Acute Coronary Syndrome in Patients with Diabetes mellitus: Features of the Course and Manifestations of Pain Syndrome
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Abstract
Acute coronary syndrome (ACS) remains a common cause of hospitalization for patients with diabetes mellitus (DM). Due to development of diabetic neuropathy, it is believed that this category of patients is characterized by a high frequency of atypical acute coronary syndrome, but data on this are quite contradictory.
The objective: to determine the features of the pain syndrome and its severity in patients with acute coronary syndrome and concomitant diabetes.
Materials and methods. The study involved 36 patients with diabetes (22 men and 14 women) aged 44–86 years, hospitalized urgently for ACS. Pain syndrome was assessed at the time of hospitalization and immediately after coronary artery revascularization according to the following criteria: visual analog scale (VAS), Numerical Rating Scale (NRS), clinical data, and biochemical markers.
Results. The majority of patients (91.67%) at the time of hospitalization complained of chest pain, the rest were not bothered by any pain. During the survey, patients described pain as «burning» (30.56%), «squeezing» (30.56%), «squeezing» (25.0%), «tingling» (5.56%). There were also complaints of difficulty breathing (13.89%), shortness of breath (11.1%), palpitations (41.67%). The appearance of excessive sweating was noticed by 16.67% of patients. There was no statistically significant difference between the results of pain assessment by VAS and NRS (p>0.1). The average value of glycemia at the time of hospitalization was 8.19±3.45 mmol/l (men – 8.17±3.61 mmol/l, women – 8.28±3.13 mmol/l). Glycemia greater than 10.0 mmol/l was detected in 8 patients, which was 22.22% of all patients. This category of patients was dominated by patients with severe pain (62.5%).
Conclusions. In patients with ACS and diabetes, the typical clinical picture of ACS prevailed (91.67% of patients) over the painless form. Prior to revascularization, moderate and severe pain occurred with equal frequency; there is no statistical difference between blood pressure, heart rate and glycemia (p>0.1) in patients with severe and moderate pain. Hyperglycemia (≥10.0 mmol/l) was found in 22.22%, among this category of patients was dominated by patients with severe pain.
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References
International Diabetes Federation. IDF Diabetes Atlas 2021 – 10th edition [Internet]. Brussels: IDF; 2021. 126 p. Available from: https://diabetesatlas.org/atlas/tenth-edition/
Chen L, Islam RM, Wang J, Hird TR, Pavkov ME, et al. A systematic review of trends in all-cause mortality among people with diabetes. Diabetol. 2020;63(9):1718–35. doi: 10.1007/s00125-020-05199-0
Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5(1):41. doi: 10.1038/s41572-019-0092-1.
Iqbal Z, Azmi S, Yadav R, Ferdousi M, Kumar M, Cuthbertson DJ, et al. Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther. 2018;40(6):828–49. doi: 10.1016/j.clinthera.2018.04.001.
Sloan G, Selvarajah D, Tesfaye S. Pathogenesis, diagnosis and clinical management of diabetic sensorimotor peripheral neuropathy. Nat Rev Endocrinol. 2021;17(7):400–20. doi: 10.1038/s41574-021-00496-z.
Angerud KH, Thylen I, Sederholm Lawesson S, Eliasson M, Naslund U, et al. Symptoms and delay times during myocardial infarction in 694 patients with and without diabetes; an explorative cross-sectional study. BMC Cardiovasc Disord. 2016;16(1):108. doi: 10.1186/s12872-016-0282-7.
Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Lambrew CT, et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA. 2000;283(24):3223–9. doi: 10.1001/jama.283.24.3223
Berman N, Jones MM, De Coster DA. Just like a normal pain, what do people with diabetes mellitus experience when having a myocardial infarction: a qualitative study recruited from UK hospitals. BMJ Open. 2017;7(9):e015736. doi: 10.1136/bmjopen-2016-015736.
Halushko O, Boliuk M. The risks and difficulties of diagnosing myocardial infarction in diabetic patients (review and own experience). Emergency medicine, 2020;16(2):37–41. doi:10.22141/2224-0586.16.2.2020.203139.
Johnson CAH, Pitta NC, Dessotte CAM, Dantas RAS, Rossi LA. Knowledge, attitudes, and beliefs about acute coronary syndrome among patients with type 2 diabetes. Rev Lat Am Enfermagem. 2021;29:e3503. doi: 10.1590/1518-8345.5435.3503.
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention. 2019;14(14):1435–534. doi: 10.4244/EIJY19M01_01.
Ministry of Health of Ukraine. Unifikovanyy klinichnyy protokol ekstrenoyi, pervynnoyi, vtorynnoyi (spetsializovanoyi), tretynnoyi (vysokospetsializovanoyi) medychnoyi dopomohy ta kardioreabilitatsiyi «hostryy koronarnyy syndrome z elevatsiyeyu sehmenta ST [Internet]. 2021. Nakaz №1936. 2021 Sept 14. Dostupno: https://zakon.rada.gov.ua/rada/show/v1936282-21#Text.
Sung YT, Wu JS. The Visual Analogue Scale for Rating, Ranking and Paired-Comparison (VAS-RRP): A new technique for psychological measurement. Behav Res Methods. 2018;50(4):1694–715. doi: 10.3758/s13428-018-1041-8.
Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain. 2016;13:67–75. doi: 10.1016/j.sjpain.2016.06.012.
Shafshak TS, Elnemr R. The Visual Analogue Scale Versus Numerical Rating Scale in Measuring Pain Severity and Predicting Disability in Low Back Pain. J Clin Rheumatol. 2021;27(7):282–5. doi: 10.1097/RHU.0000000000001320.
Kim YS, Park JM, Moon YS, Han SH. Assessment of pain in the elderly: A literature review. Natl Med J India. 2017;30(4):203–07. doi: 10.4103/0970-258X.218673.
Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804. doi: 10.1111/j.1365-2702.2005.01121.x.
Fu R, Li S-D, Song C-X, Yang J-A, Xu H-Y, Gao X-J, et al. Clinical significance of diabetes on symptom and patient delay among patients with acute myocardial infarction-an analysis from China Acute Myocardial Infarction (CAMI) registry. J Geriatr Cardiol. 2019;16(5):395–400. doi: 10.11909/j.issn.1671-5411.2019.05.002.
Arnold SV, Spertus JA, Lipska KJ, Tang F, Goyal A, McGuire DK, et al. Association between diabetes mellitus and angina after acute myocardial infarction: analysis of the TRIUMPH prospective cohort study. Eur J Prev Cardiol. 2015;22(6):779–87. doi: 1177/2047487314533622.
Read SH, Fischbacher CM, Colhoun HM, Gasevic D, Kerssens JJ, McAllister DA, et al. Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015. Diabetol. 2019;62(3):418–25. doi: 10.1007/s00125-018-4796-7.
Draman MS, Thabit H, Kiernan TJ, O’Neill J, Sreenan S, McDermott JH. A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature. Endocrinol Diabetes Metab Case Rep. 2013;2013:130058. doi: 10.1530/EDM-13-0058.
Tracey I, Woolf CJ, Andrews NA. Composite Pain Biomarker Signatures for Objective Assessment and Effective Treatment. Neuron. 2019;101(5):783–800. doi: 10.1016/j.neuron.2019.02.019.
Cowen R, Stasiowska MK, Laycock H, Bantel C. Assessing pain objectively: the use of physiological markers. Anaesthesia. 2015;70(7):828–47. doi: 10.1111/anae.13018.
Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, prediabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255–323. doi: 10.1093/eurheartj/ehz486.
Hirsch IB, O’Brien KD. How to best manage glycemia and non-glycemia during the time of acute myocardial infarction. Diabetes Technol Ther. 2012;14(1) (Suppl1):22–32. doi: 10.1089/dia.2012.0095.
