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A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature.

Draman MS, Thabit H, Kiernan TJ, O'Neill J, Sreenan S, McDermott JH - Endocrinol Diabetes Metab Case Rep (2013)

Bottom Line: His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day.We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.Silent myocardial ischaemia (SMI) is an important clinical entity.SMI is common and occurs with increased frequency in patients with diabetes.SMI is an independent predictor of mortality.Recognition may lead to early intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland.

ABSTRACT

Unlabelled: Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.

Learning points: Silent myocardial ischaemia (SMI) is an important clinical entity.SMI is common and occurs with increased frequency in patients with diabetes.SMI is an independent predictor of mortality.Recognition may lead to early intervention.

No MeSH data available.


Related in: MedlinePlus

Diminished heart rate response to phases II and IV of Valsalva manoeuvre. Event mark: the beginning of the test.
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fig3: Diminished heart rate response to phases II and IV of Valsalva manoeuvre. Event mark: the beginning of the test.

Mentions: In view of the silent nature of the patient's myocardial infarction, and the finding of peripheral neuropathy on examination, autonomic function testing was performed. This shows absence of heart rate variability in deep breathing, phase II and IV Valsalva manoeuvre response and poor heart rate response on tilt up test. This is consistent with a diagnosis of autonomic neuropathy (Figs 2, 3 and 4).


A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature.

Draman MS, Thabit H, Kiernan TJ, O'Neill J, Sreenan S, McDermott JH - Endocrinol Diabetes Metab Case Rep (2013)

Diminished heart rate response to phases II and IV of Valsalva manoeuvre. Event mark: the beginning of the test.
© Copyright Policy - license
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921998&req=5

fig3: Diminished heart rate response to phases II and IV of Valsalva manoeuvre. Event mark: the beginning of the test.
Mentions: In view of the silent nature of the patient's myocardial infarction, and the finding of peripheral neuropathy on examination, autonomic function testing was performed. This shows absence of heart rate variability in deep breathing, phase II and IV Valsalva manoeuvre response and poor heart rate response on tilt up test. This is consistent with a diagnosis of autonomic neuropathy (Figs 2, 3 and 4).

Bottom Line: His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day.We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.Silent myocardial ischaemia (SMI) is an important clinical entity.SMI is common and occurs with increased frequency in patients with diabetes.SMI is an independent predictor of mortality.Recognition may lead to early intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown Dublin Ireland.

ABSTRACT

Unlabelled: Silent myocardial ischaemia (SMI), defined as objective evidence of myocardial ischaemia in the absence of symptoms, has important clinical implications for the patient with coronary artery disease. We present a dramatic case of SMI in a diabetes patient who attended annual review clinic with ST elevation myocardial infarction. His troponin was normal on admission but raised to 10.7 ng/ml (normal <0.5) when repeated the next day. His angiogram showed diffused coronary artery disease. We here discuss the implications of silent ischaemia for the patient and for the physician caring for patients with diabetes.

Learning points: Silent myocardial ischaemia (SMI) is an important clinical entity.SMI is common and occurs with increased frequency in patients with diabetes.SMI is an independent predictor of mortality.Recognition may lead to early intervention.

No MeSH data available.


Related in: MedlinePlus