Ischaemic Heart Disease

Ischaemic heart disease develops in over three-quarters of people with Type 2 diabetes, and kills half of them.
It is often silent, often accompanied by cardiac failure, and is less amenable to surgical intervention than usual

Assessment and diagnosis

Investigate if :
		classical angina or suspicious symptoms
		unexplained breathlessness
		cardiac failure, cardiomegaly, or cardiac rhythm disorder
		arterial thrombotic event
	The threshold for investigation is lower if albumin excretion rate is abnormal
Investigate by :
		standard 12-lead ECG and chest X-ray
		cardiac ultrasound scan
		exercise stress ECG
		angiography / stress echo if indicated

Management

Intensify :
		management of arterial risk factors ( see also : Managing Arterial Risk Factors )
		education on life-style management including smoking ( see also : Life-style issues, Smoking target, Providing Nutritional Advice and Physical Exercise )
Review :
		choice of blood pressure lowering drugs ( indication for ß-adrenergic blockers )
		use of aspirin / other anti-thrombotic therapy ( all patients )
		use of cardiac failure drugs ( indication for ACE-inhibitors )
Advise :
		early coronary bypass therapy / angioplasty / stenting if indicated
Use :
		intravenous insulin to control blood glucose levels after admission for myocardial infarction
Consider :
		hormone replacement therapy in post-menopausal women ( if agreed )

Kidney Damage