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

A 72-year-old woman was admitted to the hospital with "flash" pulmonary edema, preceded by chest pain, requiring intubation. Her medical history included coronary artery disease with previous myocardial infarctions, hypertension, and diabetes mellitus. A history of angioedema secondary to lisinopril therapy was elicited. Current medications did not include angiotensin-converting enzyme inhibitors or beta-blockers. She had no previous beta-blocking drug exposure. During the first day of hospitalization (while intubated), intravenous metoprolol was given, resulting in severe angioedema. The angioedema resolved after therapy with intravenous steroids and diphenhydramine hydrochloride.
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PMID:Angioedema following the intravenous administration of metoprolol. 798 34

This study was aimed at evaluating the level of metabolic control and cardiovascular risk factors in a population of Type 2 diabetic patients with coronary artery disease. We used myocardial thallium-201 scintigraphy as a measure of coronary perfusion integrity. One hundred and forty six diabetic patients presenting with chest pain, ischaemic ECG changes or a positive exercise test underwent myocardial thallium-201 imaging perfusion in conjunction with exercise stress. Scintigrams were assessed by a computer assisted image analysis. The cardiovascular risk factors considered were sex, age, BMI and waist-hip ratio, smoking, systolic and diastolic blood pressure, serum lipids (total cholesterol and triglycerides), glycated haemoglobin A1, urinary albumin excretion, white blood cell count, and diabetes duration. The proportion of male diabetic subjects with a positive scintigraphy was 63% while that of diabetic women was 45% (p < 0.05). Mean age, anthropometric measures and diabetes indices were similar when diabetic patients with positive or negative scintigraphy were compared. The prevalence of patients with microalbuminuria and retinopathy (both non-proliferative and proliferative) was higher in positive (26% and 27%, respectively) than in negative (10% and 11%, respectively, p = 0.01) diabetic patients. Total cholesterol and white blood cell counts were also higher in positive diabetics (p < 0.05-0.01). These findings suggest that a cluster of risk factors (cholesterol, white blood cells, microalbuminuria) may be implicated in the development of coronary artery disease in Type 2 diabetes mellitus.
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PMID:Coronary artery disease in type-2 diabetes mellitus: a scintigraphic study. 805 27

Decreased heart rate variability (HRV) correlates with increased sympathetic or decreased vagal tone. This could contribute to increase local coronary hyperreactivity caused by atherosclerotic plaque disruption, thus facilitating progression from unstable angina to acute myocardial infarction (AMI). To test this hypothesis we studied 92 patients admitted to the coronary care unit for episodes of chest pain at rest associated with transient ST shifts (> 0.15 mV). Patients who developed AMI in the first 24 hours, as well as those with previous AMI, concomitant valvular or myocardial diseases or diabetes mellitus were not enrolled in the study. Thirty age-matched subjects without any evidence of coronary artery disease were chosen as controls. All patients underwent a 2 to 5 day continuous Holter monitoring during full medical treatment (including beta-blockers, heparin and aspirin). Angiography was performed within 1 week in 88 of the 92 patients. During follow-up (mean duration of 16 +/- 5 days), 26 patients (Group I) had a major coronary event (6 deaths, 7 non fatal AMI, 13 urgent revascularizations). The remaining 66 patients (Group II) had a good clinical outcome. ECG recordings during ST shifts were excluded from Holter monitoring analysis. Time domain measurements of HRV predicted mortality and total events. The most powerful predictors was the standard deviation of the means of the 5 min R-R intervals (SDANN index) which was significantly (p < 0.001) lower in Group I than Group II (55 +/- 18 versus 87 +/- 29).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[An analysis of the variability of the heart rate and its significance in the risk stratification of patients with unstable angina]. 808 15

This study was undertaken to determine whether patients with silent ischemia (SI) (a positive thallium stress test without chest pain) have nonchest-pain symptoms that might serve as "anginal equivalents." Two hundred ninety-four individuals on completing a stress test were requested to score ten symptoms on a questionnaire (0 absent; 3 severe). Forty-three with a positive test had pains (chest, back, arm, and/or jaw) (no SI), whereas 93 with a positive test did not (SI). Patients with SI and patients without SI did not differ as to age, gender, or clinical features (including presence of diabetes or a history of myocardial infarction), but patients with SI were less likely to report a history of effort-related chest pains. Patients with SI exercised longer and had a higher peak heart rate. Patients were comparable with respect to myocardial ischemia (ST segment depression, double product, thallium lung uptake, and positive thallium scintigrams) and severity of coronary disease. Patients with SI complained less of weakness (p < 0.02) and tended to have lower overall symptom scores (4.2 +/- 0.3 vs 5.4 +/- 0.6), but breathlessness was comparable for both groups. On multivariate analysis, no nonanginal symptom was associated with SI. Only absence of a history of chest pain with activity and longer exercise time were related to SI. Patients with SI have similar clinical features as those with angina but tend to be less symptomatic with myocardial ischemia even for symptoms other than chest pain.
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PMID:Symptoms of patients with silent ischemia as detected by thallium stress testing. 816 17

Unlike dipyridamole testing with thallium-201, the ability of technetium-99m sestamibi (MIBI) myocardial imaging to evaluate risk of later cardiac events has not been established. In this study, the prognostic value of dipyridamole MIBI myocardial tomography (same-day, rest-stress protocol) was assessed in 534 patients with stable chest pain consistent with angina pectoris. During follow-up (mean 13 +/- 5 months), 58 patients (11%) had a major cardiac event--nonfatal myocardial infarction (n = 14) or cardiac death (n = 44). A history of congestive heart failure, prior myocardial infarction or diabetes mellitus, and either a reversible or fixed myocardial perfusion defect on MIBI scans were univariate and multivariate predictors of increased cardiac risk. Cardiac events occurred in 2% of patients with normal MIBI scans, compared with 15% with abnormal scans, 17% with reversible perfusion defects and 16% with fixed defects (all p < 0.01). Relative risks (univariate Cox analysis) associated with an abnormal MIBI scan, a reversible perfusion defect and a fixed defect were 8.4 (95% confidence interval [CI] 2.6 to 26.8), 1.9 (95% CI 1.1 to 3.2) and 2.4 (95% CI 1.4 to 4.3), respectively. Patients with any kind of perfusion abnormality (reversible or fixed) had a significantly lower cardiac event-free survival than those with normal scans (all p < 0.0001). It is concluded that, as with thallium-201 myocardial scintigraphy, a normal MIBI scan is associated with low cardiac risk, whereas dipyridamole-induced myocardial perfusion defects identify patients with significantly increased risk.
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PMID:Prognostic value of dipyridamole technetium-99m sestamibi myocardial tomography in patients with stable chest pain who are unable to exercise. 816 59

A 61-year-old woman with hyperlipidemia was treated with gemfibrozil. She also had insulin-treated diabetes mellitus and chronic renal failure and was admitted because of severe chest pain. The ST segment was depressed and creatine kinase levels were elevated. The original diagnosis was acute myocardial infarction. In the presence of increasing chest pain, the onset of limb muscle tenderness, and increasing levels of creatine kinase, the diagnosis of myopathy secondary to gemfibrozil therapy was made and the drug was discontinued. All symptoms then subsided and creatine kinase levels returned to normal. Myopathy is a well-known complication of blood lipid-lowering drugs, especially in patients with renal failure.
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PMID:[Gemfibrozil-induced myopathy]. 825 19

Data from a community-based sample of 2,812 men and women aged 65 years and over, living in New Haven, Connecticut, were used to examine the associations between blood pressure, smoking, diabetes, anginal chest pain, and relative weight and 6-year incidence (1982-1988) of myocardial infarction and coronary heart disease mortality. Multivariate logistic regression analyses revealed that history of diabetes was associated with increased risk of incident myocardial infarction among women (odds ratio (OR) = 3.20; 95% confidence interval 1.46-7.01), while higher relative weight was a significant risk factor among men (OR = 3.46, 95% confidence interval 1.34-8.95 for middle vs. lowest tertile and OR = 3.24; 95% confidence interval 1.10-9.53 for highest versus lowest tertile). For coronary heart disease mortality, age and diabetes (OR = 4.47, 95% confidence interval 1.85-10.79) were associated with increased risk among women, as was current smoking (OR = 3.96; 95% confidence interval 1.66-9.45). Among men, age, prevalent heart disease, and use of antihypertensive medication (OR = 1.84; 95% confidence interval 1.13-3.00) were risk factors for coronary heart disease mortality. These risk estimates and the relatively high prevalences of these risk factors suggest that attributable risks may be substantial. Observed sex differences as well as differences in patterns of risk factor associations for the two endpoints suggest that there may be different risk profiles for older men and women and for different coronary heart disease endpoints.
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PMID:Risk factors for coronary heart disease among older men and women: a prospective study of community-dwelling elderly. 826 6

We report a 66-year-old man with progressive spinal paraplegia. He was well until June of 1991 when he had an onset of backache and right chest pain. On August 25, he lost sensation to void and he became unable to urinate. On the same day, he noted weakness in his legs which became progressively worse, and he was admitted to our hospital. Past medical history included diabetes mellitus which was found 3 years previously. He had upper gastrointestinal series 2 months before, which revealed a normal study. On admission, he was alert and general physical examination was unremarkable. Neurological examination revealed a mentally sound man with normal higher cerebral functions. Cranial nerves were also intact. He was unable to walk. No muscle atrophy was noted, but he had moderate to marked (2/5) weakness in both legs. No ataxia was noted in the upper extremities. Jaw jerk was normal, however, deep reflexes in the upper extremities were decreased, and absent in the lower extremities Babinski sign was present bilaterally. All sensory modalities were diminished below the Th 6 dermatome. No meningeal sign was present. Emergency myelography was performed on the day of admission, which revealed complete block from the Th4 to Th8 segments. CSF taken at that time was xanthochromic, positive Queckenstedt test containing 1,133 mg/dl of protein, 54 mg/dl of sugar and 1/3 microliters of lymphocyte. On August 31, laminectomy was performed from Th5 to Th7. The spinal bones in this area was very fragile and hemorrhagic. A soft yellowish vascular-rich tissue was surrounding the spinal cord in the epidural space. Despite surgery his weakness in legs worsened, and he became paraplegic by September 10th. He became somnolent with disorientation to time. In the subsequent course, he developed metabolic acidosis on September 26. On September 28, he became anuric and hypotensive. He expired later on that day.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A 66-year-old man with backache and progressive difficulty of gait]. 826 41

To determine the incidence of arteriographically proven coronary artery disease in black men evaluated for chest pain, we retrospectively reviewed the charts of 208 black men, aged 20 to 60, who had coronary arteriography at the Medical Center of Central Georgia (MCCG) from 1985 through January 1990. Age, type of chest pain, and risk factors commonly accepted as associated with coronary disease (hypertension, family history, left ventricular hypertrophy, diabetes, smoking, and hypercholesterolemia) were identified for each patient. Patients were categorized by previous evidence of coronary disease: 145 were studied to evaluate suspected disease and 63 to evaluate previously proven (prior catheterization) or presumptive (prior myocardial infarction) disease. Chest pain groups (typical and atypical angina) were analyzed by Pearson chi-square goodness of fit using the Diamond and Forrester age and chest pain tables as a model. Risk factors were analyzed using a maximum likelihood chi-square test. Coronary artery disease was common in the study group (48.6% of all patients) but significantly less than predicted by the Diamond and Forrester tables. Risk factors were highly prevalent, but only age and smoking were associated with catheterization-proven coronary artery disease in this group. We conclude that coronary artery disease is common in black men evaluated for chest pain but less frequent than would be expected from comparison with findings in white men presenting similar clinical features. Risk factors other than age and smoking were not associated with increased incidence of disease. A prospective study is needed to delineate a more effective means of evaluating black male patients with chest pain.
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PMID:Arteriographic incidence of coronary artery disease in black men with chest pain. 828 15

Ninety-four consecutive patients (60 men and 34 women; mean age 68.5 +/- 11.5 years) with acute myocardial infarction (MI) were investigated retrospectively, in order to evaluate the prevalence, clinical features, and short-term course of the atypical forms (symptoms other than chest pain). An atypical MI was found in 30 patients, with a prevalence of 32% (95% confidence limits 27-36%). It was most prevalent in women above sixty-five years old (P < 0.05). Abdominal pain, paroxysmal dyspnea, and pulmonary edema were the most frequent symptoms (33%, 17%, 13%, respectively). No differences were observed between typical and atypical MI in regard to risk factors (hypercholesterolemia, arterial hypertension, diabetes mellitus, cigarette smoking) and history of MI, cerebrovascular disease, peripheral vascular disease, or chronic lung disease. Significantly fewer patients with atypical MI had a history of angina pectoris (P < 0.05). No differences were observed in regard to previous medication, except for antiarrhythmic drugs, more often used by atypical patients (P < 0.05). Location and severity of MI (as judged by ECG and peak levels of creatine kinase in the serum) were similar in both subgroups, as were the complications (34% typical and 50% atypical) and death rate (12.5% and 16.7%, respectively). In conclusion, atypical MI is not less severe than typical. This emphasizes the need for a high suspicion index in many different clinical settings, but particularly (although not exclusively) in elderly females, in the presence of abdominal pain or otherwise unexplained paroxysmal dyspnea.
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PMID:Prevalence, clinical features, and acute course of atypical myocardial infarction. 828 84


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