Managing the asymptomatic diabetic patient with silent myocardial ischaemia

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dc.contributor.authorDoubell A.F.
dc.date.accessioned2011-05-15T15:56:43Z
dc.date.available2011-05-15T15:56:43Z
dc.date.issued2002
dc.description.abstractCoronary artery disease is common in diabetic patients and remains the major cause of death in these patients. However myocardial ischaemia resulting from coronary lesions does not always give rise to symptoms. The managing physician must therefore consider the benefit of screening for silent myocardial ischaemia in diabetic patients. Screening all diabetic patients is not recommended. The challenge to the physician is to select the patient subgroups likely to benefit from screening. Patients with more than one cardiac risk factor (dyslipidaemia, hypertension, smoking, family history, microalbuminuria) in addition to diabetes, as well as patients with established macrovascular disease, e.g. peripheral vascular disease, will benefit most from screening. A standard treadmill stress ECG is the recommended screening test. A number of additional tests have been proposed to select high-risk patients for screening. Of these, testing for microalbuminuria and elevated CRP levels are most likely to influence decision-making. Once silent ischaemia has been detected in a diabetic patient, the mainstay of treatment remains the aggressive control of risk factors, improvement of glycaemic control and aspirin therapy. The use of beta-blockers and ACE-inhibitors often need consideration. The attending physician must then consider referring the patient to a cardiologist for angiography and possible intervention. This decision is based on the presence of poor prognostic signs during the stress ECG and the number of risk factors present. Microalbuminuria and elevated CRP levels are helpful in assisting with the risk stratification process.
dc.description.versionReview
dc.identifier.citationCardiovascular Journal of South Africa
dc.identifier.citation13
dc.identifier.citation4
dc.identifier.issn10159657
dc.identifier.urihttp://hdl.handle.net/10019.1/10008
dc.subjectacetylsalicylic acid
dc.subjectbeta adrenergic receptor blocking agent
dc.subjectC reactive protein
dc.subjectdipeptidyl carboxypeptidase inhibitor
dc.subjectglucose
dc.subjectangiography
dc.subjectcardiovascular risk
dc.subjectcause of death
dc.subjectcoronary artery disease
dc.subjectdecision making
dc.subjectdiabetes mellitus
dc.subjectdyslipidemia
dc.subjectelectrocardiography
dc.subjectfamily history
dc.subjectglucose blood level
dc.subjectheart muscle ischemia
dc.subjecthigh risk patient
dc.subjecthuman
dc.subjecthypertension
dc.subjectmicroalbuminuria
dc.subjectperipheral vascular disease
dc.subjectprognosis
dc.subjectreview
dc.subjectrisk assessment
dc.subjectrisk factor
dc.subjectscreening
dc.subjectscreening test
dc.subjectsmoking
dc.subjectsymptom
dc.subjecttreadmill
dc.subjectAlbuminuria
dc.subjectC-Reactive Protein
dc.subjectClinical Trials
dc.subjectCritical Pathways
dc.subjectDiabetes Complications
dc.subjectDiabetes Mellitus
dc.subjectExercise Test
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMyocardial Ischemia
dc.subjectRisk Factors
dc.titleManaging the asymptomatic diabetic patient with silent myocardial ischaemia
dc.typeReview
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