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Query: UMLS:C0011849 (diabetes)
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A review of 100 cases of acute myocardial infarction admitted to the Colonial War Memorial Hospital in 1964-65 is presented. The incidence of acute myocardial infarction in this series was 97 percent in Indians and 3 percent in Fijians. The predisposing factors such as diabetes mellitus, hypertension and hypercholesterolaemia are commoner in Indians than Fijians and their role in these patients are described. The mortality rate in the first week was 23.7 percent. A two bed coronary care unit was opened in this hospital last year as part of the overall care for these patients.
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PMID:Acute myocardial infarction in Suva, Fiji. 105 51

The one year mortality of patients from the Perth Acute Myocardial Infarction Register surviving the acute episode (first 28 days) is presented. Of 1138 patients suffering definite or possible acute myocardial infarction in one year, 705 (62%) survived 28 days. There were 89 deaths (11-5%) in the subsequent 11 months. One year mortality was related to age but not sex, previous symptoms of coronary heart disease, but not hypertension or diabetes, to tachycardia and congestive cardiac failure at first examination, but not arrhythmias in the acute episode. These observations highlight the importance of protecting the myocardium in the acute phase of myocardial infarction.
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PMID:Acute myocardial infarction: one year follow-up of 1138 cases from the Perth Community Coronary Register. 107 74

Fasting blood glucose (FBG) level and oral glucose tolerance (OGT) were determined in 169 patients within 72 hours of an acute myocardial infarction. Elevated FBG levels were found in 47.5% and a reduced OGT in 72.5%. Of 32 patients who died in the hospital, FBG value was elevated in 72% and the OGT was abnormal in 89%. Of 91 patients who survived longer than six years, the initial FBG level had been elevated in 33%, and the OGT had been abnormal in 67%. Eighty percent of the group with initially raised FBG values had either latent or overt diabetes, while more than 95% of the patients with initially normal FBG values had a normal OGT. Fifty-five percent of the patients with abnormal OGT during myocardial infarction showed normal OGT six years later. The FBG level shortly after an acute myocardial infarction is a better guide to prognosis and to the prediction of subsequent development of diabetes mellitus than the OGT test.
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PMID:Hyperglycemia during acute myocardial infarction. A six-year follow-up study. 117 80

Male and female, arteriosclerotic and nonarteriosclerotic rats were subjected to acute myocardial infarction by two, subcutaneous injections (spaced 24 hr apart) of isoproterenol. During the immediate postinfarct repair phase all of the experimental animals were made severely diabetic with alloxan. Two weeks later the animals were sacrificed and their blood and pertinent organs analyzed for biochemical and pathologic changes. Females survived the myocardial infarct with superimposed diabetes in significantly greater than males. In addition to marked loss in body weight all of the experimental animals developed marked adrenal hypertrophy and thymus gland involution, cardiac hypertrophy, and unusual increase in ovarian or testicular size and weight. The combined conditions of myocardial infarction + diabetes led to substantial increases in serum creatine phosphokinase (CPK) and glutamic oxaloacetic transaminase (SGOT) whereas the enzymes glutamic pyruvic transaminase (SGPT) and lactic dehydrogenase (LDH) were reduced. Although serum triglyceride levels were greatly elevated, total cholesterol and free fatty acids were reduced. All of the animals were severely hyperglycemic and had greatly increased B.U.N. levels. Diabetes caused hypercalcemia but diabetes + myocardial infarction was associated with a definite reduction of this hypercalcemia. Despite marked adrenal hypertrophy, circulating Cmpd. B levels were subnormal. The diabetic condition and its attendant hyperlipidemia did not alter the morphologic nature of the arterial lesions in the breeder rats but the diabetes did cause definite impairment of the usual myocardial repair process observed in these rats with a particularly high incidence of left ventricular aneurysms in males.
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PMID:Metabolic and histopathologic changes in arteriosclerotic versus nonarteriosclerotic rats following isoproterenol-induced myocardial infarction with superimposed diabetes. 119 29

Carotenemia with its yellowish-red tint is found in diabetes. The frequency of this phenomenon is unknown and the relationship between skin colour and blood carotenoid level is controversial. Frequently the suspicion of diabetes arising from inspection of the skin colour is in fact confirmed by the usual laboratory tests. We decided to examine skin colour, blood carotenoids, cholesterol and total blood lipid levels in 51 overt diabetics, 42 latent diabetics and 25 healthy subjects as well as 14 patients who had recently suffered an acute myocardial infarction. The healthy subjects showed blood carotenoid levels slightly higher than the patients. As is known, in cases of increased intake of carotenoid-rich fruit and vegetables the yellowish-red skin colour is marked. Diabetic patients however show this phenomenon even though they may not follow such a diet. This finding, although diagnostically useful, does not usually parallel a high carotenoid blood level. From this point of view overt and latent diabetes are similar.
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PMID:Carotenemic, skin colour and diabetes mellitus. 122 4

Norepinephrine, epinephrine, and dopamine concentrations were studied in the cardiovscular system of postmortem material obtained from six long-term diabetics and six control subjects. Norepinephrine concentration was considerably reduced in the cardiovascular system of the diabetic patients. The mean norepinephrine concentration in the apex of the heart, the radial artery, the posterior tibial artery, and the femoral artery in the diabetics averaged 6, 9, 12, and 20 per cent, respectively, of the corresponding mean values in the controls. Epinephrine was present in the cardiovascular system in the controls but in small amounts in comparision with norepinephrine. There was no correlation between the epinephrine and the norepinephrine concentrations in the tissue. In the diabetics the epinephrine concentration in the heart and in the arteries did not differ from the values obtained in the controls. The dopamine concentration averaged 11 per cent of the norepinephrine concentration in the cardiovascular system in the controls. There was a strong correlation between tissue concentrations of dopamine and of norepinephrine. In the diabetics the dopamine concentration was reduced, but relatively less than that of norepinephrine, and constituted 53 per cent of the norepinephrine concentration. It is suggested that the depletion of the norepinephrine stores in the heart in diabetic patients may in part be responsible for their reduced survival rate in acute myocardial infarction.
Diabetes 1976 Jan
PMID:Norepinephrine, epinephrine, and dopamine contents of the cardiovascular system in long-term diabetics. 124 67

This letter was written in response to the paper by Mann et al. (British Medical Journal 2: 241-245, 1975) which reported an association between oral contraceptive (OC) use and acute myocardial infarction. Rosenberg et al. found that among 34 patients with myocardial infarction, 4 were current users of OCs and 2 used other estrogen-containing drugs. Among 1213 reference women the use was 79 and 26, respectively. The "relative risk" for OC users was 1.9 (95% confidence interval) and for other estrogen users it was 2.8 as compared with nonusers. When standardized for age these estimates became 2.2 and 2.1 and when standardized for the effects of cigarette smoking, history of hypertension, angina, and/ or diabetes the summary rate-ratio estimate for OC users decreased to 1.3 and left essentially unchanged the estimate for other estrogen users. These results are compatible with a modest increase, if any, in risk of myocardial infarction in premenopausal women associated with estrogen use, such as that reported by Mann et al.
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PMID:Letter: Myocardial infarction and estrogen therapy in premenopausal women. 126 57

The characteristics and the prognosis in 921 consecutive patients with acute myocardial infarction (AMI) admitted to one single hospital are described and related to whether they were treated in the coronary care unit or not. Patients treated in the coronary care unit (n = 779) had a 1-year mortality rate of 26% as compared with 41% for patients treated in general wards (n = 115; p < 0.001) and 74% for patients treated in the intensive care unit (n = 27; p < 0.001). Patients treated outside the coronary care unit had a different risk factor pattern including a higher age and a higher prevalence of a previous cardiovascular disease. Independent clinical risk indicators for death among patients in the coronary care unit were in order of significance, high age (p < 0.001), arrhythmia on admission (p < 0.01), acute congestive heart failure on admission (p < 0.01) and a history of diabetes mellitus (p < 0.05). In patients treated in general wards, the only risk indicator for death was a history of congestive heart failure.
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PMID:Characteristics and prognosis of patients with acute myocardial infarction in relation to whether they were treated in the coronary care unit or in another ward. 128 72

Serum immunoglobulin (Ig) levels were assayed in 672 patients admitted for acute myocardial infarction with onset within 24 hours of hospitalization. Supranormal Ig levels (A > or = 300, G > or = 1,200) or subnormal Ig levels (M < 40 mg/100 ml) were seen in patients with one or several risk factors (diabetes mellitus, alcohol abuse) or a history of previous myocardial infarction. Patients with one or more Ig anomalies were more likely to exhibit unfavorable outcomes, including early death, suggesting that increased viscosity due to aggregation of Ig molecules may occur.
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PMID:[Value of serum immunoglobulin assays in early myocardial infarction]. 140 82

An algorithm has been developed to provide predictable control of blood glucose for 48 h following acute myocardial infarction. In 29 diabetic patients intravenous infusion of soluble insulin was started upon admission to hospital and the rate adjusted hourly on the basis of bedside capillary glucose estimations. Insulin infusion rates related to glycaemia were higher in obese patients and those with severe cardiac failure. For all patients mean admission glucose levels were reduced from 18.3 +/- 5.9 mmol l-1 to 9.1 +/- 3.3 mmol l-1 at 4 h and to 8.8 +/- 2.5 mmol l-1 at 6 h. Mean glucose concentrations for 48 h after admission were 8.2 +/- 1.3 mmol l-1 for all patients. Admission glucose levels were slightly higher in patients with severe, compared to those without or mild, cardiac failure (P less than 0.1), but levels over the following 48 h were similar. Doubling insulin infusion rates before meals did not achieve tighter glycaemic control. Hypoglycaemia (glucose less than 3 mmol l-1) occurred on 11 occasions in six patients; only two episodes were symptomatic and only two episodes occurred when the insulin rates were doubled before meals. This algorithm produced tighter glycaemic control than previously published protocols, particularly in patients with severe cardiac failure. Hypoglycaemia is uncommon and the algorithm easy to administer by nursing staff.
Diabetes Res Clin Pract 1992 Jun
PMID:An algorithm for tight glycaemic control in diabetic infarct survivors. 142 42


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