Heart and diabetes. The effect of diabetes on the heart. Heart medicine treats diabetes.

Hypertensive heart disease is a common disease of the cardiovascular system accompanied by persistent high blood pressure.

The disease is based on a narrowing of the arteries, which is caused by an increase in the tonic functions of the smooth muscles of the arterial walls, and a subsequent change in cardiac output.

The trigger mechanism for this pathology is prolonged mental and emotional stress or a violation of the higher sphere of nervous activity, which leads to improper regulation of vascular tone.

As a rule, hypertension with predominant damage to the heart is diagnosed in 10-20% of the adult population over 40 years of age. It is necessary to understand what stages of the disease are distinguished, and what treatment is prescribed?

The most important sign of hypertensive disease is an episodic or constant increase in blood pressure, characterized by periodic hypertensive crises.

However, in some people the disease occurs with virtually no noticeable symptoms.

Most often, the patient feels the manifestation of the disease during a hypertensive crisis. The following symptoms occur:

Migraine.
Dizziness.
Panic state.
Dyspnea.
Chest pain.

As a rule, most people with high blood pressure experience heaviness in the back of the head, “spots” flash before their eyes, and unreasonable fatigue appears. A little less often, a person may feel sick or have a nose bleed.

If a patient has been diagnosed with hypertension for several years, angina pectoris may develop, the left ventricle enlarges, vision and kidney function are impaired.

The risk group usually includes middle-aged and elderly people - men over 40 years old, women over 50 years old, as well as those with a history of diabetes mellitus. In addition, hereditary factors also play an important role in the development of the disease.

Hypertensive disease develops under the influence of such factors:

Bad habits such as smoking and drinking alcohol.
Overeating, as a result, excess weight.
High cholesterol levels.
Stressful conditions.
Sedentary lifestyle.
Sclerotic vascular lesions.

Persistent high blood pressure affects the functioning of all internal organs, most noticeably in the last stage of the disease. Most often, with hypertension, the heart muscle suffers.

As a result, the term hypertensive heart arose.

The classification of hypertension is based on the level of increase in blood pressure:

139-160/89-98 – first degree.
159-180/99-110 – second degree.
More than 180/100 – third degree.

There are also stages in the development of the disease. At the first stage, a moderate transformation of the left ventricle occurs. And also, blood pressure increases slightly, but quickly returns to normal. At this stage, there are no disturbances in the functioning of the cardiovascular system.

At the second stage, blood pressure constantly changes, left ventricular hypertrophy is pronounced, the walls of arterioles change, large and medium-sized arteries are affected. Usually, if a disease is diagnosed at this stage, it is safe to say that the patient has a hypertensive heart.

At the third stage, blood pressure is constantly elevated, there are negative changes in the heart, kidneys, and cerebral hemispheres. As a consequence, the development of cardiac ischemia, renal and heart failure.

In heart failure, there is a low pumping function of the heart muscle, that is, the heart cannot provide a complete blood supply to the body:

This condition develops due to weakening of the myocardium, or the walls of the heart lose their elasticity.
Due to the fact that in heart failure there is little blood flow through the vessels, the pressure in the heart itself increases.
This leads to the fact that the main organ can no longer fully deliver oxygen and nutrients along with blood to the soft tissues.
In response to this, the heart begins to function at an accelerated rate to compensate for the lack of blood flow.
But, over time, it cannot contract with the same intensity because the muscle weakens.

As a result, the kidneys retain fluid and sodium in the body, which leads to swelling of the soft tissues and congestion in the lungs and other internal organs. Thus, congestive heart failure occurs.

Treatment

Diagnosis of the disease is focused on methods that will help identify the underlying causes. Based on the results of a general blood test, ultrasound and ECG of internal organs, x-rays of the heart and blood vessels, MRI, the doctor prescribes individual treatment, the guideline of which is stabilization of pressure.

Typically, treatment is as follows:

Recommendations for eliminating stressful situations, proper sleep and rest, a special diet excluding fat, salt, and sugar.
The use of medications of various mechanisms of action that affect the endurance of the heart muscle and vascular tone.
Diuretics.
Herbal teas with a sedative effect or stronger medications.

In the modern world, there are many medications aimed at treating hypertensive disease. Medicines not only help reduce blood pressure, but also protect internal organs from harmful changes.

Essential medicines include the following categories:

Diuretics.
ACE inhibitors.
Sartans.
Beta blockers.
Calcium channel blockers.

Treatment of heart failure is carried out with the help of drugs that stabilize the functioning of the heart muscle.

Treatment with diuretics helps to reduce the amount of blood circulating in the vessels, which leads to normalization of blood pressure. They are generally the first-line treatment for hypertension.

ACE inhibitors prevent the formation of a substance called angiotensin-2. This substance is a powerful agent that constricts blood vessels. Drugs in this category help dilate blood vessels and reduce blood pressure.

Sartans block receptors for angiotensin, as a result of which its vasoconstrictor ability is lost.

Beta blockers help reduce the frequency of contraction of the heart muscle, as a result, the minute volume of blood flow decreases and blood pressure decreases.

Calcium antagonists dilate peripheral vessels, decrease peripheral vascular resistance and normalize blood pressure.

It is worth noting that only a doctor prescribes medication treatment, because all medications have their own contraindications and side effects.

As a rule, the doctor prescribes a comprehensive treatment regimen, which includes several drugs with different mechanisms of action.

In a number of situations, diuretics are prescribed, which help remove excess fluid and also have the following effects on the patient’s body:

They have a beneficial effect on the cells that filter the kidney tubules.
Reduce the volume of fluid inside the vessels.
Reduces the sensitivity of arterial walls. Due to this, the walls are not so sensitive to hormones that can contribute to their narrowing.

Some broad-spectrum diuretics can block vascular channels, dilating them. As a result, you can not only reduce blood pressure, but also protect yourself from complications arising from hypertensive heart disease.

Misconceptions about the disease

There is an opinion that slightly elevated blood pressure is a natural phenomenon for older people.

In reality this is not so; such a concept does not exist in official medicine. The pressure should be within the established norm, regardless of age group and gender. Misconceptions of patients about hypertension:

You can treat in episodes, the pressure has dropped, the treatment is over.
The focus of treatment is only to reduce blood pressure.
Possibility of self-treatment.
There are enough medications, but excess weight and alcohol have nothing to do with it.

Episodic treatment is unacceptable. You can cope with the disease only with the help of daily drug therapy, which helps maintain blood pressure.

Conservative therapy involves not only the normalization of numbers, but also prevents dangerous and serious complications.

Without knowing the reasons for the development of the disease, self-medicating can lead to serious complications, even death.

By giving up smoking, alcoholic beverages, and eliminating harmful foods from your diet, you can double your chances of recovery.

Preventive actions

Everyone knows that it is better to prevent any disease than to treat it later. Hypertension often develops due to a genetic predisposition:

In this situation, if a person assumes that the occurrence of a disease is not excluded, it is worth monitoring your diet and giving up smoking and alcohol.
In addition, do not forget about medical examination for the purpose of prevention.

Hypertensive disease most often occurs in men after 40, and in women after menopause. Such features should be taken into account when monitoring your blood pressure, not forgetting about visiting a therapist.

Optimal physical activity, walking in the fresh air are useful, physical therapy and swimming will bring a lot of benefits. In addition, it is worth eliminating or reducing salt intake, monitoring blood cholesterol levels, and also monitoring your blood pressure.

In the modern world, you cannot do without stressful situations and nervous strain. It is because of the adrenaline produced at such moments that blood pressure rises. Therefore, you need to try to look at all events, even the most negative ones, only from the positive side. The video in this article will tell you what you need to know about hypertension.

Angina pectoris: signs, causes, classification

Angina pectoris is one of the most common forms of coronary heart disease, which is characterized by the appearance of paroxysmal pain in the heart or behind the sternum, caused by insufficient blood supply to the heart muscle. In most cases, angina pain is described by patients as a feeling of tightness, discomfort, burning, pressure, pain or heaviness in the chest. These unpleasant sensations can spread to the area of the upper limbs, shoulders, neck, lower jaw, throat or shoulder blade, and their appearance is not accompanied by warning signs.

Attacks of angina pectoris can develop both after physical or psycho-emotional stress, and for no apparent reason. Painful and unpleasant sensations are provoked by insufficient blood supply to the myocardium (ischemia). This condition is accompanied by insufficient oxygen supply to the heart muscle cells, which leads to painful sensations.

Causes

Most often, angina is caused by atherosclerosis of the coronary vessels, in which atherosclerotic plaques grow on the walls of blood vessels. It is these formations that contribute to the narrowing of the lumen of blood vessels and insufficient supply of oxygen-enriched blood to the myocardial cells. At moments of especially pronounced oxygen starvation (with a narrowing of the coronary arteries by 50-70%), the patient develops an attack of ischemia and angina pectoris. The severity of this form of coronary heart disease depends on the severity of ischemia (i.e., on the location and extent of the area of coronary stenosis).

In some cases, angina is caused by other pathologies:

infectious or allergic diseases;
complications after rheumatism or syphilis (endarteritis, vasculitis, aortitis, periarteritis);
abdominal pathologies (cholelithiasis, diaphragmatic hernia, etc.).

The development and progression of angina pectoris can be provoked by the following predisposing factors:

avoidable: obesity, increased levels of “bad” cholesterol in the blood, arterial hypertension, anemia, frequent stressful situations, diabetes mellitus, increased blood clotting and a tendency to thrombus formation, chronic intoxication, smoking, poor nutrition, physical inactivity;
fatal: heredity, age, menopause, taking hormonal contraceptives.

The combination of even two of the above factors increases the risk of angina.

Classification

According to the causes of angina, cardiologists classify it into the following forms:

Angina pectoris. Attacks of cardialgia are caused by emotional, mental or physical stress, which are accompanied by an increased need for oxygen in the myocardium. With this form of angina, attacks are stopped at rest or after taking Nitroglycerin.
Angina at rest. Attacks of chest pain appear during normal exercise, at rest during the day or during night sleep and are caused by spontaneous spasm of the coronary vessels.

According to the nature of the manifestation, angina pectoris can be:

stable – angina attacks appear with a certain frequency (every other day, week, once a month, etc.);
unstable - these types of angina can be new, progressive, spontaneous;
Prinzmetal's angina (atypical) - this form of angina is rare and its atypicality lies in the occurrence of a series of cyclic attacks at the same time (in the morning).

Stable angina is divided into the following functional classes:

I – the patient’s attacks occur rarely, they are not long-lasting, and appear after unusual physical activity;
II – angina attacks occur after a quick climb up the stairs or after a fast run, their appearance can be associated with various other predisposing factors (freezing weather, strong wind, overeating, etc.);
III – cardialgia (pain in the heart) can appear even during normal walking on a flat surface for about 100 meters or when climbing stairs to one floor, after any experience or excitement, immediately after going out into windy or frosty weather, such attacks of angina pectoris can significantly limit the patient’s daily activities;
IV – angina attacks can occur with any form of physical activity, the patient cannot perform even the most minimal physical activities (walking 50 m, changing clothes, sweeping the floor with a broom, etc.), cardialgia can also occur in a state of absolute rest.

Unstable angina may be accompanied by various unstable manifestations (for example, an increase in the duration of the attack). It can manifest itself in the following forms:

primary angina – attacks appear for the first time and last no more than a month;
progressive angina - attacks become more frequent, severe and prolonged, and may appear at night;
angina at rest - attacks of cardialgia appear during absolute rest (several hours after physical activity or emotional stress);
post-infarction angina - a patient who has had a heart attack develops cardialgia for 10-14 days.

The appearance of unstable angina should be a reason to immediately contact a cardiologist or call an ambulance. Without adequate care, such attacks can cause a heart attack or myocardial infarction. Such patients are treated in the intensive care unit.

Differentiation of stable and unstable angina

In order to distinguish stable from unstable angina, it is necessary to take into account the following factors:

Signs

The main symptom of angina is pain that is localized behind the sternum. It is pressing, squeezing or burning in nature and can radiate to the left arm, shoulder blade, neck, throat or lower jaw. In rare cases, some patients may experience pain radiating to the right arm or upper abdomen.

Due to a painful attack, the patient may groan, experience fear of death, and press his hand to his chest. He becomes pale, his limbs become cold or numb, his heart palpitates and his blood pressure rises.

With an atypical attack of angina, the patient may experience the following symptoms:

pain in the arm, neck, shoulder blade or teeth;
shortness of breath when inhaling and exhaling;
tachycardia;
nausea;
weakness;
sweating

In rare cases, an attack of angina is not accompanied by pain or other symptoms at all (such cases are called “silent” angina).

Angina attacks begin abruptly, usually at the peak of physical activity or psycho-emotional stress. Due to the onset of pain, the patient is forced to stop physical activity (for example, walking or running). The duration of cardialgia in this form of coronary heart disease is no more than 15-20 minutes.

Pain in the heart during an attack of angina pectoris can disappear on its own immediately after the cessation of exposure to the factor that provokes it or can be eliminated by taking Nitroglycerin. This drug causes an increase in blood flow to the myocardium and thereby eliminates the lack of oxygen in the heart.

After the attack is over, angina does not manifest itself.

Treatment of angina can be conservative or surgical, and is aimed at preventing progression of the disease and sudden death. In the absence of adequate therapy, this form of coronary heart disease can lead to the following severe complications:

myocardial infarction;
cardiosclerosis;
arrhythmia;
heart failure.

Reliable prevention of such severe consequences can only be systematic treatment of coronary heart disease and prevention of subsequent attacks of angina. If you follow all the doctor’s recommendations and timely seek medical help, the patient can avoid disability and sudden death.

“Health School” on the topic “Angina”

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An attack of angina pectoris: signs, emergency care An attack of angina pectoris can be considered a pre-infarction condition, and that is why help for severe heart pain should be provided immediately and…

Prinzmetal's angina: features of symptoms and treatment Angina is one of the conditions that accompany coronary heart disease and are caused by insufficient blood supply to the myocardium. Existence...

Is it possible to put mustard plasters on the heart during angina attacks?

The clinical manifestation of coronary heart disease is angina. There are two types of pathology: tension and rest. A characteristic sign of angina is squeezing or squeezing pain in the chest. The pathology is popularly called angina pectoris.

Angina pectoris occurs after strength exertion or emotional experiences, the pain goes away quite quickly (within 2-3 minutes) as soon as physical activity is stopped, or the patient has taken nitroglycerin.

With angina at rest, severe pain occurs at night, when the person is completely relaxed. The transition from one state to another occurs gradually. The patient experiences more frequent attacks of angina and increased pain. In this case, you cannot do without the help of a doctor.

Causes of angina pectoris

The disease occurs due to the progression of atherosclerosis of the vessels that provide blood supply to the myocardium. The highest risk factors for the occurrence of pathology are caused by:

diseases of the endocrine system (diabetes mellitus);
overweight;
elevated blood cholesterol levels;
heredity;
sedentary lifestyle;
hypertensive diseases;
smoking and drinking alcoholic beverages;

A heart attack can be a consequence of intense physical activity. Heart pain due to angina pectoris occurs:

during temperature changes;
during nervous overstrain;
from overeating;
when pressure increases;
during stressful situations and emotional outbursts.

In severe cases of the disease, attacks of heart pain appear at rest and when changing body position.

Helping a patient with angina pectoris

During heart attacks with angina pectoris, the patient’s condition can be alleviated by giving him nitroglycerin or other vasodilators.

To eliminate the factors that caused the deterioration of the condition, you need to provide the patient with complete rest. Any, even the slightest mental and physical stress is not allowed. During a heart attack, the person should be seated as comfortably as possible. Legs should be down.

A nitroglycerin tablet is placed under the tongue; if an aerosol form of the drug is used, the product is injected 3 times with pauses of 3 minutes. You can also take nitrosorbitol.

If nitroglycerin is poorly tolerated by the patient, it can be replaced with one of the following drugs:

Corvalol;
validol;
valocordin.

When the pain is relieved, the patient must remain in bed.

Important to remember! Any drug treatment should be under the supervision of the attending physician.

Is it possible to put mustard plasters on for angina?

For tracheitis, laryngitis, bronchitis, mustard plasters are placed on the upper part of the chest, in the larynx area.
For colds - on the back, feet and calves. But this method of treatment is used only for obsessive dry cough. When separating sputum, before putting mustard plasters on, you need to discuss with your doctor the feasibility of this procedure.
For neuralgia, mustard plasters are used as a distraction.
Mustard plasters are applied to the areas where pain is localized if there is pain in muscle tissues and joints. Indications for use: sprains, myalgia and others.
If you put mustard plaster on the back of your head and calf muscles, you can relieve pain from migraines and hypertension.
A mustard patch for pneumonia is placed on the back and thoracic region (in the projection of the lungs).
Mustard plasters are placed on the heart for angina pectoris.

In any case, such procedures must be agreed upon with the attending physician.

In what cases are mustard plasters contraindicated?

Despite the above indications, there are a number of pathologies and other diseases for which such procedures are prohibited. In what cases are mustard plasters contraindicated?

For skin diseases and damage to the integrity of the epidermis. These include eczema, neurodermatitis of various etiologies, allergic rashes, purulent pathologies, ulcers and wounds.
In the presence of neoplasms. Warming up can provoke the growth of pathogenic cells. This procedure should be avoided even if the tumor has already been treated. Mustard plasters should not be applied to moles and warts.
During pregnancy, since heating can lead to an increase in the tone of the uterus. If you cannot do without such manipulation, you should first consult a doctor.
For young children (up to three years old). Babies have very delicate skin and at the same time are not able to explain to their parents that mustard plaster is very hot. This may cause burns.
At elevated temperatures. A colossal load is placed on the organs of the cardiovascular and respiratory systems in a feverish state. Warming up will only complicate the situation.
People with individual intolerance to mustard (and this occurs quite often). This may cause a serious allergic reaction.

How to install mustard plasters correctly?

Before carrying out the procedure, you need to prepare dishes with heated water (no more than 45°), cling film or gauze. The skin at the site where the mustard plaster is applied should be clean and dry. Check that the skin is not damaged.

The mustard plaster is dipped in a container of hot water for a few seconds, after which it is applied to the skin and pressed lightly. The application site is covered with a blanket or terry sheet or towel. If the manipulation is carried out on the joints or calf muscles, the mustard plaster is fixed with film, a piece of gauze or a bandage.

You can take the procedure no longer than 5 minutes. If a burning sensation or discomfort is felt at the site where the mustard plaster was applied, it must be removed immediately, without waiting for 5 minutes to elapse. At the end of the procedure, the skin area is wiped with dry wipes, and the patient is dressed in warm, dry clothes.

If no negative reactions were observed during the procedure, you can increase its duration, but not more than 1-2 minutes.

The course of treatment is 5 days, although sometimes it can be increased to 10.

If an angina attack occurs, you can put mustard plaster on the heart area, but for no more than 5 minutes. This does not exclude taking medications prescribed by a doctor; they still need to be used.

Traditional methods of treatment

You can fight angina pectoris with the help of traditional medicine. There are a huge number of recipes, let’s look at the most common ones:

People with heart problems are recommended to take tea brewed from tricolor violet flowers. Treatment with this method is a very long process; you need to drink tea for several months.
Homeopathic preparations from lily of the valley flowers are a very effective remedy. During a heart attack, you need to put one pea under your tongue and dissolve until completely dissolved.
For such heart pathologies, it is useful to take a decoction of hawthorn flowers. Prepare it this way: take 2 tbsp per 400 ml of water. l. dry plant and boil for 7 minutes. Take the decoction 3-4 times a day, 1 tbsp. l.
For heart disease, it is recommended to drink beet juice. It must be diluted with boiled water in a ratio of 1:3.
Chewing fresh lemon peel daily can improve heart function.
During attacks of angina, you can take tincture of lily of the valley (3 times a day, 30 drops) or tincture of stinking cornflower (3 times a day, 25 drops). Both of these products can be purchased at the pharmacy.

In any case, if you have a heart attack, you should not self-medicate; you should immediately seek medical help.

Cardiovascular diseases occur quite often in patients with diabetes. Data published in the US National Diabetes Fact Sheet showed that in 2004, 68% of deaths in people with diabetes aged 65 years and older were due to various cardiovascular diseases, including myocardial infarction. . 16% of patients with diabetes who crossed the 65-year mark died from it.

In general, the risk of dying from sudden cardiac arrest, myocardial infarction or diabetes is 2-4 times higher than the general population.

Although all diabetics have an increased chance of developing heart disease, heart disease is most common in patients with type 2 diabetes.

The Framingham Heart Study, a long-term study of cardiovascular disease in residents of Framingham, Massachusetts, USA, was one of the first pieces of evidence to show that people with diabetes are more vulnerable to heart disease than people without diabetes. In addition to diabetes, heart disease is caused by:

high blood pressure;
smoking;
high cholesterol;
family history of early stages of heart disease.

The more risk factors a person has for developing heart disease, the more likely they are to develop cardiovascular disease, which can even be fatal. Compared to normal people with elevated risk factors for heart disease, diabetics are significantly more likely to die from heart disease. So, for example, if a person with such a serious risk factor as high blood pressure has an increased chance of dying from heart disease, then a person with diabetes has double or even quadruple the risk of dying from heart problems in comparison.

One of numerous medical studies found that people with diabetes who had no other risk factors for heart health were 5 times more likely to die from cardiovascular disease than people without diabetes.

Causes of heart disease in patients with diabetes mellitus

The most common cause of cardiovascular disease in people with diabetes is hardening of the coronary artery walls, or atherosclerosis. It occurs due to the formation of cholesterol plaques in the blood vessels that supply oxygen and nourish the heart muscle.

This accumulation of cholesterol on the walls of blood vessels, as a rule, begins even before a visible increase in blood sugar in patients with type 2 diabetes. In other words, heart disease almost always develops even before the diagnosis is made, because this type of diabetes develops gradually and latently.

When cholesterol plaques disintegrate or rupture, it causes blood clots to form, blocking blood flow in the blood vessels. This situation can lead to a heart attack. The same process can occur in all other arteries in the body - blockage of blood flow to the brain causes a stroke, and problems with blood flow to the legs or arms cause peripheral vascular disease.

Not only do people with diabetes have an increased chance of developing heart disease, they are also at higher risk of developing heart failure, a serious medical condition in which the heart cannot pump blood properly. This can cause fluid to accumulate in the lungs, causing difficulty breathing, or fluid retention in other parts of the body (especially the legs), causing swelling.

What are the symptoms of a heart attack with diabetes?

Symptoms of a heart attack include:

Difficulty breathing, shortness of breath.
Feeling weak.
Dizziness.
Excessive and unexplained sweating.
Pain in the shoulders, jaw or left arm.
Chest pain or pressure (especially during physical activity).
Nausea.

Remember that not all people experience pain or other classic symptoms of a heart attack. This is especially true for women with diabetes.

If you experience any of these symptoms, you should immediately consult a doctor or call an ambulance at home.

Peripheral vascular diseases have the following symptoms:

Cramping in the legs when walking (intermittent claudication) or pain in the thighs or buttocks.
Cold feet.
Decreased or absent impulses in the legs or feet.
Loss of subcutaneous fat on the lower legs.
Loss of hair on the lower legs.

Treatment and prevention of heart disease in patients with diabetes mellitus

There are several treatment options for cardiovascular disease in patients with diabetes, depending on the severity of the disease:

Taking aspirin to reduce the risk of blood clots, which lead to heart attacks and strokes. Low-dose aspirin is recommended for men and women with type 2 diabetes over the age of 40 who are at high risk for developing cardiovascular and peripheral vascular disease. Talk to your doctor to determine if aspirin is the right therapy for you.

Low cholesterol diet. Read the articles: and.
Physical activity not only for weight loss, but also for lowering blood sugar, high blood pressure and cholesterol levels, as well as reducing vesceral abdominal fat, which is an additional risk factor for cardiovascular disease.
Taking necessary medications.
Surgical intervention.

How to treat peripheral cardiovascular complications?

Peripheral vascular disease is prevented and treated by:

Daily walking in the fresh air (45 minutes a day, further can be increased).
Wearing special shoes if the complications are serious and there is pain when walking.
Maintaining glycated hemoglobin HbA1c below 7%.
Reduced blood pressure below 130/80.
Maintaining “bad” LDL cholesterol levels below 70 mg/dL (<1,81 ммоль/л).
Taking aspirin, a medicine that thins the blood.
Drug therapy as prescribed by a doctor.
To give up smoking.
Surgical intervention (if necessary).

How can a person with diabetes prevent heart disease?

The best way to prevent heart disease is to maintain normal blood sugar levels. More specifically, the recommendations are as follows:

Keep your blood sugar levels as close to normal as possible (range 3.8 to 6.1 mmol/L). To do this, you need to measure your sugar level on an empty stomach, before meals and 2 hours after meals, as well as before bed. Keep a self-monitoring diary and show it to your doctor if necessary.
Manage your blood pressure levels, including with medications if necessary. there must be< 130/80.
Keep your cholesterol levels under control. You may have to take medications to do this (choleretic drugs, statins, niacin, fibric acid derivatives, probucol).
Lose weight if you are obese.
Ask your doctor if you should take aspirin daily?
Exercise regularly or walk in the fresh air and move.
Eat a heart-healthy diet that is low in fat and salt.
Quit smoking.

Sources:

1. Diabetes mellitus and cardiovascular diseases // American Heart Association.

2. SugardiabetesAndillnesseshearts(Heart Disease and Diabetes) // Webmd.com

The risk of angina pectoris in diabetics is extremely high. After 45 years, this combination leads to a heart attack, severe arrhythmia, and heart failure 11 times more often than in patients with normal carbohydrate metabolism. Read further in our article about the relationship between diabetes and angina, symptoms of heart problems, the danger they pose for patients, as well as treatment and prevention.

📌 Read in this article

Diabetes and angina: relationship between diseases

It is important that not only an attack of angina pectoris can occur in this form, but also. Due to late diagnosis, coronary blood flow disorders are often accompanied by complications and death.

Why does the heart hurt slightly with diabetes?

Elevated blood sugar leads to damage to the bloodstream. Small vessels that supply blood to nerve fibers also lose their patency. Due to insufficient nutrition, the outer sheath of the nerve is destroyed.

In addition, high sugar levels contribute to the accumulation of sorbitol inside the cells, which retains water, causing tissue swelling. Free radicals are formed quickly and in large quantities, destroying nerve cells. As a result of such changes, the nerve endings in the myocardium are lost.

With physical and psychological stress, patients with angina pectoris without diabetes experience pain. It occurs due to the fact that a sufficient amount of blood cannot flow through narrowed vessels. When the patient feels pressure and pain in the chest, he stops, sits down, tries to relax, and takes Nitroglycerin.

Diabetics do not feel such a threat to the heart and continue their normal activities. Lack of oxygen and disturbances in myocardial nutrition increase.

“Silent”, “silent” ischemia is much more dangerous, the risk of sudden cardiac arrest is 3 times higher than with ordinary angina. Patients with a latent course of the disease turn to a cardiologist only in case of an extensive heart attack, when complete recovery is almost impossible.

Danger of type 2 diabetes mellitus

In this variant of the disease, increased glucose levels are combined with a special condition - insulin resistance. This means that the pancreas produces, but the cells do not respond to it. Such insensitivity to the hormone is considered an independent risk factor for severe consequences of myocardial infarction:

rhythm disturbances, cardiac impulse conduction;
resumption of angina in the post-infarction period;
addition of heart failure (edema, tachycardia, shortness of breath, liver enlargement);
long-term complications one year after a heart attack (blood stagnation in the lungs, liver, arrhythmia), relapse with fatal outcome.

These conditions are found 7 times more often in patients with type 2 diabetes who take sugar-lowering pills than in the rest of the population.

The causes of such severe myocardial ischemia are:

increased levels of cholesterol and triglycerides, free fatty acids;
multiple unstable (collapsing) atherosclerotic plaques, blockage of arteries by forming blood clots;
high activity of the inflammatory process;
insufficient formation of additional blood flow paths that bypass the area of narrowing of the artery.

Myocardial ischemia

Features of the course of heart rhythm disturbances

In type 2 diabetes, arrhythmia often occurs against the background of angina or heart attack. She is provoked by:

lack of nutrition of the heart muscle;
accumulation of toxic compounds due to improper carbohydrate metabolism;
high oxygen demand;
sudden changes in blood glucose concentration;
imbalance between calcium, potassium, sodium inside and outside the cell.

Diagnosis of the condition

If for most patients it is enough to conduct an ECG to detect ischemia, even in a painless form, then for a patient with diabetes a more in-depth diagnosis is required. A regular cardiogram is normal. Therefore, daily Holter monitoring (registration over a long period of time), as well as stress tests, is prescribed.

Functional tests in diabetics have their own characteristics. Under standard conditions, the criterion for sufficient load is the appearance of an attack or changes in the ECG.

Spirometry

In case of diabetes mellitus, it is recommended to first determine the maximum tolerated level of stress using spirometry (breathing tests) and, when it is reached, take an ECG. Stress echocardiography (ultrasound of the heart) is performed similarly.

To clarify the extent of heart damage, the following methods are indicated:

coronary angiography– helps to find areas of narrowing of the arteries, the possibility of bypass routes of blood flow, usually used in determining indications for surgery;
single photon emission CT– shows the degree of impact of nutritional deficiency on heart function;
PET-CT of the heart– reflects areas potentially dangerous for a heart attack.

Carrying out PET CT scan of the heart

Patients with diabetes and angina pectoris are advised to undergo regular laboratory blood tests - general analysis, lipid profile, coagulogram, glucose content, glycated hemoglobin.

Treatment of angina complicated by diabetes

Achieving compensation for diabetes mellitus is the most important direction of therapy. In the first type of disease, it may be recommended to change the dose, frequency of insulin administration, and add long-acting drugs.

In type 2 diabetes, if there is a high risk of heart attack, patients are prescribed a combination of long-acting insulin and tablets to lower blood sugar. The group of glucose-lowering drugs is changed less frequently. Actos and Avandia have a protective effect on the heart muscle.

To improve metabolism and blood circulation in the myocardium, use:

beta blockers (selective action only) – Nebivolol, Nebilet;
angiotensin-converting enzyme inhibitors – Prenesa, Ampril;
cholesterol-lowering – Vasilip, Crestor;
cardioprotectors (protect heart cells from damage) – Preductal, Thiotriazolin;
blood thinners – Aspirin cardio, Plavix;
potassium and magnesium salts - Panangin, Kalipoz prolongatum.

The goal of therapy is to normalize the levels of sugar, cholesterol, triglycerides, and lipoprotein complexes. Patients are recommended to maintain blood pressure no more than 130/80 mmHg. Art., visit a cardiologist at least once a month, undergo instrumental and laboratory diagnostics.

Prevention measures

To slow down the progression of atherosclerosis, angina pectoris, diabetes, it is necessary to strictly follow the nutritional rules:

Sugar, foods with a high glycemic index (quickly increase blood glucose), fatty meat, offal, semi-finished products, margarine, store-bought sauces, butter, cottage cheese, cream above 10% fat content are excluded from the diet;
Every day the menu should include vegetable salads dressed with vegetable oil, fresh fruits, berries (unsweetened);
Whole grain porridge, low-fat cottage cheese, fermented milk drinks, boiled and baked vegetables, and herbs are allowed.

Alcohol and smoking, stress and lack of physical activity have an adverse effect on the course of coronary disease.

Therefore, it is vital for patients to reconsider their lifestyle in order to promptly stop damage to the heart and blood vessels. A minimum of 30 minutes per day should be allocated for physical therapy, walking, and swimming. To prevent blockage of the coronary arteries, aspirin 100 mg is prescribed for a long period of time, alone or in combination with clopidogrel.

Angina pectoris occurs in diabetes against the background of damage to blood vessels and nerve fibers of the myocardium. Its course is often hidden, symptoms are absent or atypical, and an ECG at rest also does not show any abnormalities. High glucose levels cause rhythm disturbances, cardiac muscle contractility, rapid progression of ischemia, and the appearance of a heart attack with complications.

To identify the disease, stress tests, coronary angiography, and CT are needed. Treatment is aimed at compensating for diabetes, reducing the load on the heart, normalizing the fat composition of the blood and the coagulation system. For prevention, it is important to adhere to dietary nutrition, dosed physical activity, and give up bad habits.

Useful video

Watch the video about diabetes:

Diabetes mellitus is one of the main causes of cardiovascular diseases. Heart failure, in turn, worsens the course of diabetes.

Heart damage is a common and unfavorable prognosis complication of diabetes mellitus. Coronary insufficiency comes to the fore in such patients. Let's look at the main features of heart damage in diabetes and methods of treating them.

The effect of diabetes on the heart and blood vessels

Heart damage in diabetes mellitus occurs in many patients. About half of patients develop a heart attack. Moreover, with diabetes, this disease occurs in relatively young people.

Disturbances in the functioning of the heart and pain are associated primarily with the fact that large amounts of sugar in the body lead to the deposition of cholesterol on the walls of blood vessels. There is a gradual narrowing of the vascular lumen. This is how atherosclerosis develops.

Under the influence of atherosclerosis, the patient develops coronary heart disease. Patients are often bothered by pain in the heart. It must be said that against the background of diabetes, it is much more severe. And as the blood becomes thicker, there is an increased risk of blood clots.

People with diabetes are much more likely to have high blood pressure. It causes complications after myocardial infarction, the most common of which is an aortic aneurysm. If the healing of the post-infarction scar in patients is impaired, the risk of sudden death increases significantly. The risk of recurrent heart attacks also increases.

What is "diabetic heart"

Diabetic cardiopathy is a condition of cardiac muscle dysfunction in patients with impaired diabetes compensation. Often the disease does not have pronounced symptoms, and the patient feels only aching pain.

Heart rhythm disturbances occur, in particular tachycardia, bradycardia. The heart cannot pump blood normally. Due to increased loads, it gradually grows in size.

The manifestations of this disease are:

heart pain associated with physical activity;
increasing swelling and shortness of breath;
patients are bothered by pain that does not have a clear localization.

In young people, diabetic cardiopathy often occurs without significant symptoms.

Risk factors in diabetic patients

If a person has developed diabetes, then under the influence of negative factors the risk of developing cardiovascular diseases increases markedly. These are the factors:

if someone in the family of a diabetic has had a heart attack;
with increased body weight;
if the waist circumference is increased, this indicates the so-called central obesity, which occurs as a result of an increase in the amount of cholesterol in the blood;
increase in triglyceride levels in the blood;
frequent increase in blood pressure;
smoking;
drinking large amounts of alcoholic beverages.

Myocardial infarction in diabetes mellitus

Ischemic disease in diabetes mellitus threatens the patient’s life with many dangerous complications. And myocardial infarction is no exception: a high incidence of death has been observed among patients suffering from diabetes.

Features of myocardial infarction in patients with diabetes are as follows.

Pain radiating to the neck, shoulder, shoulder blade, jaw. It is not relieved by taking nitroglycerin.
Nausea, sometimes vomiting. Be careful: such signs are often mistaken for food poisoning.
Heartbeat disturbance.
In the area of the chest and heart there is an acute pain of a compressive nature.
Pulmonary edema.

Angina in diabetes mellitus

With diabetes, the risk of angina doubles. This disease is manifested by shortness of breath, palpitations, and weakness. The patient is also concerned about increased sweating. All these symptoms are relieved with nitroglycerin.

Angina pectoris in diabetes mellitus has the following characteristics.

The development of this disease depends not so much on the severity of diabetes as on its duration.
Angina pectoris occurs in diabetics much earlier than in people who do not have abnormalities in the level of glucose in the body.
Pain with angina is usually less severe. In some patients it may not appear at all.
In many cases, patients experience heart rhythm dysfunctions, which are often life-threatening.

Development of heart failure

Against the background of diabetes mellitus, patients may develop heart failure. It has many flow features. For a doctor, treating such patients is always associated with certain difficulties.

Heart failure appears at a much younger age in patients with diabetes. Women are more susceptible to the disease than men. The high prevalence of heart failure has been proven by many researchers.

The clinical picture of the disease is characterized by the following signs:

increase in heart size;
development of edema with blue discoloration of the extremities;
shortness of breath caused by stagnation of fluid in the lungs;
dizziness and increased fatigue;
cough;
increased urge to urinate;
weight gain caused by fluid retention in the body.

Drug treatment of the heart for diabetes mellitus

Drugs from these groups are used to treat heart diseases caused by diabetes.

Antihypertensive drugs. The goal of treatment is to achieve blood pressure levels less than 130/90 mm. However, if heart failure is complicated by renal problems, even lower blood pressure is recommended.
ACE inhibitors. A significant improvement in the prognosis of heart disease has been proven with regular use of such drugs.
Angiotensin receptor blockers can stop cardiac hypertrophy. Prescribed for all groups of patients with heart disorders.
Beta blockers can reduce heart rate and lower blood pressure.
Nitrates are used to stop a heart attack.
Cardiac glycosides are used to treat atrial fibrillation and severe edema. However, at present, the scope of their application is noticeably narrowing.
Anticoagulants are prescribed to reduce blood viscosity.
Diuretics - prescribed to eliminate edema.

Surgical treatment

Many patients are interested in whether bypass surgery is performed as a treatment for heart failure. Yes, it is carried out, because bypass surgery gives a real chance to remove obstacles in the blood flow and improve the functioning of the heart.

Indications for surgery are:

chest pain;
arrhythmia attack;
progressive angina;
increased swelling;
suspected heart attack;
sudden changes in the cardiogram.

Radical elimination of heart disease in diabetes mellitus is possible with surgical treatment. The operation (including bypass surgery) is performed using modern treatment methods.

Surgery for heart failure includes the following.

Balloon vasodilation. It eliminates the area of narrowing of the artery supplying the heart. To do this, a catheter is inserted into the arterial lumen, through which a special balloon is supplied to the narrowed area of the artery.
Aortocoronary stenting. A special mesh structure is inserted into the lumen of the coronary artery. It prevents the formation of cholesterol plaques. This operation does not lead to significant trauma to the patient.
Coronary artery bypass surgery allows you to create an additional path for blood and significantly reduces the possibility of relapses.
The implantation of a pacemaker is used for diabetic cardiac dystrophy. The device reacts to all changes in cardiac activity and corrects it. The risk of arrhythmias is significantly reduced.

The goal of treating any disorder of the heart is to bring its parameters to the physiological norm as much as possible. This can prolong the patient’s life and reduce the risk of further complications.

Greetings! Diseases of the cardiovascular system are particularly relevant throughout the world, as they cause earlier aging, disability of the population and even early death.
Let's talk about heart and vascular diseases in combination with diabetes, what effect diabetes has, the causes of heart damage and coronary artery disease (angina), what treatment awaits these patients.
The article will be relevant for all patients with excess weight, prediabetes, as well as with an existing sweet disease.

In people with type 2 diabetes, high blood sugar is a serious factor in the development of coronary artery disease. Coronary heart disease, or IHD for short, is a heart disease that results in myocardial infarction with the development of heart failure. All this leads to human disability, decreased quality of life and early death.

Diabetes mellitus and effects on the heart

Currently, in countries that have achieved significant success in the treatment of coronary artery disease, only patients with diabetes mellitus are the only group in which mortality among men has decreased slightly, and among women it has only increased. Therefore, US doctors from the American Heart Association decided to classify diabetes mellitus as a heart disease.

Scientists estimate that more than 60% of people with type 2 diabetes will have a shortened life expectancy due to the development of early signs of coronary artery disease. In addition, in men with diabetes mellitus, sudden death develops one and a half times more often, and in women with diabetes mellitus - 4 times more often than in people of both sexes without diabetes.

IHD in diabetes mellitus has a characteristic type of course. The most frequently mentioned are painless variants of the course of IHD, which leads to later detection of the problem and initiation of treatment. Clinical manifestations begin to appear already in the later stages, when the coronary bed is significantly affected.
This leads to the rapid onset of complications soon after diagnosis. Unfortunately, complications develop faster in women than in men. The risk of developing heart failure in women is 5.1 times higher, while in men it is 2.4 times higher.

Causes of cardiac vascular damage in diabetes mellitus

So why do people with diabetes live shorter lives than people without diabetes? This is due to a chronic increase in blood sugar. Hyperglycemia affects atherogenesis, i.e. the formation of atherosclerotic plaques that narrow or completely block the lumen of blood vessels, and this, in turn, causes myocardial ischemia (heart muscle).

How is this effect of hyperglycemia realized? Scientists are confident that high blood sugar causes dysfunction of the endothelium (the inner wall of blood vessels), i.e. the very place where lipids are deposited, increasing the permeability of the wall and creating plaque. Also, high sugar increases oxidative stress and the formation of free radicals, which also negatively affect the vascular endothelium.

The process of defeat itself, of course, is much more complicated, but I will not bore you with incomprehensible terms. I think that the basic mechanism is clear to you. Numerous studies have reliably proven the relationship between an increase in glycated hemoglobin and the risk of developing coronary artery disease. So, with an increase in HbA1c by 1%, the risk of developing coronary artery disease increases by 10%.
But it was found (the study lasted 7 years) that postprandial glycemia (sugar level 2 hours after a carbohydrate load, i.e. after a meal) is a more significant factor in the development of IHD than the HbA1c level. Currently, postprandial hyperglycemia is considered as an independent factor in the development of coronary artery disease in diabetes mellitus.
To prove my words, I will give numbers. A number of studies have shown that an increase in blood sugar 2 hours after a meal (exceeding 9 mmol/l) with normal fasting sugar (less than 6.1 mmol/l) and normal HbA1c was accompanied by a twofold increase in the risk of coronary heart disease and sudden death. Therefore, first of all, in assessing compensation for diabetes mellitus, one should focus not on fasting sugar levels or HbA1c, but on blood sugar levels after meals.

But in reality, how are things going? Most people with diabetes limit themselves to rare measurements of sugar levels in the morning on an empty stomach and sometimes test for glycated hemoglobin, while they are completely unaware of their postprandial sugar levels.

Coronary heart disease (CHD, angina), diabetes mellitus and lipids

In addition, an imbalance in the ratio of different types of lipids (dyslipidemia) also has a great impact on atherogenesis. The term “diabetic dyslipidemia” has even been proposed.
The components of this dyslipidemia are:

increased triglycerides (hypertriglyceridemia)
increased low-density lipoproteins (LDL)
reduction of high-density lipoproteins (HDL)

An increase in triglycerides as a factor in the development of coronary heart disease began to be considered quite recently. A large study has proven that with an increase in these lipids, the risk of developing cardiovascular diseases in men increases by 30%, and in women by 75%.

The role of lowering HDL (good cholesterol) levels in the development of coronary artery disease is already well known. At any level of LDL (conditionally “bad” cholesterol), the risk of coronary heart disease is higher, the lower the concentration of HDL in the blood. A decrease in HDL concentration by just 0.1 mmol/L leads to a 1.5-fold increase in the risk of developing angina and myocardial infarction.
An increase in the low-density lipoprotein fraction is an independent risk factor for coronary artery disease. Increased atherogenicity is associated with their longer circulation in the blood. The small particle size and high concentration facilitates their penetration into the vascular wall through the endothelium. It is this type of cholesterol that is captured in the vessel wall by macrophages, after which this complex (LDL + macrophage) turns into foam cells, which make up the atherosclerotic plaque.

Hyperinsulinism and vascular damage in coronary artery disease

One follows from the other, i.e., the initial tissue insulin resistance leads to an even greater release of insulin by the pancreas in order to overcome it, thereby increasing the resistance.
An increase in insulin levels (hyperinsulinemia) does not simply disappear for the body without leaving a trace. High insulin levels are an independent predictor of myocardial infarction and death from coronary artery disease, regardless of age, body mass index, blood pressure, glucose, cholesterol, smoking and physical activity. In other words, high insulin levels increase the risk in any case, if any.

Insulin in large quantities affects the vascular wall due to its effect on the coagulation system, while coagulation accelerates, platelet aggregation increases, which promotes the formation of intravascular thrombi, which can form on a damaged atherosclerotic plaque, thereby contributing to blocking the lumen of the vessel.
Also, excess insulin causes thickening of the basal layer of the vascular wall, further narrowing the lumen.

Heart treatment for diabetes

What can be concluded from this article? To stop or slow down the process of atherosclerosis of the coronary vessels (heart vessels), you need:

Normalize not only fasting glucose, but also ensure that blood sugar 2 hours after eating is within normal limits (no more than 7.8-8.0 mmol/l).
Normalize lipid levels (triglycerides, low-density lipoproteins and high-density lipoproteins).
Eliminate insulin resistance, and along with it hyperinsulinemia will go away.

When the degree of vasoconstriction has reached a critical level, and there are unstable plaques, doctors recommend surgical intervention. Currently, different types of operations are performed, for example, coronary bypass surgery or stenting of the heart vessels (see picture below).

In parallel, such patients are prescribed medications that affect vascular tone, dilating them. These include nitroglycerin preparations. Also, if the plaque is unstable, medications are prescribed to stabilize it. These are mainly statins.
All these measures are used when there is advanced coronary heart disease. To prevent it and in the initial stages, a change in lifestyle and nutrition is sufficient.
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With warmth and care, endocrinologist Lebedeva Dilyara Ilgizovna