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Diabetes and heart disease

September 4th, 2013


Diabetes and heart disease

A few weeks ago, a 70-year-old male patient came to see me because he felt tight in the chest and could not breathe. Before coming to see me, he had to sleep on a stack of 4-5 pillows to keep his head elevated. He could not walk well and it became hard to walk in a straight line. He had had diabetes for quite a while and had been taking medication. However, he did not control his blood sugar level very seriously, as he did not want to give up his favorite food.

He also had suffered from kidney failure in the past, as his kidneys were only working 10% in removing toxins, but they were fine in removing fluids.

I examined him and found that his blood pressure was quite high (170/100mmHg). His pulse was normal. His lungs and stomach were fine. However, I noticed that he could not stand with his feet close together when his eyes closed, which should be easy for any healthy person. He had to keep his feet quite wide apart when he walked, although his limbs were perfectly strong. This indicated that something was wrong with his brain in the part that controls the body’s balancing skills.

His blood test and heart check-up revealed that he was suffering from severe myocardial infarction and heart failure, aggravated by the fact that his kidneys could not remove waste very well. Further tests showed that the arteries to his kidneys were also narrowed, as well as an artery that connected to his brain.  Coronary angiogram (dye test) test result proved that his coronary artery was also narrowed.

I treated this patient with balloon angioplasty at three arteries – the one from the neck to the brain, coronary artery and another smaller blood vessel that supplies blood to the heart. After the treatment, his symptoms disappeared almost completely, but he still needed dialysis, as his kidneys had to work extra hard to fight all those substances his body received during the treatment.

For this patient, the most important thing was to minimize his risk factors. This means he should lower his blood sugar level and keep his blood pressure in check.

At first, the patient complained that the treatment was expensive, due to the fact that he had four imported coated stent. I explained that it was the price to pay for all those years he had taken his body for granted and eaten carelessly. The treatment was just a solution, not the answer to a healthier life. He would need to watch his diabetes. I told him that from that day on, every time he spent 100 baht on a meal, keep 20 baht for future treatment.

Those with diabetic are at high risk of having hardened or narrowed artery. It can happen to any artery at any area of the body — eyes, heart, brain, kidney, or limbs. The worst part is once the person starts to feel the symptoms, the artery is usually very narrowed already.

There have been attempts to detect tendency or early signs of hardened artery because it is believed that early intervention can help lower its damage to other body parts. Simple things as reducing risk factors could then help treat it when it is still easily treatable. Magnetic Resonance Image or MRI can detect plague buildup in the artery. Another easy way is to measure blood pressure at the arms and the legs, then compare the two. If the difference is big, something might be up.

Early signs or not, the golden rules for everyone are to eat right, exercise and maintain healthy body weight. This is especially important for those from a family with diabetes or obesity. Teaching children to exercise goes a long way. Those who exercised when they were young could get back on track more easily. Eating right and keeping your weight in a healthy range are also important.

Artery abnormalities can happen to 20-year-olds or younger. To prevent it, healthy habits must be taught from childhood. Prevention is always better (and cheaper) than cure. Apart from this, you can also help save future cardiologists from having too many patients!

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.


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