Diabetic Cardiomyopathy

Cardiovascular diseases has affected large number of population worldwide and in developed countries it is responsible for half of all deaths, coronary artery disease (CAD) alone is responsible for 1 of every 4.7 deaths in the United States (Eichner et al., 2002).

As this disease progresses and the workload of the heart is consistently increased, ventricular hypertrophy occurs. At first, the hypertrophied heart muscles will increase contractility, thus increasing cardiac output; however, as hypertrophy of the ventricular myocardial cells continues, it begins to have poor contractility, requires more oxygen to perform, and has poor circulation from the coronary arteries. This can result in heart tissue ischemia and lead into cardiac dysrhythmias (Lewis et al. 2014, 768).

Diabetes refers to a set of several different diseases. It is a serious health problem throughout the world and fourth leading cause of death by disease in the country. All types of diabetes result in too much sugar, or glucos in the blood. To understand why this happens it would helpful if we understand how the body usually works. When we eat, our body breaks down the food into simpler forms such as glucose. The glucose goes into the bloodstream, where it then travels to all the cells in your body. The cells use the glucose for energy. Insulin, a hormone made by the pancreas, helps move the glucose from bloodstream to the cells. The pathophysiology of diabetes mellitus further explains the concept on how this disease works. Pancreas

According to the National Heart, Lung and Blood Institute (NHLBI), Coronary heart disease is a cardiovascular disease caused by a cholesterol substance termed plaque, accumulating within the coronary arteries, which is where oxygen-rich blood is delivered to the heart. Progressively, the flow of oxygen to the heart will suffer if hardened plaque begins to narrow the coronary arteries. Furthermore, blood clots could occur upon the surface of plaque if it ruptures. Large blood clots will incapacitate blood flow through the coronary arteries. As a result, angina or a heart attack may follow plaque-blocked oxygen-rich blood flow. The NHLBI refers to CHD as a progressive disease where a destabilised heart can lead to conditions such as heart failure

The cardiac muscle cells can be affected by heart disease through the inability to maintain its homeostasis through the calcium pump. If there is excess calcium within the heart it results in the in ability of the heart muscle to relax. As a result, the ADP/ATP ratio increases, phosphocreatine decreases, and energy stores are depleted. Furthermore, this imbalance affects the energy needed to relax the left ventricle. Secondly, diastolic heart failure can occur from changes in preload, afterload, renin-angiotension-aldosterone system, and the sympathetic nervous system. These changes affect the fibrillar collagen within the extracellular matrix that affects the ability of the ventricular to relax. These changes along with those compensatory mechanisms results in continuous resistance that results in increased in left ventricular end-diastolic pressure (McCance & Huether, 2010).

Over the past years, heart disease has constituted one of the leading causes death in America. In fact, statistics show that one in every seven deaths is as a result of heart-related diseases (American Heart Association, 2016). Conversely, most deaths reported are of elderly individuals aged above the 65 years. However, there are also other underlying conditions that elevate the risk of developing heart diseases. According to the American Heart Association (2016) 62% of men and 67.8% of women have high blood pressure that are aged between 65-74 years of age. High blood pressure exposes older people to high-risk chances of developing cardiovascular diseases, characterized by high rates of mortality, morbidity, and disability. Cardiovascular

A decrease in the radial (RS) and circumferential strain (CS) is remarkable in patients with diabetes mellitus [51]. Diastolic dysfunction as an early manifestation of diabetic heart has been reported in patients with diabetes mellitus with normal left ventricular ejection fraction (LVEF) [52]. Longitudinal appearance is the primary manifestation in diabetics with left ventricular systolic dysfunction [53]. Patients with diabetes type 2 show reduced in systolic and diastolic velocity during exercise [54].

One of the patient’s secondary diagnoses is atherosclerotic heart disease of native coronary artery without angina pectoris. He had a heart valve replacement in 2011. Atherosclerosis is a disease in which plaque made of fat, cholesterol, calcium, and other substances builds up inside the arteries. This is an issue because the plaque hardens over time and narrows the arteries, which then limits the flow of oxygenated blood to vital tissues. This condition can lead to heart attacks, strokes, and death. Coronary artery atherosclerosis is the single largest killer of both men and women in the United States (Boudi, 2016). The patient’s atherosclerosis is located in the coronary artery. This artery is one of two main blood vessels that branch off

Diabetes is a disease that is high blood sugar. When you don't take your insulin you could very well go into a diabetic coma. This disease is not something like the flu that goes away in a few days, it is very long lasting. In order to not have a cardiovascular disease too, you have to keep an eye on blood pressure and cholesterol levels. Smoking can also cause a cardiovascular disease. There are also two types of diabetes. Type 1 diabetes is also referred to juvenile diabetes, and other things. Of all the people with diabetes about 90% have type 2. Type 2 means your body doesn't produce enough insulin for proper function. People that suffer from obesity are most likely to suffer from type two. Having only one can of soda a day raises your

Cardiomyopathy is a long-term (chronic) disease of the heart muscle. The disease makes your heart muscle thick, weak, or stiff. As a result your heart has to work harder to pump blood. Over time cardiomyopathy can lead to heart failure.

Congenital heart diseases (CHD) are defects in the heart that are present from birth and affect 8 in every 1,000 newborns each year (National Heart Lung and Blood Institute, 2011). Hypertrophic cardiomyopathy (HCM) is the most common congenital disease of the heart (O’Hanlon and Pennell, 2009) and the most common cause of sudden cardiac death (SCD) among apparently healthy athletes and younger generations (Maron, 1995; Maron and Maron, 2013). HCM is a condition in which there is abnormal thickening of the myocardium in the left ventricle (LV), also know as left ventricular hypertrophy (LVH), where the heart is not dilated and there is no other systemic or cardiac cause (Maron et al 2003; Maron et al 2006). Although many patients are asymptomatic to HCM, some patient’s will present with, or develop progressive exercise intolerance, heart failure symptoms and SCD (Keren et al 2008).

The patient’s chart did not state which type of cardiomyopathy he had a history of, but there are four types of cardiomyopathies. Dilated cardiomyopathy is when both heart ventricles are dilated and the heart’s pumping function is impaired because the ventricular walls stretch out to very thin widths (Dechant, 2016). Hypertrophic cardiomyopathy is where the walls of the ventricles thicken and grow inwards, and could impair the outflow of blood when the heart contracts (Dechant, 2016). Restrictive cardiomyopathy is when the ventricles stiffen in elasticity, restricting the inflow of blood into the ventricles at rest (Dechant, 2016). Finally, arrhythmogenic right ventricular cardiomyopathy could involve either ventricle and is when the myocardial tissue is replaced by fatty tissue, impairing overall ventricular function (Dechant, 2016).

Obstruction is the action of obstructing or the state of being obstructed. An obstruction disease is a disease that impedes or prevents passage or progress of blood through the veins or arteries inthe body. Coronary artery disease, also known as atherosclerotic heart disease, is damage or disease to heart's major blood vessels, the arteries. Coronary artery disease is usually caused by a buildup of plaque. This buildup of plaque causes the arteries to become narrow and harder, which limits blood flow to the heart. People that get coronary artery disease can be asymptomatic and not experience any symptoms. But people may experience chest pain, indigestion or nausea, light headness, or sweating, fast heart rate or shortness of breath. CAD has

The term “ventricular remodelling” includes a complex of anatomic, functional, cellular, and molecular changes in the myocardium in response to the injury Markers of cardiac remodelling are hemodynamic and echocardiographic changes which correlate with cardiac impairment (Cohn et al., 2000; Kubanek et al., 2013). In HF animal models, the process of left ventricular (LV) remodelling begins rapidly, and continues to progress; LV are a greater cardiac chamber dilation, a greater increase in systolic and diastolic volume index and a progressive decline in the ejection fraction (EF) (Eaton et al., 1981; Korup et al., 1997; Cohn et al., 2000; Kubanek et al., 2013).

Other issues that make diabetes and related conditions should be evaluated by the healthcare provider. For example, if an older adult who has diabetes smokes, counseling and other services should be looked at and discussed with the patient. Some are willing to quit smoking but it is still tough to do it on your own. The problems of smoking and the disease caused by it are clear and have been discussed in many places. Smoking cessation should therefore be part of the plan for a diabetic patient. Medication taken by the older patient with diabetes should also be looked at. Some combinations of medications can increase blood pressure or affect other chemical balance of the body causing serious conditions or