Silent myocardial ischemia in patients with type 2 diabetes mellitus: a clinical case

Background. Type 2 diabetes mellitus (DM) is an important medical, social, and economic problem due to the high prevalence of disease, which often leads disability significantly increases mortality in elderly people. One causes coronary heart disease (CHD) patients with type DM autonomic cardiovascular neuropathy, characterized by damage nervous system manifests itself a varying clinical picture, including silent myocardial ischemia (SMI). The SMI among much higher than people without it. purpose was study case patient CHD, raise awareness influence on CHD progression focusing diagnostic research treatment strategies. Materials methods. detected analyzed. complaints were as following: blood pressure, moderate shortness breath during walking, pain, numbness lower extremities. Anamnesis: over 20 years; endovascular stenting right common iliac artery obliterating atherosclerosis arteries extremities; hypertension 10 obesity. Based this data, suspected. Results. Holter monitoring revealed rare episodes reversible ischemic repolarization. ECG demonstrated deviation electrical axis left, hypertrophy left ventricular myocardium, diffuse violation repolarization processes. Ultrasound found aortic atherosclerosis, hypertrophy, decrease contractility. vessels extremities showed signs decompensation peripheral flow. Coronary angiography critical subocclusions (90 %), chronic occlusion middle segment (100 %). There established diagnosis: (silent ischemia); stenotic (coronary May 2019); arterial II stage, degree 2; HF stage; NYHA; mellitus, insulin-dependent, decompensated; obesity I (condition after January 2018); pancreatitis remission, peptic ulcer duodenum (operated 1981); cholecystitis remission. prescribed: insulin therapy, nebivolol, eplerenone, candesartan, clopidogrel, rosuvastatin. bypass grafting recommended. Conclusions. Thereby, timely diagnosis adequate can avoid complications improve quality lifetime. With DM, masked remains undiagnosed, leading death, therefore more attention such needed.