Background : Patients with long
standing DM undergoing surgical interventions
are put under great challenge
as they may have cardiovascular
and/or cardiac autonomic
neuropathy
(CAN). CAN is serious,
often
overlooked and under diagnosed,
with possible arrhythmias
and
silent ischemia that threaten life.
Objectives:
Screening
for one of the
under
diagnosed high risk problem
by
assessment of CAN in long standing
type 2 diabetic women undergoing
stressful situations. Study
design:
Cross section study. Patients
and
methods:
100 type 2 diabetic
women
scheduled for major surgery
were
assessed by the autonomic
function
tests. CAN was assessed by
analyzing
HR variations during three
standard
tests (deep breathing, lying to standing and valsalva maneuver).
Sympathetic functions were assessed
by checking orthostatic hypotension.
The CAN score of each patient
was analyzed. Continuous 24
hours
ECG monitoring (Holter) to
evaluate
arrhythmia, QTc and QTd.
Transthoracic
Doppler echocardiography,
stressing on LVH, diastolic
and
systolic dysfunctions were carried
out. Cases were classified as
mild
(with only one abnormal test) or
severe
CAN when 2 or more abnormal
function tests were present. Exclusion
criteria include any systemic
illness
that can affect the study results
or the autonomic functions,
smoking,
hypertension and cases
with
evident ischemia. Results:
CAN
was
detected in 70% of the studied
cases,
and 70% was severe CAN.
Postural
hypotension was detected in 34% of the studied cases. QTc
prolongation and QT dispersion were
frequent. ECG and Doppler echocardiography
changes of LVH were
more
prevalent among patients with
CAN.
Diabetics with CAN were significantly
older had longer duration of
DM
and higher HbA1-c, higher pulse
pressure,
triglyceride, uric acid and
urinary
albumin execration rate.
They
also had significant increased
LVM
index and diastolic dysfunction.
Conclusion: Middle aged women
with long standing diabetes are vulnerable
to CAN with postural hypotension
and prolonged QTc intervals,
QT
dispersion, and increased LVMI.
Identification
of CAN is crucial to exercise
prevention against hazards of
CV
insults during stressful situation
and
cases with severe CAN may be
in
need for CAD screening preoperatively.