What may cause diabetes

Czech version

Authors: Miroslav Pernický; Juraj Papinčák; Adriana Reptová; Soňa Kiňová; Ján Murín
Authors‘ workplace: I. interná klinika LF UK a UN Bratislava, Slovenská republika, prednostka doc. MUDr. Soňa Kiňová, CSc.
Published in: Vnitř Lék 2015; 61(5): 447-450
Category: Case reports

Overview

The case study describes a case of 49-year-old man with morbid obesity since childhood (BMI 40 kg/m²), arterial hypertension (approx. since aged 15, treated since 2004), dyslipidemia (since 2006), type 2 diabetes mellitus (since 2006, on insulin therapy since 2008) and smoking (until 2011, 20 cigarettes a day). Treatment: 16 types of medication, 8 for hypertension, statin, therapy for diabetes, aspirin, allopurinol. In 2010 (when aged 45) hospitalized in our clinic with dyspnoea and chest pain with a high pressure reading of 180/110 mm Hg (identified symptoms of heart failure with LV ejection fraction of 33 %, in NYHA II functional class, echocardiographically: left atrium: 46 mm, left ventricular chamber size in diastole: 70 mm, interventricular septum: 12 mm, septal hypokinesis, Doppler ultrasonography of lower limb arteries (calcification, diffuse atherosclerotic changes, absent stenosis), CT coronary angiography (significant stenosis of the left coronary artery). Treatment started with 40 mg oral dose of furosemide daily. In May 2011 he was hospitalized with an acute coronary syndrome: acute NSTEMI of the inferior wall (coronarography: 2-vascular problems, implemented PKI, implanted DES – ramus circumflexus, paroxysmal atrial fibrillation, NYHA III functional class, left ventricular ejection fraction: 30 %, pulmonary hypertension). In 2012 renal denervation for resistant hypertension was carried out, carotid stent implanted for stenosis of the carotid artery, presence of diabetic nephropathy (KDOQI stage 3, GF 40 ml/min). In August 2014 admitted to our clinic with pulmonary oedema, cardiogenic shock, acute ischemia of the right calf with peripheral embolisation, presence of atrial flutter, impairment of renal parameters, echocardiographically: left atrium: 55 mm, left ventricle size: 75 mm, akinesis of the septum and posterior wall, occlusion of the right leg arteries (given the patient‘s serious state angio-surgical intervention was contraindicated, vitally indicated leg amputation considered), the patient died after 4 days of hospitalization in an intensive care unit after unsuccessful treatment. A combination of diabetes, hypertension and ischemic heart disease is frequent and prognostically serious. Diabetes increases cardiovascular morbidity and mortality and therefore we should check for diabetes in all cardiovascular patients.

Key words:
acute coronary syndrome – type 2 diabetes mellitus – hypertension – ischemic heart disease – cardiogenic shock

Sources

1. Mokáň M, Galajda P, Prídavková D et al. Prevalencia diabetes mellitus a metabolického syndrómu na Slovensku. Diabetes Obez 2006; 6(12): 10–16.

2. Murín J. Ischemická choroba srdca – dá sa liečiť ovplyvnením kardiálneho metabolizmu? Cardiology Lett 2014; 23(4): 269–275.

3. Murín J, Pernický M, Kiňová S. Srdcové zlyhávanie – dá sa liečiť ovplyvnením kardiálneho metabolizmu? Vnitř Lék 2014; 60(5–6): 437–441.

4. Murín J. Ako postupovať v liečbe kardio-vaskulárnych ochorení diabetikov. Diabetológia a obezitológia 2014; 14: 34–35.

5. Murín J, Kiňová S. Komentár k Odporúčaniam Európskej kardiologickej spoločnosti a Európskej diabetologickej spoločnosti o prístupe k diabetikovi s kardiovaskulárnym ochorením. Cardiology Lett 2014; 23(4): 253–258.

6. Dickstein K, Cohen-Solal A, Filippatos G et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008; 10(10):933–989.

7. Roger VL, Go AS, Lloyd-Jones DM et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation 2011; 123(4): e18-e209.

8. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33(14): 1787–1847. Erratum in Eur Heart J 2013; 34(2): 158.

9. Špinar J, Vítovec J Metabolický syndrom a kardiovaskulární onemocnění. Vnitř Lék 2009; 55(7–8): 653–658.

10. Anker SD, Ponikowski P, Varney S et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet 1997; 349(9058): 1050–1053.

11. Ashrafian H, Frenneaux MP, Opie LH. Metabolic mechanisms in heart failure. Circulation 2007; 116(4): 434–448.

12. Berry C, Clark AL. Catabolism in chronic heart failure. Eur Heart J 2000; 21(7): 521–532.

13. Bartoš V, Pelikánová T (eds). Praktická diabetologie. Maxdorf: Praha 1996. ISBN 80–85800–31–4.

14. CODE 2: Revealing the cost of type 2 Diabetes in Europe. Smith Kline Beecham Pharmauceuticals 1999.

15. Česká diabetologická společnost. Standardy péče o diabetes 2. typu. Prakt Lék 1997; 77: 401–403.

16. Perušičová J. Trendy soudobé diabetologie. Sv. 6. Galén: Praha 2002: 57–95. ISBN 807262153X.

17. The Diabetes Control and Complications Trial Research Group: The Effect of intensive Treatment of Diabetes on the Development and progression of long term Complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977–986.

18. Murín J, Pernický M. Troponíny a srdcové zlyhávanie. Cardiol Lett 2014; 23(6): 405–409.