Arul Murugan, C (2011) Metabolic factors and their impact on prognosis and short term complications of Acute Myocardial Infarction in Type 2 Diabetes Mellitus (Serum Uric Acid, Sugar & Total Cholesterol). Masters thesis, Coimbatore Medical College, Coimbatore.
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Abstract
INTRODUCTION : Coronary artery disease is the most common cause of mortality in type 2 diabetes mellitus. Type 2 diabetes is also increasing in epidemic proportions in south Indian population. Despite the development of modern coronary care unit, acute myocardial infarction diabetes mellitus is still challenge to physicians because of atypical presentation of AMI in diabetes, too many variables predicting the outcome of treatment. Acute Myocardial Infarction is the leading cause of mortality in both developed and developing countries. Factors contributing to death in diabetics following Acute Myocardial Infarction are many. These factors relate mainly to electrical disturbances in the form of Arrhythmia (Carmeliet E, Thompson CA) and mechanical disturbances in the form of pump failure (Hochman et. al., Bertrand M et. al.). Most sudden deaths in Acute Myocardial Infarction occur within one hour due to ventricular fibrillation and also due to left ventricular failure when there is an extensive injury (Lewis EF et. al.). Rest of the deaths following Myocardial Infarction occur within first one week and death cannot be predicted and occurs suddenly. Hence many trials have been conducted to identify markers that would be helpful to predict the risk of such adverse cardiac events. Thus it is evident that elevated Uric acid levels is a good marker of oxidative stress and useful to assess the prognostic events in AMI. This forms the basis of the study. Hyperglycemia on admission is a well known predictor of mortality after myocardial infarction even among without known type 2 diabetes mellitus as evidenced by journal of American college of cardiology (J Am Coll Cardiol, 2002; 40:1748-1754). This study is one to validate prognostic role of uric acid along with blood sugar & total cholesterol after myocardial infarction in type 2 diabetes mellitus. AIMS OF THE STUDY : 1. To know about serum uric acid level and impact on short term mortality. 2. On admission glucose and total cholesterol levels and their impact on severity of AMI along with serum uric acid elevation. 3. To study the atypical presentations in DM presenting with acute myocardial infarction 4. To assess the prognostic significance of serum Uric acid level in Acute Myocardial Infarction in type 2 diabetics. 5. To evaluate serum Uric acid levels with incidence of cardiac failure in diabetes with AMI. 6. To validate the relation between Quantitative serum Uric acid level on admission and Killip’s class status on AMI in type 2 DM. 7. To know whether the incidence of Arrhythmias bears a relation with serum Uric acid level in Acute Myocardial Infarction. MATERIALS AND METHODS : The study was conducted at Coimbatore medical college hospital, Coimbatore during the period of AUGUST 2008 – JULY 2010. 100 known type 2 diabetics on treatment who were presenting with AMI were included in the study and serially followed up in the intensive care units. Out of 100 patients 54 were males, 46 were female diabetics. Study Design : This is a prospective study design, This study is aimed to assess the prognostic role of metabolic factors serum uric acid,total cholesterol & blood sugar levels following Acute Myocardial Infarction in type 2 DM & correlating their levels with short term complications. This study included 100 known type 2 diabetics on medications presented with Acute myocardial infarction. This study included 100 type 2 DM patients of Acute Myocardial Infarction of which patient who had a normal Uric acid level were taken as a control and the rest who had elevated Uric acid level were taken up as study population. In both groups the complications and short term outcome were compared. Inclusion Criteria : Patients with previous history of type 2 diabetes with Acute ST ELEVATION Myocardial Infarction were entered into the study. A definite diagnosis of Acute ST Elevation Myocardial Infarction was made if the patients satisfied the following criteria: 1. A History of typical retrosternal compressive chest pain or atypical presentations in type 2 diabetes lasting for more than 30 minutes, not relieved by rest or nitrates. 2. Atypical symptoms, 3. Typical ECG changes of Acute ST Elevation Myocardial Infarction (ST,T changes in two contiguous leads) Exclusion Criteria : 1. Patients with elevated renal parameters. 2. Patients with Gout. 3. Patients with History of chronic alcoholism. 4. Patients with previous History of IHD & on Aspirin therapy. 5. Patients with newly diagnosed Diabetes mellitus. 6. Patients with hypertension and patients on Diuretics therapy. 7. Patients with hematological malignancy, hypothyroidism. CONCLUSION : 1. Measuring serum Uric acid level along with sugar & cholesterol is one of the predictable prognostic indicators in Acute Myocardial Infarction and one of the early and short term predictor. 2. A high serum Uric acid level associated with short term mortality in Acute Myocardial Infarction. 3. Atypical presentation in myocardial infarction were much more common in diabetic patients. 4. Elevated serum Uric acid is strongly associated with cardiac Arrhythmias as against controls and can be used as an immediate prognostic indicator in Acute Myocardial Infarction. 5. Elevated serum Uric acid level may be Arrhythmogenic. Further studies require to confirm and to treat. 6. There is a strong association of elevated serum Uric acid and cardiac failure. 7. Patients with high Uric acid level belonged to higher Killip class status (III & IV).
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Metabolic factors ; impact ; prognosis ; short term complications ; Acute Myocardial Infarction ; Type 2 Diabetes Mellitus ; Serum Uric Acid ; Sugar ; Total Cholesterol. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Feb 2018 20:24 |
| Last Modified: | 17 Feb 2018 20:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/5848 |
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