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Also, the diabetic patient may show subtle signs of diabetic cardiomyopathy related to decreased left ventricular compliance or left ventricular hypertrophy or a combination of both. A prominent "a" wave can also be noted in the jugular venous pulse, and the cardiac apical impulse may be overactive or sustained throughout systole.
Blood pressure should be lowered a maximum of 10% over the first hour and 25% over the first two hours as rapid lowering of blood pressure can lead to decreased blood flow in the brain and cause the development of an ischemic stroke. Once blood pressure is stabilized, patients can be changed from intravenous medications to oral. [3]
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to fill with and pump blood.. Although symptoms vary based on which side of the heart is affected, HF typically presents with shortness of breath, excessive fatigue, and bilateral leg swelling. [3]
Women, diabetic individuals, and elderly individuals are more likely to present with atypical symptoms other than chest pain. [8] Women may present with back pain, shortness of breath, heartburn, nausea, and vomiting. [19] Heart disease in women goes undetected prior to a major cardiac event in up to 60% of cases. [19]
Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; [1] this may be measured by echocardiography or cardiac catheterization.
Lung restriction in diabetes could result from chronic low-grade tissue inflammation, microangiopathy, and/or accumulation of advanced glycation end products. [46] In fact the presence restrictive lung defect in association with diabetes has been shown even in presence of obstructive lung diseases like asthma and COPD in diabetic patients.
On average, women develop CVD approximately 10 years after their male counterparts. [101] In the United States, approximately 6% of women over 20 have coronary heart disease. [103] The highest prevalence of CVD is present in adults over the age of 80, and women and men have similar rates of disease after the age of 60. [99]
While the general signs for all types of shock are low blood pressure, decreased urine output, and confusion, these may not always be present. [6] While a fast heart rate is common, in those on β-blockers, those who are athletic, and in 30% of cases of those with shock due to intra abdominal bleeding, heart rate may be normal or slow. [7]