DIABETIC CARDIOMYOPATHY - A UNIQUE ENTITY OR A COMPLICATION OF CORONARY-ARTERY DISEASE

The increased incidence of congestive heart failure and the increased mortality and morbidity in the diabetic patient following myocardial i nfarction or coronary artery bypass graft can be explained by the pres ence of diabetic cardiomyopathy. Noninvasive studies in young diabetic patients show no cardiac abnormality, but in older diabetic patients mild cardiac diastolic dysfunction is detectable. This mild cardiomyop athy can become clinically detectable in the presence of hypertension and can be severe in the presence of myocardial ischemia. Microvascula r disease is unlikely to cause diabetic cardiomyopathy. Cellular chang es, including defects in calcium transport and fatty acid metabolism, may lead to myocellular hypertrophy and myocardial fibrosis, initially causing diastolic dysfunction that may advance to systolic dysfunctio n. Glycemic control, energetic detection and treatment of hypertension with appropriate antihypertensive agents, and early detection and tre atment of ischemic heart disease are essential in preventing and treat ing diabetic cardiomyopathy.