Diabetes - Induced Heart Disease
Grandma: I have been into this office to see you many times. I also know how the diabetes that I have can affect the heart. I was hoping that you could tell Dustin about the seriousness of heart disease and its relationship to diabetes.
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Glossary Myocardial disease - Narrowing of the coronary arteries sufficiently to prevent adequate blood supply to the myocardium. The narrowing is usually caused by atherosclerosis, and may progress to the point where the heart muscle is damaged due to a lack of blood supply. Angina pectoris - Severe pain and sensation of constriction about the heart caused by a deficiency of oxygen supply to heart muscle. Myocardial infarction - Condition caused by partial or complete blockage of one or more of the coronary arteries. |
Dr. Ponds: I would be glad to. As with many of the complications due to diabetes, myocardial disease is caused by atherosclerosis. Atherosclerosis is the hardening of the arteries due to plaque build up and to excess glucose sugar levels in the blood. Atherosclerosis is most damaging to the heart when large plaque deposits narrow and block the vital myocardial arteries. In diabetics atherosclerosis is greatly accelerated, and symptoms can occur at earlier stages compared to that of the non-diabetic.
Dustin: Yes, my grandma has told me of some of the complications that can occur in the diabetic person. How exactly does hardening of the arteries affect the heart?
Dr. Ponds: Well, there are two different degrees of severity when dealing with diabetes-induced heart disease. Angina pectoris is where plaques have started to line arterial walls, resulting in a reduced flow of blood. Angina is defined as pain, and pectoris deals with the chest. Many diabetics have this on our reservation but don't know it. Some symptoms of angina pectoris include chest pain, left arm pain, jaw pain, and can include irregular heart beat, shortness of breath, and swelling of the ankles.
Let me tell you, if people don't get these symptoms checked out right away more serious complications could arise.
Myocardial infarction is most commonly known as a heart attack. Myocardial is defined as heart muscle, and infarction is defined as death. A person doesn't even want to get close to this stage of the disease. This happens when a myocardial artery has been completely blocked due to a steady plaque build up. Immediate action needs to be taken to unclog this artery before the blocked area dies from lack of blood and vital nutrients. The physical symptom of myocardial infarction is acute chest pain lasting for 15 minutes or more. Severe damage is seen when arterial blockage is not taken care of within one hour.
Grandma: Dustin, this is why your grandma takes such good care of herself.
Dustin: All of this sounds very serious, so what can people do to take care of themselves?
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Glossary Electrocardiogram - (ECG) A record of the electrical activity of the heart that gives important information concerning the spread of excitation to the different parts of the heart. This test is of great value in the diagnosis of cases of abnormal cardiac rhythm and myocardial damage. Nuclear tracer scan - A radioactive dye is put into the blood stream, and then an X-ray is taken of the heart to see if blood supply is completely circulated to all areas of the heart. Coronary arteriography - Pictures obtained through X-ray after a coronary artery has been injected with a radioactive dye. Cardiac Catheterization - Passage of a tiny plastic tube into the heart through a blood vessel. Samples of blood are withdrawn for testing; blood pressure and cardiac output are measured. Used in diagnosis of heart disorders and anomalies. |
Dr. Ponds: Diabetics can curb the damaging effects of heart disease through early detection. There are a number of tests available to see if arterial closure is occurring in the vascular system. An electrocardiogram (ECG) measures electrical activity in the heart and can pinpoint problem areas. The nuclear tracer scan and coronary arteriography involves the use of a non-damaging radioactive dye that is circulated through the blood stream. X-ray pictures accurately show blockage areas. I have a picture here if you want to check it out:
Another effective test method is cardiac catheterization. A small plastic tube travels through a blood vessel to the heart. Blood pressure and cardiac actions can then be measured.
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Glossary Digitalis - Powdered form of the dried leaves of Digitalis purpurea that act to increase cardiac output by increasing the contractibility of cardiac muscle.Calcium entry blockers - A group of drugs that act by slowing the influx of calcium ions into the muscle cells resulting in decreased myocardial oxygen demand. Coronary angioplasty - The alteration of the structure of a coronary vessel by dilating the vessel using a balloon inside the artery. Laser angioplasty - The surgical process that alters the structure of a coronary vessel by vaporizing plaques lining artery walls. Bypass surgery - A means of circumvention, by alternating the route for the blood to bypass an obstruction if a main or vital artery becomes obstructed. |
Advanced stages of atherosclerosis require immediate treatment. In the case of a heart attack, different medications are immediately available. Digitalis is a drug that increases the heart muscle contractions, and therefore increases output. Calcium entry blockers allow vascular muscle cells to relax, resulting in a lowered blood pressure and a lowered myocardial oxygen demand. These drugs can be very effective, but there are also surgical techniques out there that will do just as good.
Coronary angioplasty is one effective surgery used to open congested arteries. Angio is defined as vessel, and plasty is defined as repair. A small balloon is inserted into the artery and then inflated. This compacts the plaques to open a larger passage area. Take a look at this picture:
Laser angioplasty is where a laser is inserted and plaques are then vaporized. Bypass surgery is actually more effective than the angioplasty surgeries in people suffering from diabetes-induced heart disease. This surgical technique channels the flow of blood completely around the area of congestion using a bypass from a leg vein:
Grandma: Next time I should bring in Dustin's mom. She needs to come and talk to you. Maybe you could tell her what she needs to do to help herself out.
Dr. Ponds: I would be glad to. People that have Type II diabetes need to take care of themselves. Significant portions of diabetics, smoke, have elevated cholesterol levels, are overweight, live sedentary lifestyles, have elevated blood pressure, and are at a 2-4 times higher risk compared to that of the health conscious diabetic. All of these problems need to be taken care of to slow the damaging effects of heart disease and atherosclerosis.
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