TMSS Medical College Journal

Objectives: To determine the frequency of silent myocardial ischemia (SMI) in type 2 diabetic patients. Material and Methods: This study was conducted in the Department of Cardiology, TMSS Medical College & RCH, Bogra from May 2012 to November 2012. A total of 100 patients who had type 2 diabetes mellitus (DM) for 5 years or more, were included in the study. All patients with type 1 DM, symptomatic ischemic heart disease, previous myocardial or valvular heart disease were excluded from the study. Full blood count and fasting plasma glucose were performed in all patients. The main tools for the diagnosis were electrocardiogram, exercise tolerance test (ETT) and echocardiography. Patients having normal electrocardiogram and exercise tolerance test were labeled as having no silent ischemic heart disease. Those patients who turned out to have silent ischemic heart disease were subjected to echocardiography. Results: Out of 100 patients, 50 were male and 50 female. Forty-four (445) out of 100, had silent myocardial ischemia. Among these 44 patients, 25 were male and 19 female (13:1). The majority of patients were in the age group of 50-59. Conclusion: All patients with type 2 diabetes of more than 5 years duration should be screened with ETT for silent myocardial ischemia. Key words: Silent ischemic heart disease, type 2 diabetes mellitus, silent myocardial ischemia

Coronary artery disease (CAD) accounts for 80 per cent of mortality in type 2 Diabetics. Previously, diabetic nephropathy was the commonest cause of death in diabetics but with the availability of renal replacement therapy, ischemic heart disease (IHD) has emerged as the leading cause of death in these patients. According to estimates CAD mortality will double from 1990 to 2020 and approximately 82 percent increase will occur in the developing world? Despite having age related problems elderly male patients with diabetes mellitus have a more favorable risk factor control than corresponding female patients.4 Silent ischemia is ischemia in the absence of symptoms or episodes of ST elevation or depression occurring without chest pain.