What are the pathological causes of diabetic heart disease?

The pathological causes of diabetic heart disease mainly include the following:

What are the pathological causes of diabetic heart disease?

1. tachycardia at rest
Early diarrhea may involve the vagus nerve, and the sympathetic nerve is relatively excited. Therefore, the heart rate tends to increase. Anyone who has a heart rate of more than 90 beats/min during rest should be suspicious and autonomic dysfunction. This heart rate is often fixed. It is not easily affected by various conditioning reactions. Sometimes the heart rate can reach 130 beats/min, which is more suggestive of vagus nerve injury.


2. Painless myocardial infarction
Because diabetic patients often have autonomic neuropathy, cardiac pain afferent nerve function decline, the incidence of painless myocardial infarction is high, up to 24% to 42%, patients only have nausea, vomiting, congestive heart failure, or performance For arrhythmia, cardiogenic shock, some only fatigue, weakness, dizziness and other symptoms, no obvious pain in the precordial area, it is easy to miss diagnosis and misdiagnosis, the mortality rate is as high as 26% to 58%, diabetic patients with acute myocardial infarction More than non-diabetic patients, the disease is heavier, the prognosis is poor, and easy to re-infarction, the prognosis is worse, prone to cardiac arrest, must be vigilant, usually not strict control of diabetes is more likely to occur, some patients Ventricular fibrillation occurs due to oral hypoglycemic drugs.

3. Upright hypotension
When the patient stands up from the supine position, such as systolic blood pressure drop > 4kPa (30mmHg) or diastolic blood pressure drop > 2.67kPa (20mmHg) called orthostatic hypotension (or orthostatic hypotension, postural hypotension), sometimes systolic And diastolic blood pressure decreased, especially diastolic blood pressure decreased significantly, even decreased to O, often accompanied by dizziness, weakness, palpitations, sweating, visual impairment, fainting, and even shock, especially with hypertension and oral antihypertensive drugs, or Diuretics, vasodilators and tricyclic antidepressants are more likely to occur. It can also be seen after insulin injection. At this time, attention should be paid to the identification of hypoglycemia. The cause of orthostatic hypotension may be multifaceted. Any link of the reflex arc can cause hypotension, but in most patients, sympathetic damage is the main cause of orthostatic hypotension. The cause of orthostatic hypotension in diabetic autonomic neuropathy may be:
(1) The effective circulating blood volume decreases after standing, and the reflex heart rate cannot be accelerated;
(2) peripheral blood vessels are not reflectively contracted or contracted poorly;
(3) catecholamine and renin-angiotensin-aldosterone system can not rapidly regulate the response, mainly sympathetic nerve damage, such manifestations are seen in more advanced cardiovascular autonomic neuropathy, the main pathogenesis of blood pressure regulation reflex arc In the middle of the nerve damage, when the patient is standing from the supine position, due to sympathetic neuropathy, the release of norepinephrine is reduced, and the peripheral vasoconstriction is not compensated; the amount of adrenaline is insufficient. The cardiac output is reduced so that both systolic and diastolic blood pressures are reduced.

4.Sudden death
Patients with this disease may have sudden death due to various stresses such as infection, surgery, anesthesia, etc. Clinical manifestations of severe arrhythmia (such as ventricular fibrillation, flutter, etc.) or cardiogenic shock, sudden onset, patients only Feeling short-term chest tightness, palpitations, rapid development to severe shock or coma, blood pressure decreased significantly during physical examination, paroxysmal tachycardia or heartbeat, cardiac arrest, often died within a few hours, accompanied by infection, the symptoms are often Covered by the primary disease and delayed diagnosis and treatment.