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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Experimental and clinical evidence points to the existence of a cardiomyopathy associated with diabetes mellitus that is not due to coronary atherosclerosis. The condition is characterized by distinct clinical presentations and physiologic and biochemical abnormalities. Potential mechanisms for the development of diabetic cardiomyopathy are complex but are probably associated, in part, with hyperglycemia and hyperlipidemia. Primary hypertension is also associated with the development of myocardial abnormalities. Many of these changes are similar to those seen in diabetic cardiomyopathy. It is now clear that the co-existence of hypertension and diabetes mellitus produces a more severe cardiomyopathy than that produced by hypertension or diabetes alone. Potential mechanisms for interaction are numerous. Treatment of hypertension in diabetic patients must be targeted to more specific needs. Antihypertensive drugs should not worsen cardiac risk factors or glucose control and should have favorable effects on left ventricular function. The calcium antagonists and angiotensin-converting enzyme inhibitors have pharmacologic profiles that make them attractive as monotherapy for diabetic patients.
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PMID:Myocardial disease in hypertensive-diabetic patients. 268 10

We performed a retrospective study in 72 autopsies of diabetic patients (DMP) selected out of 2,239 adult autopsies, comprehending the period between 1966 to 1982. In order to analyse the possible Diabetic Cardiomyopathy, the DMP were divided into 8 groups according to the presence or the absence of Myocardial Fibrosis (MF) and Congestive Heart Failure (CHF). The Diabetes Mellitus (DM) incidence according to the race, sex, age and the presence of Kimmestiel-Wilson (KW) were in agreement with the literature data. The majority of the deaths occurred after the sixth-decade and we did not find any DMP with Malignant Hypertension. Hypertension and Coronary Artery Disease (CAD) increased the frequency of anatomical cardiac alterations, as follows: 1. MF was more associated with CAD, 2. Hypertension was more frequent in DMP with KW in the nodular form; 3. Hypertension increased the frequency of left ventricular hypertrophy; 4. Myocardial Infarction occurred in the absence of occlusive vascular phenomena. The Myocardial Fibrosis (MF) observed in DMP without ACD and without hypertension may be final anatomic demonstration of a gradual metabolic-functional process, and not the basic mechanism of the CHF in the possible Diabetic Cardiomyopathy.
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PMID:[The heart and diabetes. An anatomo-clinical study]. 269 52

This report describes the case of a 70-year-old female suffering from diabetes mellitus and dilatative cardiomyopathy with congestive heart failure. It is likely that alveolar-capillary membrane damage occurred apart from cardiac involvement. Diffuse interstitial pulmonary fibrosis subsequently occurred with consequent acute progressive respiratory failure and death. The cause of the damage to the alveolar-capillary membranes is still unknown and we thought that long-term administration of captopril might have contributed to the damage itself, since like all ACE-inhibitors, captopril is able to bring about tissular storage of both bradykinin and prostaglandins and therefore alter the pulmonary reactivity to phlogistic stimuli.
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PMID:[Acute progressive respiratory insufficiency caused by diffuse interstitial pulmonary disease in a diabetic patient with dilated myocardiopathy]. 270 34

Although a relationship has been suggested between abstinence from alcohol and improvement in left ventricular (LV) function, no long-term studies in large groups of patients have been done to confirm this impression or to demonstrate an effect on survival. To address these questions, the authors analyzed the outcome in 105 male patients with alcoholic cardiomyopathy and 64 control male patients with nonalcoholic dilated cardiomyopathy. Survival data were available for all patients. The correlates of survival were assessed via the Cox proportional hazards model. Variables considered were age, race, drinking pattern (current drinker versus former drinker), presence of coronary artery disease (CAD), hypertension, and diabetes, and these echo variables: left atrial (LA) size, posterior wall thickness, LV end diastolic dimension (LVDD), minimal E point septal separation, wall motion, presence of incomplete mitral leaflet closure (IMLC) or low cardiac output, and the ratio of relative wall thickness to LVDD. The two study groups were comparable with respect to all echocardiographic variables. At a mean follow-up of 17.2 months +/- 12.1 months, 42.85% of the alcoholics and 41% of the nonalcoholics had died. Nonsurvival in the alcoholic group was significantly associated with only two factors: an increased LVDD and the presence of IMLC. The drinking pattern was not significantly associated with survival. By contrast, in the nonalcoholics,the variables most closely related to survival were LVDD, low cardiac output, increasing age, and abnormal wall motion. Therefore: (1) the risk factors in alcoholic and nonalcoholic cardiomyopathy are similar although IMLC appears to be a relatively specific prognostic factor for alcoholic cardiomyopathy and (2) abstinence from alcohol does not appear to improve survival.
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PMID:Risk factors in alcoholic cardiomyopathy. 270 34

Clinically significant differences between various beta-adrenoceptor blocking drugs exist. Patients with ischaemic heart disease and exertional angina pectoris benefit from all types of beta-blockers. Drugs with intrinsic sympathomimetic action (ISA) given intravenously may be safer in some patients with acute myocardial infarction than those drugs without ISA. In cardiac patients at rest they may have a vasodilator action and cause less myocardial depression than beta-blockers without ISA. When, however, the cardiac sympathetic tone is high pindolol and other beta-blockers with ISA act as any other beta-blockers, producing haemodynamic impairment. Studies have shown that beta-blockers with ISA confer less benefit in secondary prevention after myocardial infarction and they are not suitable for the treatment of obstructive cardiomyopathy. Non-selective beta-blockers may be advantageous in hypokalaemic arrhythmias. Beta 1-blockers may be preferred for patients with bronchoconstriction, diabetes, peripheral vascular disease and, theoretically to some extent in theory also in patients with hypertension. The extent and nature of side effects may also influence the selection of the most suitable beta-blocker in cardiovascular therapy.
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PMID:Differences in betablocking drugs in cardiovascular therapy. 290 77

The clinical records of 72 patients with spinocerebellar ataxias which had manifested before the age of 20, were examined in a retrospective study. Depending on whether the muscle stretch reflexes in the legs were positive or negative, two groups were distinguished, that of early onset cerebellar ataxia with retained tendon reflexes (EOCA) (13 P.) and that of Friedreich's ataxia (FA) (59 P.). The clinical course was much worse in the FA patients compared with EOCA. Cardiomyopathy and diabetes mellitus were not a feature of EOCA. Scoliosis and a disturbed position sense in the toes were more frequent in FA cases. The striking differences in clinical signs and course of the diseases justify the differentiation of EOCA from FA, as suggested by Harding in 1981.
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PMID:[Differential diagnosis of Friedreich ataxia]. 292 87

One of the leading causes of mortality in diabetics is myocardial disease. In the past few years this subject has generated a significant amount of interest with the result that myocardial problems associated with diabetes are far better understood. Though originally thought to occur as a result of atherosclerosis, various studies have shown that heart disease can occur in the absence of atherosclerosis, suggesting a diabetic cardiomyopathy. Using diabetic animals, it has been possible to characterize diabetes-induced myocardial abnormalities. Diabetic rat hearts do not respond to conditions of high stress as well as controls. The functional depression is accompanied by altered cardiac enzyme systems. A decrease in myosin ATPase activity which appears to be a result of diabetes-induced hypothyroidism is seen. Also, a depression of sarcoplasmic reticular calcium ATPase, along with a depression of calcium uptake by the SR, is seen in diabetic rat hearts. Na+, K+ ATPase activity has also been shown to be depressed and the depression appears to correlate with depressed atrial contractility. High levels of circulating fats in diabetics may alter the integrity of membranes leading to altered enzyme activities. Insulin treatment has been relatively successful at reversing or preventing myocardial changes in the diabetic rat. Other treatments that have been studied include thyroid hormone treatment, since the depression of myosin ATPase can be corrected by such treatment; and carnitine treatment, as the elevation of long chain acyl carnitines (LCAC) and the resulting depression of calcium uptake in the SR can be so normalized. These treatments have not been successful at normalizing cardiac function. A combination of the two treatments normalized function only partially, suggesting that factors besides myosin ATPase and SR calcium uptake are involved. Other treatments that have been tried include vanadate, methyl palmoxirate, and choline and methionine. Vanadate treatment has proved to be encouraging in that it normalizes both function and hyperglycemia. Methyl palmoxirate, a fatty acid analog, normalized only the elevation of LCAC but did not affect function. Methionine and choline were only partially successful in preventing the functional alterations of diabetic rat hearts. The purpose of the present article is to review our understanding of diabetes-induced myocardial problems and their possible causes. Findings from our laboratory and others are described in which attempts have been made to normalize cardiac function.
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PMID:Diabetes-induced abnormalities in the myocardium. 293 41

In order to test the importance of the association of diabetes mellitus and arterial hypertension in generating morphological and functional changes of the left ventricle (LV) consistent with a cardiomyopathy, 37 patients, aged 27 +/- 6.7 years, were studied by standard and digitized M-Mode echo: eighteen of them were affected by diabetes mellitus, 11 by arterial hypertension, 8 by diabetes and hypertension. Each group was compared to the others and with a group of 14 normal subjects. In order to verify the importance of increased ventricular after-load in modifying ventricular performance of diabetic patients, changes of the peak rate of systolic and diastolic variation of LV diameter and changes of the peak rate of interventricular septum and posterior wall excursion (IVSE, PWE) were evaluated after methoxamine hydrochloride infusion in 8 diabetic and 6 normal subjects. In diabetics the ratio between ventricular thickness and diameter (h/r) was greater than normal subjects (p less than 0.02); this ratio resulted higher in patients with diabetic rhinopathy who also exhibited an isovolumic diastolic period longer than normal (p less than 0.02). Both h/r ratio and isovolumic diastolic period (IDP) were higher in diabetic-hypertensive group as compared to normals (p less than 0.001), strictly diabetic (p less than 0.01 and p less than 0.001) or hypertensive subjects (p less than 0.01). Diabetic-hypertensive group, exhibited a lowering of the systolic and diastolic peak rate of IVSE (p less than 0.01) as well as of systolic peak rate of PWE as compared to the other three groups (p less than 0.05).
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PMID:[Diabetic cardiomyopathy: preclinical pathology disclosed by the increase in ventricular afterload]. 296 61

Diabetes was introduced in rats by an intravenous injection of streptozotocin (65 mg/kg). Animals were sacrificed 8 weeks later and mitochondria were isolated from the ventricular tissue by differential centrifugation. The state 3 respiration, oxidative phosphorylation rate and Mg2+-dependent ATPase activities were depressed in mitochondria from diabetic hearts. These changes were partially reversible upon 2 weeks of insulin and fully reversible after 4 weeks of insulin therapy. Mitochondrial calcium uptake but not calcium binding, was decreased in diabetes and this change was fully reversible by 2 weeks of insulin administration. The observed alterations in mitochondrial function could not be explained on the basis of any changes in mitochondrial lipid and protein composition or subcellular contamination. These results indicate the presence of a generalized depression in mitochondrial function in chronic diabetes and such a defect is suggested to contribute in the development of cardiomyopathy at late stages of diabetes.
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PMID:Heart mitochondrial function in chronic experimental diabetes in rats. 299 24

1,2-Diacylglycerol has been proposed to be a secondary messenger; therefore, in this study we evaluated the amount of 1,2-diacylglycerol in heart tissue from streptozocin-induced diabetic rats and examined the effect of insulin treatment on 1,2-diacylglycerol content. Diabetic rats had lower body and ventricular weights and higher ratios of ventricular to body weight, all of which shifted toward normal values after 4 wk of untreated diabetes followed by 4 wk of insulin treatment. The contents of major phospholipids were significantly depressed in the diabetic rat hearts. In contrast, the triglyceride and cholesterol contents in the myocardium were increased by streptozocin injection and completely normalized by insulin treatment, and glucose levels returned to normal. The 1,2-diacylglycerol content in the myocardium was also significantly elevated in the diabetic rats compared with age-matched controls. Moreover, the 1,2-diacylglycerol content was significantly higher in rats with 4 wk of diabetes than in those with 8 wk of diabetes. Insulin treatment in the diabetic rats, however, did not produce any decrease in 1,2-diacylglycerol content. The results of this study suggest that the development of cardiomyopathy induced by streptozocin injection is associated with a high 1,2-diacylglycerol level, which may result in the activation of protein kinase C. Insulin is one of the agonists that generates 1,2-diacylglycerol in myocytes; however, the relationship between the sustained 1,2-diacylglycerol level and the normalization of diabetes by insulin administration is unclear.
Diabetes 1988 Sep
PMID:Alteration of 1,2-diacylglycerol content in myocardium from diabetic rats. 304 83


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