Asian Journal of Nursing Education and Research

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Comparison of Clinical Presentation of Acute Coronary Syndrome in Diabetic Vs Non-Diabetic Patients


Affiliations
1 College of Nursing, AIIMS, New Delhi, India
2 Dept. of Emergency Medicine, AIIMS, New Delhi, India
3 PGIMER, Chandigarh, India
4 Meenakshi Ammal Dental College, Chennai, India
5 College of Nursing, AIIMS, NewDelhi, India
     

   Subscribe/Renew Journal


Background: Diabetes mellitus (DM) is one of the major risk factors of acute coronary syndrome (ACS). There are certain differences reported in clinical presentation of patients with ACS between diabetic and non-diabetic patients. Objective: To compare the clinical profile and symptoms experienced by diabetic and non-diabetic patients of ACS. Methodology: A descriptive cross-sectional survey was conducted among 60 diabetic and 60 non-diabetic patients hospitalized with ACS in atertiary care centre, Delhi. The sample size of 120 i.e. 60 in each diabetic and non- diabetic group, was statistically calculated. Patients were enrolled only if they were hemodynamically stable and did not have any cognitive dysfunction or communication disability. Consent was obtained from patients after explaining the objectives of the study. Data on patient as well as clinical profile and initial symptoms of ACS were collected using structured interview. Results: The mean age of the patients with DM was 64.23+14.7years and without DM was 64+13.1years. Majority of the patients in both groups were males, married, belonged to nuclear family and were from urban setting. When 56.67% of diabetic patients were employed, 63% of non-diabetic patients were retired (p=0.001). Two third of the patients were diagnosed to be diabetic for more than one year. Majority of the patients who were on treatment were receiving oral hypoglycemic agents. As compared to non-diabetic patients of ACS, more number of diabetic patients with ACS were found to have high cholesterol level, alcoholism, family history of CAD, previous history of ACS, history of CABG and endovascular coronary interventions. Significantly higher number of diabetic patients i.e,83.3% were found to have STEMI as compared to 38.3% in non-diabetic patients. Cardiac enzymes were elevated in 90% of the diabetic patients as compared to 55% of non-diabetic patients (p=0.001). When 86.7% of nondiabetic patients experienced chest pain as one of the initial symptom of ACS, only 20% diabetic patients experienced the same in non-diabetic patients(p=0.001). Among prevalent symptom of ACS, chest pain, cold sweat, nausea/vomiting and palpitation were reported by significantly higher number of non-diabetic patients. significantly higher number of diabetic patients reported shortness of breath/ dyspnea, gastric discomfort, unusual fatigue, anxiety, syncope/giddiness and headache. While, significantly more number of non-diabetic patients reported pain in shoulders and arms. Significantly more number of diabetic patients reported jaw pain and neck pain. Conclusion: As per the present study findings, chest pain is less prevalent as an initial symptom of ACS in patients of diabetes and the diabetic patients may experience various atypical symptoms other than chest pain during ACS. Dyspnea, syncope/ giddiness were the major symptoms experienced by diabetic patients during ACS as compared to non-diabetic patients. Appropriate measures must be taken for diabetic patients by the health care providers to facilitate early and adequate management of ACS.

Keywords

Symptoms, Diabetic Patients, Non-Diabetic Patients, Acute Coronary Syndrome.
Subscription Login to verify subscription
User
Notifications
Font Size


  • Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. The Lancet 2006; 367(9524): 1747-57.

  • Organization WH. Prevention of cardiovascular disease: World Health Organization; 2007.

  • Junghans C, Sekhri N, Zaman MJ, Hemingway H, Feder GS, Timmis A. Atypical chest pain in diabetic patients with suspected stable angina: impact on diagnosis and coronary outcomes. European Heart Journal—Quality of Care and Clinical Outcomes 2015; 1(1): 37-43.

  • Brieger D, Eagle KA, Goodman SG, et al. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. 2004. 2009.

  • Canto AJ, Kiefe CI, Goldberg RJ, et al. Differences in symptom presentation and hospital mortality according to type of acute myocardial infarction. American heart journal 2012; 163(4): 5729.

  • Brieger D, Eagle KA, Goodman SG, et al. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. Chest 2004; 126(2): 461-9.

  • Khafaji HAH, Al Suwaidi JM. Atypical presentation of acute and chronic coronary artery disease in diabetics. World journal of cardiology 2014; 6(8): 802.

  • DeVon HA, Penckofer S, Larimer K. Midwest nursing research society sage best paper award: The association of diabetes and older age with the absence of chest pain during acute coronary syndromes. Western journal of nursing research 2008; 30(1): 130-44.

  • Culic V, Eterovic D, Miric D, Silic N. Symptom presentation of acute myocardial infarction: influence of sex, age, and risk factors. American heart journal 2002; 144(6): 1012-7.

  • Chiariello M, Indolfi C. Silent myocardial ischemia in patients with diabetes mellitus. Circulation 1996; 93(12): 2089-91.

  • Funk M, Naum JB, Milner KA, Chyun D. Presentation and symptom predictors of coronary heart disease in patients with and without diabetes. The American journal of emergency medicine 2001; 19(6): 482-7.

  • Hwang SY, Park EH, Shin ES, Jeong MH. Comparison of factors associated with atypical symptoms in younger and older patients with acute coronary syndromes . Journal of Korean medical science 2009;24(5):789-94 .

  • Stephen SA, Damey BG, Rosenfeld AG. Symptoms of acute coronary syndrome in women with diabetes: an integrative review of the literature. Heart & Lung: The Journal of Acute and Critical Care 2008; 37(3): 179—89.

  • Milner KA, Vaccarino V, Arnold AL, Funk M, Goldberg RJ. Gender and age differences in chief complaints of acute myocardial infarction (Worcester Heart Attack Study). American Journal ofCardiology 2004; 93(5): 606—8.

  • Richman PB; Brogan GX, Nashed AN, Thode HC. Clinical Characteristics of Diabetic vs Nondiabetic Patients Who “Rule—in” for Acute Myocardial Infarction. Academe emergency medicine 1999; 6(7): 719-23.

  • Association AD. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes care 2007; 30(6): 1374—83.

  • Garratt KN, Brady PA, Hassinger NL, Grill DE, Terzic A, Holmes DR. Sulfonylurea drugs increase early mortality in patients with diabetes mellitus afier direct angioplasty for acute myocardial infarction. Journal of the American College ofCardz'ology 1999; 33(1): 119—24.

  • Lopez—Jimenez F, Goldman L, Johnson PA, et al. Effect of diabetes mellitus on the presentation and triage of patients with acute chest pain without known coronary artery disease. The Americanjournal ofmedz'cz'ne 1998; 105(6): 500-5.

  • Fazel R, Fang J, Kline-Rogers E, Smith D, Eagle K Mukherjee D. Prognostic value of elevated biomarkers in diabetic and non— diabetic patients admitted for acute coronary syndromes. Heart 2005; 91(3): 388—90.

  • Kannel WB, Abbott RD. Incidence and prognosis of unrecognized myocardial infarction: an update on the Framingham study. New EnglandJoumal ofMedzcme 1984; 311(18): 1144—7.

  • Bradley R, Schonfeld A. Diminished pain in diabetic patients with acute myocardial infarction. Geriatrics 1962; 17: 322.

  • Dhandapani M, Dhandapani S, Agarwal M, Mahapatra AK Pain perception following different neurosurgical procedures: a quantitative prospective study. Contemporary nurse. 2016 Jun 28;52(4):477-85.

  • Mahak C, Shashi Y, Hemlata NM, Sandhya G, Dheeraj K, Dhandapani M, Dhandapani SS. Assessment of utilization of rehabilitation services among stroke survivors. Journal of neurosciences in rural practice. 2018 Oct;9(4):461.

  • DeVon HA, Ryan C], Ochs AL, Shapiro M. Symptoms across the continuum of acute coronary syndromes: differences between women and men. Americanjournal 0f crztzcal care 2008; 17(1): 14-24.

  • Dhandapani S; Aggarwal A, Srinivasan A, Meena R, Gaudihalli S, Singh H, Dhandapani M, Mukherjee KK, Gupta SK. Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: is there a relation?. Surgical neurology international. 2015;6(Supp121):S543.

  • Aggarwal A, Dhandapani S, Praneeth K, Sodhi HB, Pal SS, Gaudihalli S, Khandelwal N, Mukherjee KK, TewaIi MK, Gupta SK, Mathuriya SN. Comparative evaluation of H&H and WFNS grading scales with modified H&H (sans systemic disease): A study on 1000 patients with subarachnoid hemorrhage. Neurosurgical review. 2018 Jan 1;41(1):241-7.

  • Shanna M, Gopichandran L, Riju S. Knowledge about Ataxia and Caregiver Burden: Cross Sectional Survey among Primary Care Givers of Patients with Spinocerebellar Ataxia and Parkinsonism. Asian Journal of Nursing Education and Research. 2018 Mar 31.


Abstract Views: 244

PDF Views: 0




  • Comparison of Clinical Presentation of Acute Coronary Syndrome in Diabetic Vs Non-Diabetic Patients

Abstract Views: 244  |  PDF Views: 0

Authors

A. Dhanya
College of Nursing, AIIMS, New Delhi, India
Praveen Agarwal
Dept. of Emergency Medicine, AIIMS, New Delhi, India
Manju Dhandapani
PGIMER, Chandigarh, India
Jaideep Mahendra
Meenakshi Ammal Dental College, Chennai, India
Lakshmanan Gopichandran
College of Nursing, AIIMS, NewDelhi, India

Abstract


Background: Diabetes mellitus (DM) is one of the major risk factors of acute coronary syndrome (ACS). There are certain differences reported in clinical presentation of patients with ACS between diabetic and non-diabetic patients. Objective: To compare the clinical profile and symptoms experienced by diabetic and non-diabetic patients of ACS. Methodology: A descriptive cross-sectional survey was conducted among 60 diabetic and 60 non-diabetic patients hospitalized with ACS in atertiary care centre, Delhi. The sample size of 120 i.e. 60 in each diabetic and non- diabetic group, was statistically calculated. Patients were enrolled only if they were hemodynamically stable and did not have any cognitive dysfunction or communication disability. Consent was obtained from patients after explaining the objectives of the study. Data on patient as well as clinical profile and initial symptoms of ACS were collected using structured interview. Results: The mean age of the patients with DM was 64.23+14.7years and without DM was 64+13.1years. Majority of the patients in both groups were males, married, belonged to nuclear family and were from urban setting. When 56.67% of diabetic patients were employed, 63% of non-diabetic patients were retired (p=0.001). Two third of the patients were diagnosed to be diabetic for more than one year. Majority of the patients who were on treatment were receiving oral hypoglycemic agents. As compared to non-diabetic patients of ACS, more number of diabetic patients with ACS were found to have high cholesterol level, alcoholism, family history of CAD, previous history of ACS, history of CABG and endovascular coronary interventions. Significantly higher number of diabetic patients i.e,83.3% were found to have STEMI as compared to 38.3% in non-diabetic patients. Cardiac enzymes were elevated in 90% of the diabetic patients as compared to 55% of non-diabetic patients (p=0.001). When 86.7% of nondiabetic patients experienced chest pain as one of the initial symptom of ACS, only 20% diabetic patients experienced the same in non-diabetic patients(p=0.001). Among prevalent symptom of ACS, chest pain, cold sweat, nausea/vomiting and palpitation were reported by significantly higher number of non-diabetic patients. significantly higher number of diabetic patients reported shortness of breath/ dyspnea, gastric discomfort, unusual fatigue, anxiety, syncope/giddiness and headache. While, significantly more number of non-diabetic patients reported pain in shoulders and arms. Significantly more number of diabetic patients reported jaw pain and neck pain. Conclusion: As per the present study findings, chest pain is less prevalent as an initial symptom of ACS in patients of diabetes and the diabetic patients may experience various atypical symptoms other than chest pain during ACS. Dyspnea, syncope/ giddiness were the major symptoms experienced by diabetic patients during ACS as compared to non-diabetic patients. Appropriate measures must be taken for diabetic patients by the health care providers to facilitate early and adequate management of ACS.

Keywords


Symptoms, Diabetic Patients, Non-Diabetic Patients, Acute Coronary Syndrome.

References