Halo 194 (Jan 2018)
Acute myocardial infarction as the first manifestation of untreated diabetes mellitus
Abstract
Introduction: Coronary artery disease has an accelerated, progressive course in patients suffering from diabetes mellitus, due to the synergistic effects of aterosclerosis, hyperglicemia and other risk factors characteristic of the disease. Untreated diabetes mellitus (DM) leads to an acceleration in aging of blood vessels, leading to a two to four times greater risk for developing acute myocardial infarction. As the result of a commonly present diabetic neuropathy, these patients often develop an asymptomatic or 'silent' myocardial infarction. Objective: The main objective of this case report is to point out the specificity of acute coronary artery disease in patients with diabetes mellitus, especially due to the lack of typical myocardial ischemia symptoms. Material: Data collected from medical reports and discharge papers was used. Case report: The patient is a 58 year old man, who called the emergency service complaining of vertigo and fatigue. His symptoms first appeared that morning as he was tying his shoe laces from a sitting position. When the doctor arrived, he had no symptoms or complaints. He had been diagnosed with diabetes mellitus type II ten years ago, but had not been taking prescribed medicine to treat his condition. On examination, the patient is conscious, oriented, with arterial blood pressure 80/40mmHg, heart rate 100/min, glicemia 20.3mmol/l and normal heart and lung sounds on auscultation. The ECG trace showed changes characteristic of acute myocardial infarction, even though the patient denied having chest pain. The patient was treated by dual antiplatelet therapy and immediately transported to the catheterization lab, where a stent was placed into the circumflex branch of his left coronary artery. The patient would remain in the hospital for the next nine days, where his glycemia would be stabilized and another stent placed into his LAD (left anterior descending artery) in another act. He would leave the hospital in good health with recommendations for further treatment of both his diabetes mellitus and coronary artery disease. Discussion and conclusion: More than 422 million people suffer from diabetes mellitus in the world today and 600 thousand in Serbia with the constant tendency of growth. Research shows that 60% of coronary artery complications are asymptomatic which results in an inadequate and slow reaction from patients, leading very often to most grave complications.
