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[Heart failure after myocardial infarct in decompensated diabetes mellitus. Acute therapy with
1Abteilung Kardiologie, Philipps-Universität Marburg.
Insights
This case study highlights the successful management of a complex patient with type 1 diabetes, coronary artery disease, and heart failure who experienced myocardial infarction and pneumonia. Comprehensive treatment led to improved cardiac function and enabled further intervention.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
Background:
- The patient presented with multiple comorbidities including type 1 diabetes mellitus, coronary artery disease (CAD), and chronic heart failure.
- A subacute myocardial infarction precipitated acute decompensation of cardiac function, diabetes, and concurrent pneumonia.
Observation:
- Initial management involved hemofiltration, catecholamines, antibiotics, insulin therapy, and systemic heparinization for acute heart failure, acute renal failure, diabetic nephropathy, and pulmonary edema.
Findings:
- Chronic treatment with digitalis, aspirin, insulin, an ACE inhibitor, and a loop diuretic resulted in significant improvement.
- The patient's heart failure improved to NYHA functional class II.
Implications:
- This comprehensive management strategy allowed for subsequent percutaneous coronary intervention (PCI) for multi-vessel coronary artery disease with low procedural risk.
- The case underscores the importance of integrated care for patients with complex cardiovascular and metabolic conditions.
Abstract:
In a 63-year-old woman with longstanding type I diabetes mellitus, CAD and chronic heart failure, a subacute myocardial infarction developed, together with decompensation of cardiac function and diabetes and concurrent pneumonia. Acute heart failure with acute renal failure on top of diabetic nephropathy, and interstitial pulmonary edema was initially treated with hemofiltration and catechol amines together with antibiotic and perfusor-regulated insulin therapy, and systemic heparinization. Subsequent chronic treatment with digitalis, acetyl salicylic acid, insulin and a combination of an ACE inhibitor and a loop diuretic resulted in an improvement of heart failure to NYHA functional class II where PTCA of coronary multi-vessel disease could be performed with low risk.