Silent myocardial ischaemia and cardiac autonomic neuropathy in diabetics

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S B Gupta1, R B Pandit

  • 1Department of Cardiology, Central Railway Headquarters Hospital, Byculla, Bombay.

Indian Heart Journal
|July 1, 1992
PubMed

Insights

Diabetic patients often have silent heart issues. Cardiac autonomic neuropathy may explain why they don't feel chest pain during latent coronary artery disease.

Area of Science:

  • Cardiology
  • Diabetology
  • Neurology

Background:

  • Diabetes mellitus is a significant risk factor for cardiovascular disease.
  • Diabetic patients may experience atypical or absent symptoms of coronary artery disease (CAD).
  • Cardiac autonomic neuropathy (CAN) is a common complication of diabetes.

Purpose of the Study:

  • To investigate the prevalence of latent coronary artery disease (CAD) in diabetic patients using treadmill exercise electrocardiography.
  • To assess the association between cardiac autonomic neuropathy (CAN) and treadmill test results in diabetic patients.
  • To explore the role of CAN in the presentation of silent myocardial ischemia in diabetes.

Main Methods:

  • 47 diabetic patients underwent treadmill exercise electrocardiography (ECG).
  • All participants were evaluated for cardiac autonomic neuropathy (CAN).
  • Coronary angiography was performed on a subset of patients.

Main Results:

  • 18 patients (36.3%) tested positive on the treadmill test, indicating latent CAD.
  • The incidence of CAN was significantly higher in the treadmill-positive group (72.2%) compared to the treadmill-negative group (31.0%) (p < 0.01).
  • Coronary angiography confirmed significant CAD in 8 of 9 patients from the positive group and 1 of 4 patients from the negative group.

Conclusions:

  • The incidence of silent myocardial ischemia in diabetic patients is high.
  • Cardiac autonomic neuropathy is strongly associated with positive treadmill test results in diabetics.
  • CAN may be a primary reason for the absence of typical anginal pain in diabetic patients with CAD.

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