الفهرس 
Pathophysiology of Ischemic Heart diseaseOnly 14 pages are availabe for public view
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Abstract
Coronary artery disease is the ultimate cause of death in more than half of diabetic patients and frequently manifests itself silently and prematurely. Patients with diabetes have a two-to-three fold increase in risk of early death from coronary artery disease.
Aim of this study was to assess frequency and clinical predictors of silent myocardial ischemia in high-risk asymptomatic patients with diabetes mellitus.
The present study was done on 30 diabetic patients at high risk to develop coronary artery disease. Mean age of the study group was 50.9 ± 5.3 years (range 40-60). There were 28 males and 2 females. Twenty-six patients were hypertensive (86.6%), 14(46.7%) were smokers.
All patients were subjected to full history taking, thorough clinical examination, fasting and postprandial blood sugar levels, fasting triglyceride, and total cholesterol levels.
Resting ECG was done to all patients under complete resting condition.
Technetium scintigraphy:
Twenty-eight diabetic patients underwent myocardial perfusion scan using Tc-99 sestamibi, one-day protocol; two patients was stressed pharmacologically using dobutamine.
Twelve patients, (40%) showed normal myocardial perfusion scanning, whereas eighteen patients with perfusion defect (s) (60%) (These were considered to have SMI).
Stress technetium sestamibi scintigraphy is a useful modalities in screening of coronary artery disease in diabetic patients. In addition, it gives valuable information about the presence of multivessel disease, and can define the affected vessels.
Coronary angiography:
Significant CAD (> 50% diameter stenosis) was detected in 9 patients. 2 patients had a one-vessel CAD, 5 patients had a two-vessel CAD, and 2 had a three-vessel CAD. Normal coronary arteries or < 50% lesions were present in 9 patients
The present study found that Type II D.M (NIDDM), poor diabetic control, long duration of diabetes, diabetic complications, dyslipidemia and smokers are the most important predictive factors for SMI and those populations deserve to be screened for CAD.