ACUTE MYOCARDIAL INFARCTION IN PATIENT WITH DIABETES MELLITUS TYPE 1

LUGANSK MEDICAL UNIVERSITY DEPARTMENT OF INTERNAL MEDICINE (CARDIORHEUMATOLOGY)

Sonya E.B, Komal Prete Kaur, Sonina, DD.

УДК:616.12-005.4+616.379-008.64
Coronary heart disease (CHD) is the most common disease in most countries of the world,it occupies a leading place among all causes of morbidity, mortality, and persistent disability. According to epidemiological studies of coronary heart disease it is more prevalent in males. The main mechanisms of CHD development are: coronary atherosclerosis; coronary spasm ; microcirculation disturbance, and coronary thrombosis,which occur against a background of internal and external risk factors (age, gender, psycho-emotional factors, smoking, obesity, dyslipoproteinemia, hypertension , heredity, etc.). The prescence of each factor and their combination exacerbates the development and course of CHD. The combination of coronary artery disease with diabetes (1 or type 2) doubles the risk of CHD.
According to the WHO Expert - Diabetic cardiomyopathy refers to a specific metabolic diseases of the heart muscle. One of the most common mechanisms of metabolic abnormalities in the myocardium is a defect in ATPase activity of muscle fibers of the heart due to modification of sulfhydryl groups. In DM type-1 on the background of the metabolic imbalance develops a mismatch between myocardial energy supply and demand it of oxygen, increasing at low load and leading to dystrophic changes in myocardium. For women before menopause, regardless of blood pressure levels, the effect of aging on the structure and endothelial function was less pronounced than in men, which defines a lower risk of cardiovascular accidents. This effect is associated with endothelium-protective features of endogenous estrogens, which affect the increase in the release of nitric oxide. Long history of diabetes type 1, the presence of the generation of localized microangiopathy aggravates the course of cardiomyopathy with development of vascular lesions, even before the development of noncoronary chronic ischemic heart disease (aged 30 years and above). Under the influence of one or more risk factors expressed forms of cardiomyopathy may be complicated by myocardial necrosis in the absence of organic lesions of the coronary arteries.
On the example of a clinical case, we want to demonstrate features of the development and course of infarction in patients with diabetes mellitus type 1 at age 37 with preserved menstrual function.
Mutual burdening microangiopathic changes of coronary vascular disorders of autonomic regulation of vascular tone and heart rate variability as a result of diabetic neuropathy, hypertensive manifestations and progressive endothelial dysfunction were the cause of recurrent myocardial infarction in our patient, despite low levels of atherogenic fractions and baseline total cholesterol.
Should pay attention to the burdening of the metabolic lesion of the heart muscle with diabetes mellitus type 1 with a long history of moderate hypertension, uncontrolled hyperglycemia and endothelial dysfunction.
In order to prevent complications demonstrated by the example of a clinical case, there should be regular monitoring of the endothelial function of metabolic disorders and a constant and adequate correction for the development of diabetes type 1.