Introduction:
The International Diabetes Federation predicts that throughout the next three decades, the number of patients in North America with diabetes mellitus (DM), a worldwide epidemic, will rise by 35 percent. In this demographic, heart disease is the primary cause of mortality, and around 25 percent of patients who have acute coronary syndrome (ACS) also have diabetes mellitus. These patients, in comparison to the general population, have more complex coronary anatomy, a high burden of comorbidities (such as hypertension, chronic renal disease, and heart failure), and an increased risk of stent-related complications, such as stent thrombosis and restenosis. These concerns all contribute to the dismal prognosis that diabetes mellitus patients have following an acute coronary syndrome.
What Is Cardiac Revascularization?
In patients with ischemic heart disease who are not candidates for other interventions like heart bypass surgery because of procedure failure, small coronary arteries, cardiac stenosis, or widespread coronary artery disease, myocardial revascularization is a different approach to treat the disease. Percutaneous myocardial revascularization (PMR), which is less invasive than trans myocardial revascularization (TMR), is the other kind.
Both employ high-energy lasers to cut openings in the heart's epicardium, its outer layer, and endocardium, its inner layer, enabling blood to enter the myocardium, its middle, muscular layer, straight from the left ventricle.
1. Transmyocardial Revascularization (TMR)
To gain access to the heart, the surgeon creates a cut in between the ribs and then stretches the ribs apart along one side. If the patient's heart is still beating, the treatment can be performed without requiring a cardiopulmonary bypass machine.
The blocked coronary artery is subsequently bypassed by applying a high-energy laser beam to the left ventricle region, which penetrates the heart muscle's layers from the outside in. This allows oxygenated blood to exit the ventricle straight into the myocardium. The initial incision is closed by the surgeon using stitches.
2. Revascularization of The Heart using Percutaneous Means (PMR)
A small incision is made on the groin to insert a catheter, or thin tube, into the femoral artery after the surgeon administers a local anesthetic. Following the initial catheter's placement, a fiber-optic catheter is inserted and directed to the heart via the blood arteries.
The catheter then emits a high-energy laser beam into the left ventricle's endocardium, which travels to the myocardium. Put differently, the laser makes an internal hole in two layers of the heart muscle. The incision is closed, and the catheters are removed once PMR is finished.
Are There Complications of Revascularization?
Revascularization carries a risk of consequences, just like any other medical surgery. If the patient also has diabetes, chronic renal disease, coronary artery disease, or any other illness outside of PAD, problems may be more likely. Revascularization procedures may be followed by silent embolization, calcification, microvascular illness, and restenosis.
When receiving interventional therapies, patients may experience complications, including bleeding, when the doctor inserts the catheter. Rarely, either too much blood flowing to the limb after the treatment or the development of a clot that stops blood flow from the heart to the limb are possible outcomes of the procedure.
What is The Goal of Revascularization?
Revascularization is done to assist in restoring blood flow to the heart in cases when the arteries are damaged (coronary artery disease).
Why Cardiac Revascularization Required In Diabetic Patients?
Compared to non-diabetic individuals, diabetic patients are more likely to have increased levels of insulin resistance, dyslipidemia, obesity, hypertension, and plasma fibrinogen. When type 2 diabetes does not yet manifest as an official disease, many of these risk factors are also present in the prediabetic state. Additionally, diabetes is a significant risk factor for cardiovascular events on its own. Type 2 diabetes is classified as an equivalent condition to coronary artery disease (CAD). It is associated with the highest risk of coronary artery disease according to guidelines from Europe and the United States National Cholesterol Education Programme report.
How Does Diabetes Affect the Heart?
Elevated blood sugar levels can potentially harm heart-controlling neurons and blood arteries over time. In addition, individuals with diabetes are more prone to suffer from additional illnesses that increase the risk of heart disease:
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Elevated blood pressure can cause damage to arterial walls by increasing the force of blood flow through the arteries. Diabetes and high blood pressure together can significantly raise one's risk of heart disease.
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Excess LDL ("bad") cholesterol in the circulation can cause arterial walls to become plaque-ridden.
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It is believed that high blood triglycerides, a kind of fat, and either high LDL or low HDL ("good") cholesterol might cause arterial hardening.
How to Take Care of The Heart?
These lifestyle modifications can help manage diabetes and reduce the risk of heart disease or prevent it from getting worse:
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Maintain a nutritious diet. Consume more whole grains, lean protein, and fresh produce. Reduce the intake of processed foods (such as candy, chips, and fast food) and avoid trans fats. Reduce the intake of alcohol, sugar-filled beverages, and water.
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Pursue a balanced weight. Even a small weight loss will help decrease blood sugar and triglycerides if a person is overweight. 5 percent to 7 percent of body weight, or 10 to 14 pounds for a 200-pound individual, is considered modest weight reduction.
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Exercise helps control diabetes by increasing the body's sensitivity to insulin, a hormone that allows the body's cells to use blood sugar as fuel. In addition to lowering the risk of heart disease, physical activity helps regulate blood sugar levels. Make an effort to engage in moderate-intensity physical exercise, like brisk walking, for at least 150 minutes per week.
Conclusion:
It has been demonstrated that diabetes mellitus is a separate risk factor for the development of accelerated atherosclerosis. It is now evident that atherosclerosis and diabetes mellitus have the same etiology. The pathogenic processes that link diabetes to atherosclerosis include inflammation, elevated oxidative stress, dyslipidemia, and hyperglycemia with AGE formation. After revascularization operations, individuals with diabetes had poorer clinical outcomes and more widespread atherosclerosis. Technological advancements have led to better results following coronary revascularization with PCI or CABG. Most data used to compare PCI with CABG is derived from earlier PTCA trials, which did not use the intensive secondary preventative measures and antiplatelet treatments currently advised after revascularization. The most common methods for keeping such patients safe are reducing recognized risk factors and maintaining adequate glycemic control.
