Diagnosis of diabetic macroangiopathies

Diabetic makroangiopatiâ-generalized atherosclerotic changes developing in medium and large caliber arteries against the background of the prolonged course of diabetes. Diabetic makroangiopatiâ leads to CORONARY HEART DISEASE, hypertension, strokes, peripheral arterial lesions occlusal. Diagnosis of diabetic macroangiopathies includes the study of lipid metabolism, the USDG arteries limbs, cerebrovascular, kidneys, EKG, Echocardiography, etc. The basic principles of treatment of diabetic macroangiopathies are correction of hyperglycemia and Dyslipidemia, monitoring ad improvement rock properties of the blood. Makroangiopatiâ-diabetic complication of diabetes mellitus, resulting in the predominant lesion of cerebral, renal, coronary and peripheral arteries. Clinically diabetic makroangiopatiâ is expressed in the development of myocardial infarakta angina pectoris, ischemic strokes, renovskularna hypertension, diabetic gangrene. Diffuse vascular lesions are of paramount importance in the prediction of diabetes, increasing the risk of stroke and coronary heart disease in 2-3 times; gangrene of limbs-in 20 times.

Atherosclerosis of developing diabetes, has a number of specific features. In diabetics, itoccurs in 10-15 years earlier than do persons not suffering from impaired carbohydrate metabolism, and progresses more rapidly. For diabetic macroangiopathies typicalgeneralized defeat most arteries (coronary, cerebral, visceral, peripheral). In connection with the prevention and correction of diabetic macroangiopathies is of paramount importance in Endocrinology.

Causes of diabetic macroangiopathies

In diabetic macroangiopathies is a thickening of the basement membrane of the arteries of medium and large caliber with the formation of the atherosclerotic plaques. Their subsequent calcification, ulceration and necrosis are local blood clots and occlusion of thelumen of blood vessels, which leads to disruption of blood flow in certain areas.

To the specific risk factors for developing diabetes macroangiopatii diabetes includehyperglycemia and Dyslipidemia, insulin resistance, obesity (especially on abdominal′nomutype), arterial hypertension screening, increased blood clotting, Endothelial dysfunction,oxidative stress, systemic inflammation. Traditional risk factors for atherosclerosis are smoking, occupational intoxication, physical inactivity, age (men over 45 years of age,women older than 55 years), heredity.

Classification of diabetic angiopathy

Diabetic angiopathy-a shorthand term used to defeat small vessels-capillaries andarterioles (mikroangiopatia) prekapillârnyh, medium and large caliber arteries(macroangiopathies). Diabetic angiopathy is the late complications of diabetes mellitus,developing on average 10-15 years after the manifestation of the disease.

Diabetic makroangiopatiâ can occur near syndromes: atherosclerosis of the coronary arteries and aorta of the cerebral arteries, atherosclerosis and peripheral arterialatherosclerosis. Diabetic mikroangiopatia, retinopathy may include nefropatiu,mikroangiopatiu of the lower limbs. The defeat of the vessels may take the form of a universal angiopathy, combines macro-and mikroangaopatiû.

In turn, contributes to impairment mikroangiopatia èndonevral′naâ peripheral nerves, i.e.the development of diabetic neuropathy.

Symptoms of diabetic macroangiopathies

Atherosclerosis of the coronary arteries and aorta in diabetic macroangiopathies is the development of coronary heart disease with acute (heart attack) and chronic (infarction, stenocardia) forms. ISCHEMIC HEART DISEASE in diabetes mellitus may be atypical (foraritmičeskomu or bezbolevomu option), thereby increasing the risk of sudden coronarydeath. Diabetic makroangiopatiâ is often accompanied by a variety of postinfarktnymicomplications: aneurysms, arrhythmias, tromboèmboliâmi, cardiogenic shock, heart failure.In diabetic macroangiopathies is very high risk of developing recurrent myocardialinfarctions. The risk of death from heart attack in patients with diabetes mellitus in 2 times higher than in people without diabetes.

Atherosclerosis cerebral arteries resulting from diabetic makroangiopatiej, found in 8% of patients. It can be chronic brain ischemia or ischemic stroke. The likelihood of brain vascularcomplications of diabetes is increased 2-3 times if you have hypertension.

Obliterating atherosclerotic lesions of the peripheral vessels (atherosclerosis) is 10% of patients with diabetes. Clinical manifestations of diabetic macroangiopathies in this case include numbness, and foot chills may also appear, peremežaûŝuûsâ lameness, gipostaticeski swelling of the limbs, severe pain in the muscles of the lower legs, thighs, buttocks, which is sometimes amplified if any physical activity. With a drastic violation of blood flow in the distal limbs divisions develops critical ischemia, which can lead to leg and foot tissue necrosis (gangrene). Necrosis of the skin and subcutaneous tissue can occur without additional mechanical damaging impacts, but more often take place against the backdrop of a prior breach of the integrity of the skin (with pedicures, fractures of the foot, gribkovom lesions of skin and nails, etc.). With less blood flow in diabetic expressed violations macroangiopathies develop chronic trophic ulcers.

Diagnosis of diabetic macroangiopathies

Diagnosis of diabetic macroangiopathies is designed to determine the degree ofdestruction of the coronary, cerebral and peripheral vessels. To determine the algorithmcounseling survey endocrinologist, diabetes, cardiology, vascular surgeon, cardiac surgeon,neurologist.

A study of biochemical blood profile includes the identification of the level of glycemia(blood glucose), indicators of lipid spectrum (cholesterol, triglycerides, lipoproteins), platelets, coagulation diagram.

Examination of the cardiovascular system in diabetic macroangiopathies provides for the registration of ECG, ECG monitoring and ad load tests (veloergometry, treadmill test),echocardiography, aortic USDG, myocardial scintigrafiû perfuzionnuû (to detect hiddenischemia), coronarography, CT-Angiography.

Clarification of the Neurologic status is performed using ULTRASONIC DOPPLEROGRAPHYand duplex scanning the cerebral vascular angiography of cerebral vessels.

For the assessment of peripheral vascular bed in diabetic macroangiopathies isULTRASONIC DOPPLEROGRAPHY and duplex receptacles limbs, the peripheralArteriography, rheovasography, capillaroscopy arterial oscillografiâ.

Treatment of diabetic macroangiopathies

Treatment of diabetic macroangiopathies is aimed at slowing the progression of thedangerous vascular complications threatening patient permanent disabilities or death. The basic principles of therapy of diabetic macroangiopathies are correction of hyperglycemiaand Dyslipidemia syndromes, hypercoagulation, arterial hypertension.

With a view to achieving the compensation carbohydrate metabolism in patients withdiabetes makroangiopatiej insulin therapy is under the control of blood glucose levels.Correction of carbohydrate metabolism is achieved through the use of lipid-lowering drugs (statins, antioxidants, fibrate) as well as diet, limiting the intake of animal fats.

And increased risk of thromboembolic complications to the appointment antiagregantnyhdrugs (dipyridamole, acetylsalicylic acid, Pentoxifylline, heparin, etc.). Purpose ofhypertensive therapy in diabetic macroangiopathies is to achieve and maintain the target level of HELL-130/85 mm Hg. art. To do this, preferably the appointment of ACE-inhibitors(captopril), diuretics (furosemide, verošpirona, gipotiazida); patients who have suffered a heart attack-beta-adrenoblokatorov (atenolola etc.).

Treatment of trophic ulcers of the limbs is carried out under the supervision of a surgeon.In acute vascular accidents is the intensive therapy. According to the performed surgery(CABG, surgery of cerebrovascular insufficiency, endarterectomy, amputation, etc.).

Forecast and prevention of diabetic macroangiopathies

Mortality from cardiovascular complications in patients with diabetes mellitus reaches 35-75%. Of these, approximately half of the deaths from myocardial infarction, occurs in 15% of acute cerebral ischemia.

Key to preventing diabetic macroangiopathies is to maintain optimal blood glucose levelsand hell, the diet, weight control, giving up bad habits, all medical recommendations.