Article Type

Original Study


Background : Patients with longstanding DM undergoing surgical interventionsare put under great challengeas they may have cardiovascularand/or cardiac autonomicneuropathy(CAN). CAN is serious,oftenoverlooked and under diagnosed,with possible arrhythmiasandsilent ischemia that threaten life.Objectives:Screeningfor one of theunderdiagnosed high risk problembyassessment of CAN in long standingtype 2 diabetic women undergoingstressful situations. Studydesign:Cross section study. Patientsandmethods: 100 type 2 diabeticwomenscheduled for major surgerywereassessed by the autonomicfunctiontests. CAN was assessed byanalyzingHR variations during threestandardtests (deep breathing, lying to standing and valsalva maneuver).Sympathetic functions were assessedby checking orthostatic hypotension.The CAN score of each patientwas analyzed. Continuous 24hoursECG monitoring (Holter) toevaluatearrhythmia, QTc and QTd.TransthoracicDoppler echocardiography,stressing on LVH, diastolicandsystolic dysfunctions were carriedout. Cases were classified asmild(with only one abnormal test) orsevereCAN when 2 or more abnormalfunction tests were present. Exclusioncriteria include any systemicillnessthat can affect the study resultsor the autonomic functions,smoking,hypertension and caseswithevident ischemia. Results:CANwasdetected in 70% of the studiedcases,and 70% was severe CAN.Posturalhypotension was detected in 34% of the studied cases. QTcprolongation and QT dispersion werefrequent. ECG and Doppler echocardiographychanges of LVH weremoreprevalent among patients withCAN.Diabetics with CAN were significantlyolder had longer duration ofDMand higher HbA1-c, higher pulsepressure,triglyceride, uric acid andurinaryalbumin execration rate.Theyalso had significant increasedLVMindex and diastolic dysfunction.Conclusion: Middle aged womenwith long standing diabetes are vulnerableto CAN with postural hypotensionand prolonged QTc intervals,QTdispersion, and increased LVMI.Identificationof CAN is crucial to exerciseprevention against hazards ofCVinsults during stressful situationandcases with severe CAN may beinneed for CAD screening preoperatively.

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Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.