"مشاكل وأمراض القلب من المضاعفات الشائعة في معظم مرضى السكر خصوصا كبار السن بسبب زيادة ترسب الدهون وضيق الأوعية الدموية"
*prophylaxis &treatment.. الوقاية والعلاج
1-anti-platelets... مضادات التجلط
"أي مريض سكر أكبر من 40 سنة يفضل يمشي على دواء لزيادة سيولة الدم لمنع حدوث جلطات في القلب او المخ نتيجة لضيق الأوعية الدموية ماعداااااا مريض الضغط"
a-aspocid 75 mg or ezacard 75 mg
Contain "aspirin 75 mg"
1-2قرص يوميا بعد الفطار يوميا
*major contraindications of aspirin.. موانع استخدام الأسبرين
☆peptic ulcer... قرحة المعدة
☆bronchial asthma.. حساسية الصدر
☆chronic kidney disease... مريض الكلى والنقرس
b-plavix or clopex tab
-Contain "clopidogrel"
-قرص بعد الفطار يوميا
-الأحسن لكنه غالي بنلجأله إذا كان الأسبرين لا يمكن استخدامه
2-statins
"اي مريض سكر من كبار السن لازم يمشي على مخفضات الدهون في الدم حتى لو الدهون طلعت طبيعية في التحليل مع زيادة الجرعة إذا كانت الدهون عالية
Ex:-ator 10mg, 20mg, 40mg tab
-Contain "atrovastatin"
-نبدأ بقصر 10مجم بعد العشاء يوميا
-اذا كانت الدهون عالية نبدأ ب10مجم ونزود الجرعة تدريجيا حتى تتحسن النتائج
#Medical background about the relation between D.M and cardiovascular diseases :-
*Diabetes and Specific CVD
Atherosclerotic CHD
-Both type 1 diabetes and type 2 diabetes are independent risk factors for CHD.
-Moreover, myocardial ischemia due to coronary atherosclerosis commonly occurs without symptoms in patients with diabetes.
- As a result, multivessel atherosclerosis often is present before ischemic symptoms occur and before treatment is instituted.
-A delayed recognition of various forms of CHD undoubtedly worsens the prognosis for survival for many diabetic patients.
**Diabetic Cardiomyopathy
-One reason for the poor prognosis in patients with both diabetes and ischemic heart disease seems to be an enhanced myocardial dysfunction leading to accelerated heart failure
(diabetic cardiomyopathy).
- Thus, patients with diabetes are unusually prone to congestive heart failure.
-Several factors probably underlie diabetic cardiomyopathy: severe coronary atherosclerosis, prolonged hypertension, chronic hyperglycemia, microvascular disease, glycosylation of myocardial proteins, and autonomic neuropathy. Improved glycemic control, better control of hypertension, and prevention of atherosclerosis with cholesterol-lowering therapy may prevent or mitigate diabetic cardiomyopathy.
*imp:-
-An early clinical trial suggested that sulfonyl ureas used for control of hyperglycemia are cardiotoxic and may exacerbate diabetic cardiomyopathy. This side effect, however, was not confirmed in a recent large clinical trial.
**Stroke
-Mortality from stroke is increased almost 3-fold when patients with diabetes are matched to those without diabetes.
-The most common site of cerebrovascular disease in patients with diabetes is occlusion of small paramedial penetrating arteries.
-Diabetes also increases the likelihood of severe carotid atherosclerosis.
- Patients with diabetes, moreover, are likely to suffer irreversible brain damage with carotid emboli that otherwise would produce only transient ischemic attacks in persons without diabetes. Approximately 13% of patients with diabetes >65 years old have had a stroke.
posted from Bloggeroid
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