How is differential diagnosis of diabetic heart disease?

In the previous article, we talked about the symptoms and signs of diabetic heart disease. Now let's talk about the differential diagnosis of diabetic heart disease.

How is differential diagnosis of diabetic heart disease?

1. The diagnostic criteria for diabetic coronary heart disease are similar to those of non-diabetic patients, but the incidence of painless myocardial ischemia and myocardial infarction is higher in diabetic patients; it should be vigilant, and the diagnostic conditions are as follows:
     (1) Diabetes diagnosis is clear;
     (2) angina pectoris, myocardial infarction, arrhythmia or heart failure;
     (3) The electrocardiogram shows that the S-T segment is horizontally ordownwardly inclined, and the amplitude is ≥0.05-0.1 mV, and the T-wave is flat, inverted or biphasic;
     (4) Doppler ultrasound suggests left ventricular diastolic and systolic dysfunction, and segmental wall motion is weakened;
     (5) Coronary angiography suggests lumen stenosis >50%; it is the most accurate method for diagnosing coronary heart disease;
     (6) Radionuclide (such as 201 Tl) examination of myocardial perfusion defects, combined with single photon emission computed tomography (SPECT) or positron emission tomography (PET), can be found in myocardial metabolic  abnormalities, help to improve The accuracy of the diagnosis;
     (7) Nuclear magnetic resonance imaging (MI) may indicate cardiac macrovascular disease and myocardial infarction;
     (8) Exclude other organic heart disease.
2. The clinical diagnosis of diabetic cardiomyopathy is difficult, and it is sometimes difficult to distinguish it from other cardiomyopathy such as hypertensive cardiomyopathy. The following points can be used as a reference:
     (1) Diabetes diagnosis is established;
     (2) There is arrhythmia, heart enlargement or heart failure occurs;
     (3) Echocardiography suggests left ventricular enlargement, diastolic or systolic dysfunction, and decreased myocardial compliance;
     (4) Radionuclide or MI indicates the presence of cardiomyopathy;
     (5) chest X-ray shows an enlarged heart, which may be accompanied by pulmonary congestion;
     (6) coronary angiography excludes coronary artery stenosis;
     (7) Exclude other causes of cardiomyopathy.
3. Diabetic cardiac autonomic neuropathy lacks specific criteria, clinical diagnosis can refer to the following indicators:
     (1) Diabetes diagnosis is established;
     (2) The heart rate is greater than 90 beats/min at rest, or the heart rate is fast and fixed and is not affected by other various conditions, and other factors such as cardiac insufficiency, anemia and fever are excluded;
     (3) erect hypotension, systolic blood pressure decreased by ≥30mmHg and  diastolic blood pressure decreased by ≥20mmHg;
     (4) Heart rate difference per minute is ≤10 times in deep breathing; heart rate difference is ≤10 times per minute in vertical position; ≤1.1 in fatigue response index; RR interval in 30th heart rate and RR in 15th heart rate in standing position The ratio of the pitch is <1.03.