAD
Diabetic Patients have a 2-5 fold increase in the rates of PAD
Age of occurence of PAD
PAD in people with DM > 40y is found to be 20 %
Male/Feamale ratio of PAD
Loss of female protection with equal Male to female ratio
Clinical Presentation of PAD
Symptoms of PAD
Typical vs Atypical Symptoms in Patients with Symptomatic PAD
Signs of PAD
- Absence of pedal pulse ( 8%dorsalis pedis 2% posterior tibialis)
- Cold extremities
- Pale or bluish colour of the skin
- thin ,shiny skin with scanty hair (dystrophic toenail)
Common Sites of Claudication
Investigastions in PAD
- Doppler US
- Angiography
- Ankle Brachial Index (ABI) : normal value 0.98-1.31
Describe ABI
Levels of ABI
Impairment of the collaterals
- Diabetic patients have a diminished ability to establish collateral circulation , especially around the knee
Medial Calcinosis
- False High Ankle Brachial Index
- Adverse effect on both angioplasty and surgical bypass.
Dx of PAD
Cerebral Stroke & DM
- Stroke is twice higher in diabetic population than non-diabetics
- Mortality and disability from stroke are also worse in the diabetic person compared to non- diabetic people
(May because of elevation of blood glucose level following stroke)
