Download diabetic autonomic neuropathy

DR ZIAD NOFAL
CARDIOLOGIST
DAMASCUS
HOSPITAL
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Involvement of peripheral and autonomic
nervous systems
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Most common complication of diabetes
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Underdiagnosed and Undertreated
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Substantial morbidity/mortality (CAN)
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Least recognized and
understood complications
of diabetes.
Can involve the entire
autonomic nervous
system (ANS)
May be either clinically
evident or subclinical
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Distal symmetric polyneuropathy
Focal Mononeuropathies
Autonomic neuropathy
Polyradiculopathies
Mononeuropathy multiple
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CAN is defined as the impairment of
autonomic control of the
cardiovascular system in the setting
of diabetes after exclusion of other
causes .
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Perioperative unstability
Resting tachycardia
Loss of reflex heart rate variations
Hypertension Exercise intolerance
Orthostatic hypotension
Postprandial hypotension
Silent myocardial ischaemia
Left ventricular dysfunction and hypertrophy
QT interval prolongation
Impaired baroreflex sensitivity
Non-dipping, reverse dipping
Sympathovagal imbalance
Dysregulation of cerebral circulation
Sympathetically mediated vasodilation of coronary vessels
Arterial stiffness
Peripheral vascular function
Peripheral blood flow and warm skin
Arteriovenous shunting and swollen veins
Venous pressure Leg and foot oedema
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Clinically, the impairment in autonomic
function is associated with
resting tachycardia
exercise intolerance
orthostatic hypotension
intraoperative cardiovascular instability
silent cad
increased mortality
1.Tachycardia
(HR >100 bpm)
2.Decreased exercise tolerance
3.Orthostasis (>20mmHg fall in systolic BP upon
standing without compensationHR)
4.Cardiac denervation syndrome= SILENT MI
5.Paradoxic supine or nocturnal hypertension
6.Intraoperative and perioperative cardiovascular
instability
7. Left ventricular diastolic dysfunction
Decreased thermoregulation
2. Decreased sweating
3. Altered blood flow
4. Impaired vasomotion
5. Edema
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Exercise intolerance is usually due to impaired
augmentation of cardiac output resulting from
inadequate sympathetic modulation.
Sympathetic tone may be increased during the day and
parasympathetic tone decreased at night, which may
predispose to nocturnal arrhythmogenesis .
prevalence of QT prolongation was 16 percent overall
(11 percent in men, 21 percent in women .
fixed heart rate in the range of 80 to 90 beats per
minute, and is associated with painless myocardial
infarction and sudden death .
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There is day-to-day variability of symptoms
that may be exacerbated by insulin therapy,
which can provoke hypotension in both
diabetic and nondiabetic patients with
autonomic failure.
In occasional patients, supine and standing
systolic blood pressures may fall profoundly
after meals (postprandial hypotension)
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A posture-induced tachycardia
without a fall in blood pressure can
result in similar symptoms as are
experienced in postural
hypotension. The etiology is poorly
understood.
 poor
glucose control
 elevated triglyceride levels
 elevated body mass index
 smoking
 hypertension
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Making changes in posture slowly."
Tensing the legs by crossing them while
actively standing on both legs. In one report of
patients with autonomic neuropathy, this
procedure raised the cardiac output by 16
percent and the systemic blood pressure by 13
percent . It can therefore minimize postural
symptoms.
Performing dorsiflexion of the feet or handgrip
exercise before standing.
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