Résumé
Patients with diabetes have an increased risk for development of cardiomyopathy, even in the absence of well known risk factors like coronary artery disease and hypertension. Diabetic cardiomyopathy was first recognized approximately four decades ago. To date, several pathophysiological mechanisms thought to be responsible for this new entity have also been recognized. In the presence of hyperglycemia, non-enzymatic glycosylation of several proteins, reactive oxygen species formation, and fibrosis lead to impairment of cardiac contractile functions. Impaired calcium handling, increased fatty acid oxidation, and increased neurohormonal activation also contribute to this process. Demonstration of left ventricular hypertrophy, early diastolic and late systolic dysfunction by sensitive techniques, help us to diagnose diabetic cardiomyopathy. Traditional treatment of heart failure is beneficial in diabetic cardiomyopathy, but specific strategies for prevention or treatment of cardiac dysfunction in diabetic patients has not been clarified yet. In this review we will discuss clinical and experimental studies focused on pathophysiology of diabetic cardiomyopathy, and summarize diagnostic and therapeutic approaches developed towards this entity.
Sujets)
Humains , Calcium , Cardiomyopathies , Maladie des artères coronaires , Diabète , Cardiomyopathies diabétiques , Fibrose , Glycosylation , Défaillance cardiaque , Hyperglycémie , Hypertension artérielle , Hypertrophie ventriculaire gauche , Espèces réactives de l'oxygène , Facteurs de risqueRésumé
To report a case with dynamic ST segment elevation suggestive of anteroseptal acute myocardial infarction [AMI] that proved to be bilateral pulmonary thromboembolism [PTE]. A 50-year-old woman with syncope was transferred to the emergency department. Findings from the admission electrocardiogram were suggestive of anteroseptal AMI; however, coronary angiography revealed that the patient had normal coronary arteries. On further evaluation, the patient was found to have massive bilateral PTE. This report emphasizes the role of evolving electrocardiographic changes in the diagnosis of PTE, particularly in patients with chest pain and ST segment elevation suggestive of acute coronary syndrome