Cardiovascular neuropathy in course of diabetes mellitus

Abstract

Cardiovascular autonomic neuropathy (CAN) is serious but often overlooked chronic complication of diabetes. Clinical manifestation of CAN derives from loss of circulatory adaptation to alternating conditions. A fixed heart rate, not responding to stress, exercise, rest indicates cardiac denervation. There is an increased risk of serious ventricular arrhythmias leading to sudden death. Loss of adaptation in vascular system is observed as hypertension in supine position and rapid fall of blood pressure after standing or after meal. Disorders in organ (cerebral, coronary) circulations can lead to stroke or myocardial infarction. There is a link between CAN and others chronic complications of diabetes like retinopathy, nephropathy, diabetic foot syndrome and probably cardiomyopathy. The pathogenetic treatment consists of ideal glucose control with avoidance of hypoglycaemia, blood pressure and lipid control, cessation of smoking and alcohol intake and pharmacotherapy with alpha-lipoic acid, benfothiamine and ACE inhibitors. Symptomatic treatment depends on prevailing symptoms and includes: controlled exercise training, increased consumption of salt and fluids, tight lower-extremity stockings, beta-blockers without intrinsic activity, mineralocorticoids, α1-mimetics, sometimes clonidine and somatostatin analogues. (Diabet. Prakt. 2008; 9: 54-62)