What is the proposed mechanism for atypical or silent ischemia in diabetes?

It has been suggested that one mechanism of silent ischemia is cardiac autonomic neuropathy (CAN), which is a form of autonomic neuropathy involving damage to autonomic fibers, innervating blood vessels and the heart (Manzella & Paolisso, 2005).

Why do diabetics experience silent ischemia?

Silent ischemia is particularly prevalent in people with diabetes. People with diabetes are at increased risk for coronary artery disease (CAD), in which the coronary arteries feeding the heart muscle become narrowed by a substance called plaque, blocking the supply of oxygen-rich blood.

Why does diabetes cause silent MI?

When it comes to silent heart attacks, diabetics are particularly susceptible for a couple of reasons: Higher Risk of Heart Disease – Diabetic patients are at an increased risk of silent heart attack in large part because the condition has already put their heart in a more precarious position overall.

Why would diabetic patients have atypical presentation for ACS?

Diabetics may have a diminished awareness of ischemic chest pain which could result in an uncharacteristic presentation. This may be explained by autonomic neuropathy and prolongation of the anginal perceptual threshold[28].

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Why do diabetics have atypical chest pain?

In patients with diabetes, however, there is evidence that ischaemia may be painless, or experienced atypically due to autonomic neuropathy affecting the sensory innervation of the heart.

What is diabetic ischemia?

In patients with diabetes mellitus, the ability of ischemic tissue to synchronize the molecular and cellular events leading to restoration of tissue perfusion in response to the atherosclerotic occlusion of a patent artery is markedly impaired.

Can diabetes cause ischemia?

There is strong evidence that the nerve fiber degeneration and a loss of nerve fibers are ischemic in diabetic polyneuropathy. Diabetic nerves reveal a paradoxical contrast between their physiological resistance to ischemia and increased morphological susceptibility to ischemia.

What is silent diabetes?

“Diabetes starts as a silent disease, advancing painlessly, almost imperceptibly,” says Dr. Ferrer, who sees 25 to 30 diabetic patients per week. “It mainly attacks the small blood vessels, damaging the kidneys, eyes, and nerves. It can also affect larger blood vessels.”

How does diabetes affect the presentation of myocardial infarction?

Factors unique to diabetes increase atherosclerotic plaque formation and thrombosis, thereby contributing to myocardial infarction. Autonomic neuropathy may predispose to infarction and result in atypical presenting symptoms in the diabetic patient, making diagnosis difficult and delaying treatment.

How does diabetes cause coronary heart disease?

Over time, high blood sugar can damage blood vessels and the nerves that control your heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease: High blood pressure increases the force of blood through your arteries and can damage artery walls.

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Which patients are likely to have atypical presentation of ACS?

The atypical symptoms tend to occur more commonly among those who are older, female, diabetic (possibly due to autonomic neuropathy), hypertensive, and with prior heart failure. They were reported in 5.7% and 12.3% of patients with unstable angina and NSTEMI, respectively [2].

What are atypical symptoms of ACS?

Symptoms occurring in the ACS setting without chest pain or discomfort have been described34,35 and are frequently labeled as “atypical.” These include unexplained shortness of breath, especially in those who present with ACS and left ventricular dysfunction36; pain or discomfort in other body locations, such as that …

What does it mean to have atypical symptoms?

Reviewed on 3/29/2021. Atypical: Unusual, or not fitting a single diagnostic. category.

What is a silent myocardial infarction?

Silent myocardial infarction (SMI) relates to absence of symptoms usually associated with myocardial ischemia. Its risk factors include heavy smoking, family history of heart disease, age, high blood cholesterol and systemic blood pressure, diabetes, and overweight [3, 4].

What does atypical angina mean?

Definition. Angina pectoris which does not have associated classical symptoms of chest pain.

Why might angina pectoris be a symptom linked to diabetes?

People with diabetes are at increased risk for CHD, a condition in which the heart muscle does not get a sufficient supply of blood, oxygen, and nutrients to meet its needs because of partial or complete blockage of the coronary blood vessels.