Diabetic cardiovascular disease

Last reviewed: 28 Apr 2022
Last updated: 08 Mar 2021

Summary

Definition

History and exam

Key diagnostic factors

  • chest pain
  • dyspnea on exertion
  • hypotension
  • rales
  • S3 gallop
  • BP >140/90 mmHg
  • nausea
  • diaphoresis
  • tachycardia
  • indigestion
More key diagnostic factors

Other diagnostic factors

  • unilateral weakness, numbness, and/or tingling
  • headache
  • intermittent claudication
  • bruits
  • aphasia
  • hemisensory loss
  • cranial nerve palsies
  • seizures
  • vertigo
  • limb pain at rest
  • diminished/absent lower extremity pulses
  • ulcers or gangrene
  • peripheral edema
  • smooth shiny skin with hair loss
  • pallor
Other diagnostic factors

Risk factors

  • cigarette smoking
  • hypertension
  • dyslipidemia
  • poor glycemic control
  • physical inactivity
  • albuminuria
  • elevated C-reactive protein
  • strong family history of cardiovascular disease (CVD)
  • overweight and obesity
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • HbA1c
  • lipid profile
More 1st investigations to order

Investigations to consider

  • exercise stress test
  • treadmill or pharmacologic stress echocardiogram
  • treadmill or pharmacologic myocardial perfusion scanning
  • ankle-brachial index (ABI)
  • CT angiography
  • coronary angiography
  • noncontrast head CT
  • MRI brain
  • duplex ultrasonography of carotid arteries
  • C-reactive protein
More investigations to consider

Treatment algorithm

INITIAL

acute myocardial infarction

ACUTE

highly significant coronary artery disease: without acute myocardial infarction

ONGOING

diabetic cardiovascular disease: stable and/or after intervention

Contributors

Authors

Alexander Meyer, MD

Cardiovascular Medicine Fellow

Wexner Medical Center

The Ohio State University

Columbus

OH

Disclosures

AM declares that he has no competing interests.

Laura Davidson, MD, MS

Assistant Professor of Medicine

Division of Cardiology

Bluhm Cardiovascular Institute

Northwestern University

Feinberg School of Medicine

Chicago

IL

Disclosures

LD declares that she has no competing interests.

Charles Davidson, MD

Vice Chairman, Clinical Affairs

Department of Medicine

Clinical Chief

Division of Cardiology

Medical Director

Bluhm Cardiovascular Institute

Northwestern Memorial Hospital

Professor of Medicine

Northwestern University

Feinberg School of Medicine

Chicago

IL

Disclosures

CD declares that he has no competing interests.

Acknowledgements

Dr Laura Davidson and Dr Charles Davidson would like to gratefully acknowledge Dr Leonard E. Egede, the previous contributor to this topic, and would like to gratefully acknowledge the review by Dr Shreenidhi Venuraju, MB BS, MRCP, Wellington Hospital South, UK.

Disclosures

LEE is an author of a number of references cited in this topic. SV not disclosed.

Peer reviewers

Irfan Moinuddin, MD

Assistant Professor

Chicago Medical School

Rosalind Franklin University

Lombard

IL

Disclosures

IM declares that he has no competing interests.

David Leehey, MD

Medical Director

Hines VA Hospital

Hines

IL

Disclosures

DL declares that he has no competing interests.

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