 |
| What are the complications of diabetic coronary heart disease? |
Diabetic myocardial infarction
(1) aura symptoms: some have chest tightness, shortness of breath, or the original paroxysmal becomes persistent; some have angina or pre-palm discomfort, according to the general myocardial infarction observation, the aura symptoms are early and late, its 56.9% of aura symptoms were 1 week before onset; 21.6% were 2 weeks before onset; 6.6% were 3 weeks before onset; the rest were 4 weeks before onset or earlier.
The symptoms of aura are mainly angina pectoris, accounting for 61.8%. It is characterized by frequent pain, increased pain, and prolonged attack time. It is necessary to closely observe the symptoms of aura, and timely treatment is beneficial to the prognosis of myocardial infarction.
(2) Chest pain: Chest pain is the main symptom of myocardial infarction. It occurs mostly in emotional excitement. After nervous or tired, after moving heavy objects, sometimes it occurs in deep sleep. The painful nature and location resembles angina, but the pain is very intense. Long duration, usually 0.5 ~ 24h, sometimes a few patients with atypical pain, such as the abdomen, jaw, shoulder and toothache, there are still some patients, especially the elderly without any pain, called painless myocardial infarction, these are not Typical symptoms or no pain are easily missed, misdiagnosed, and should be paid attention to.
(3) Digestive tract symptoms: After the onset of diabetic myocardial infarction, about one-third of patients have nausea, vomiting, abdominal distension, and occasionally even diarrhea. These gastrointestinal symptoms may be related to autonomic dysfunction, or ischemic involvement. Caused by mesenteric artery.
(4) Signs: acute illness, anxiety, restless gray, sweaty, breathing tight, after the onset of 12, may have fever, the next day body temperature can reach 38 ° C, or even 39 ° C, then gradually decline, return to normal after about 1 week , pulse fineness, most of more than 100 times / min, blood pressure decreased, systolic blood pressure is often 70 ~ 100mmHg (9 ~ 13kPa), sometimes blood pressure drops, indicating that shock may occur, most of the heart rhythm, heart sounds often have a second heart sound split, Sometimes galloping, systolic murmurs in the apex, most indications of impaired papillary function, a small number of patients may have pericardial friction, about 20% of the pericarditis occurred a few days after the infarction.
(5) Electrocardiogram examination: Electrocardiogram examination is of great significance for the diagnosis of confirmed myocardial infarction. More than 90% of patients can show clear abnormal electrocardiogram within a few hours or even ten hours after onset. However, sometimes typical ECG often appears after 24h. Or more obvious, the electrocardiogram of acute myocardial infarction is often ischemic, and the lesion and necrosis are combined.
a. Pathological Q wave: suggesting necrotic changes, the main feature is that the lead to the myocardial necrosis area shows pathological Q wave, width > 0.04s, can be QR or QS type and its depth > 1/4R wave.
b. ST-segment elevation: a damage-type change, characterized by a lead-oriented lead, showing an abnormal rise in the ST segment, which can be as high as 2 to 15 mm and convex, with the arch back up and its starting point R-wave The descending branch is different from the tip of the R wave, sometimes close to the peak, and is curved upward from the convex arch, and then descends to the isobar. Therefore, the electrocardiogram is called a unidirectional curve, and the ST segment is raised. It is a wave pattern that occurs early in myocardial infarction, and sometimes it can last for ten hours or several days before gradually returning to the isobar.
c. Ischemic T wave: also known as inverted T wave, suggesting subepicardial ischemia. When the ST segment of the electrocardiogram is in a unidirectional curve, the ST segment and the T wave are merged, which is difficult to distinguish. After a few days, the ST segment is restored. When the isobar is pressed, the T wave is inverted and becomes deeper and deeper. After a long time, the T wave gradually becomes shallower and erect.
The lead diagram of the electrocardiogram facing the infarct area, the above three typical patterns appear, and the corresponding lead in the infarct area, the R wave is increased, the S-T segment is lowered and the T wave is high, which is called a mirror image.
d. Endocardial myocardial infarction pattern: Some subendocardial myocardial infarction, only a thin layer of inferior endocardium, unlike the complete necrosis of the wall, the degree of necrosis is less than 1/3 of the thickness of the epicardium. The θ wave does not appear on the electrocardiogram, but on the corresponding lead, there is a significant ST segment drop phenomenon, which can sometimes drop to 3 to 5 mm, accompanied by T wave inversion, and often R wave becomes low. Changes usually last for days or even weeks.
e. T wave inversion: In some patients with mild myocardial infarction, the θ wave does not appear on the ECG. Only the T wave gradually becomes inverted under dynamic observation, becoming a symmetric deep T wave, sometimes accompanied by a mild ST segment. Elevated, gradually recovered after a few weeks, from two-way, flat to erect, this situation suggests that may be subendocardial infarction, or its infarct range is small, so-called small focal infarction, there is still a normal heart in the infarct Muscle fiber, so there is no θ wave.
The pathological θ wave lasts for the longest time and often lasts for several years or even for a lifetime. However, when the connective tissue shrinks in the lesion, its area will gradually shrink, and with the good collateral circulation, the θ wave will gradually become smaller, even in the Some leads can disappear completely and gamma waves appear.
2. Cardiogenic shock There is no special report on the incidence of myocardial infarction complicated with cardiogenic shock. The data in Beijing is 20.6% and the shock mortality is 56.1%.
3. Congestive heart failure Heart failure is one of the important complications of acute myocardial infarction. The analysis of acute myocardial infarction in Beijing from 1971 to 1975, the incidence of heart failure was 16.1% to 23.8%, and the mortality rate of myocardial infarction. From 18.2% to 45.1%, acute myocardial infarction complicated with heart failure is mainly left heart failure, but the disease continues to develop, which can lead to bilateral heart failure or heart failure.
4. Arrhythmia Arrhythmia is a common complication of myocardial infarction, the incidence of which accounts for about 80%, the type of arrhythmia is about 80% to 100% for ventricular premature contraction, and the electronic monitoring system and crown have been used for more than a decade. The development of heart disease care unit (CCU), the early detection of arrhythmia and timely treatment, has greatly reduced the mortality of myocardial infarction complicated with arrhythmia.
5. Heart rupture and dysfunction of papillary muscles Cardiac rupture is one of the most critical complications of acute myocardial infarction. It is divided into two types according to its rupture: one is rupture of the ventricular wall, penetrating the pericardial cavity, causing pericardial tamponade, heart Sudden death; the second is myocardial structural rupture, including papillary muscle rupture and interventricular septal perforation, often sudden heart failure or shock.
6. Late complications
(1) ventricular aneurysm: ventricular aneurysm is not a real tumor, and its mechanism is mainly due to myocardial necrosis, the lesion is replaced by connective tissue to form a scar.
(2) post-infarction syndrome: in the recovery period of acute myocardial infarction, usually in the second to 11 weeks after myocardial infarction, fever, chest tightness, fatigue, cough and other symptoms, known as post-infarction syndrome, often accompanied by triad , that is, pericarditis, pleurisy (pleural effusion), pneumonia, the cause is mostly considered to be caused by autoimmunity, the incidence rate is 1% to 4%.
Diabetes complicated with acute myocardial infarction is a serious acute and chronic mixed disease. The condition is heavy and complicated, difficult to control, and the mortality is high. Therefore, the treatment should be comprehensive and timely, and diabetes should always be thought of when rescuing myocardial infarction. In the treatment of diabetes, the severity of myocardial infarction should be considered in order to achieve the purpose of treatment.
No comments:
Post a Comment