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DIABETIC CARDIOVASCULAR COMPLICATIONS

CORONARY ARTERY DISEASE

An uncontrolled diabetic is at a higher risk of having a heart attack than the non-diabetic. This is because uncontrolled hyperglycemia affects the blood vessels of the heart and this causes coronary artery disease.

Atherosclerosis causes coronary stenosis in one or more of the coronary arteries. These arteries supply oxygenated blood to the heart muscle (myocardium). Coronary stenosis interrupts the supply of blood to the muscles. This causes ischemia of the heart muscles.

The symptoms would be those of ischemia: a chest pain, or a dull ache or crushing sensation usually under the sternum (angina pectoris, unstable angina) that may radiate into the neck, jaw and teeth, shoulder and or left arm, or occasionally straight through to the back or shoulder blade or upper abdomen. These symptoms are usually brought on by exertion, exercise or anxiety. However in unstable angina, they may occur at rest without any preceding activity.

If the blockage is great enough, the heart muscle will be severely damaged and the muscle cells will die. This is called a myocardial infarction (heart attack) and sudden death of the person may result. Alternatively a person may become disabled because of an inability to function normally due to a badly damaged heart.

PERIPHERAL VASCULAR DISEASE

This is a condition of the blood vessels usually of the legs and feet. The symptoms are caused by ischemia in the tissues of the limb affected. Uncontrolled hyperglycemia affects the vessels of the body in the same way that it affects the vessels of the heart. Atherosclerosis causes obstruction in the blood vessels. This causes a decrease in the oxygenated blood reaching the muscles. The most frequent symptom of chronic peripheral vascular disease is intermittent claudication. This is a pain, ache, or cramp in the lower leg muscle caused by a lack of oxygen getting to the muscle. Sometimes it may be a tired feeling that happens when walking. The most common places for this to happen are in the calf, but claudication can also occur in the foot, thigh, hip, or buttocks.

If the blockage is acute, the symptoms would be of severe pain, coldness, numbness, and extreme paleness in the limb, the foot is cold and pale, and pulses are absent distal to the obstruction.

Severe peripheral vascular disease causes ulcers of the affected limb along with dry, scaly skin and poor hair and nail growth. The ulcers are difficult to heal and may progress to necrosis and/or gangrene. Gangrene can lead to amputation of the limb above the necrotic/gangrenous area. This is not only traumatic physically, but also emotionally. The individual will have to make extreme changes to their life style and adaptations in many spheres of daily living.

CEREBROVASCULAR DISEASE

Cerebrovascular disease occurs when the blood vessels of the brain are affected by atherosclerosis. The blockage of the blood vessel occurs in the brain. This causes ischemia of part of the brain, leading to death of brain tissue and the symptoms of a stroke.

The symptoms of a stroke include:
Hemiplegia (full or partial)
Paralysis of the facial muscles
Difficulty in speaking (dysphonia) due to the muscles of the mouth, face and tongue being affected by the stroke
Difficulty in generating speech due to the left side of the brain being affected (Aphasia)
Memory impairment.
A stroke frequently causes severe disablement and recovery and rehabilitation is often long and difficult for both the individual who has had the stroke and their loved ones.

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