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| What are the diagnostic and examination methods for diabetic coronary 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 or downwardly 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. The rate is 3 to 5 times higher, and more than 70% of diabetic patients die from cardiovascular complications or concomitant diseases. Myocardial infarction is the leading cause of death in patients with type 2 diabetes.
Diagnostic methods for diabetic coronary heart disease:
1. Electrocardiogram examination S-T segment is horizontal or down-sloping, and ≥0.05mV, T wave is flat, biphasic or inverted.
2. 24-hour dynamic electrocardiogram and/or cardiac load test (such as active plate test, treadmill exercise test, atrial pacing isoproterenol intravenous drip, two-step exercise test, etc.).
3. X-ray, electrocardiogram, echocardiography and heart vector map examination suggest that the heart is enlarged, and myocardial enzyme examination can play an auxiliary diagnostic role for myocardial infarction.
4. CT examination Quantitative and qualitative analysis of cardiac morphology, cardiac function, myocardial tissue examination and myocardial perfusion to determine the presence of coronary heart disease.
5. Magnetic resonance imaging suggests cardiac macrovascular disease and clear myocardial infarction; PET can show early myocardial metabolic abnormalities, but it is expensive and economical conditions permit.
6. Radionuclide cardiac imaging including dynamic visualization of myocardial development and combined exercise tests at rest, "cold spot" development with 201Tl or 99mTc-MIBI for normal myocardium development without ischemic development, and with 99mTc coke The "hot spot" development method in which phosphate is used to develop newly necrotic myocardium and normal myocardium is not developed, and myocardial infarction and early diagnosis of coronary heart disease are performed. Newer imaging methods include single photon emission computed tomography.
7. Coronary angiography is a gold indicator for the diagnosis of coronary atherosclerotic lesions, which can be diagnosed and localized, guide the choice of treatment plan, and judge the prognosis, but it should be noted that patients with syndrome X can have typical angina manifestations, but coronary angiography results May be negative as it may be caused by small blood vessels.
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