The features of the pain syndrome in diabetic patients with myocardial infarction
Keywords:diabetes mellitus, myocardial infarction, acute coronary syndrome, pain, painless form
Background. Due to the frequent development of neuropathy in diabetic patients, it is believed that this category of patients is characterized by a high incidence of atypical acute coronary syndrome, but data about this are quite contradictory. The purpose of the study was to determine pain syndrome features and its severity in patients with acute coronary syndrome and diabetes mellitus. Materials and methods. The study involved 24 patients with diabetes (19 men and 5 women) aged 45–83 years, hospitalized urgently for the acute coronary syndrome. Assessment of pain syndrome was performed at the time of hospitalization and immediately after coronary artery revascularization according to the following criteria: visual analogue scale (VAS), numerical rating scale (NRS), clinical data (sweating, tremor, blood pressure, pulse), blood glucose level. Results. Most patients (87.5 %) at the time of hospitalization complained of chest pain, the rest were not bothered by any pain. Patients described pain as “burning” (29.17 %), “squeezing” (29.17 %), “tightness” (25.0 %), “tingling” (4.17 %). There were also complaints of difficulty breathing (12.5 %), shortness of breath (12.5 %), palpitations (41.67 %), excessive sweating (16.67 %). There was no statistically significant difference between the results of pain assessment by VAS and NRS (p > 0.1). The results of the subjective assessment of pain syndrome by VAS and NRS indicate that before revascularization, moderate and severe pain occurred with equal frequency. There were no statistically significant fluctuations in blood pressure and heart rate before and after the intervention in patients with different pain severity (p > 0.1). At the time of hospitalization, the mean systolic blood pressure was 135.71 ± 18.70 mmHg, diastolic blood pressure was 83.71 ± 14.67 mmHg, heart rate was 73.08 ± 11.35 bpm. The mean value of glycemia at the time of hospitalization was 8.19 ± 3.45 mmol/l (8.17 ± 3.61 mmol/l in men, 8.28 ± 3.13 mmol/l in women). Blood glucose level ≥ 10.0 mmol/l was detected in 5 patients, i.e. in 20.83 % of all patients. The majority of these individuals had severe pain (60.0 %). Conclusions. In patients with myocardial infarction and diabetes mellitus, the typical clinical picture of ACS (87.5 %) prevailed over the painless form. Before revascularization, moderate and severe pain occurred with equal frequency; there is no statistical difference between blood pressure, heart rate and blood glucose level (p > 0.1) in patients with severe and moderate pain. Hyperglycemia (≥ 10.0 mmol/l) was detected in 20.83 % of patients, most of them had severe pain (60.0 %). The lack of difference between the values of the studied pain criteria may be due to the sample size, the low sensitivity of the criteria, the development of diabetic neuropathy. As a result, there is a need for further study of the phenomenon of pain syndrome in patients with ACS and diabetes mellitus.
World Health Organization. Diabetes 2020. https://www.who.int/news-room/fact-sheets/detail/diabetes.
МОЗ України. Всесвітній день боротьби з діабетом: що треба знати про хворобу. 2017. https://moz.gov.ua/article/health/vsesvitnij-den-borotbi-z-diabetom-scho-treba-znati-pro-hvorobu.
CDC. National Diabetes Statistics Report, 2020. Estimates of Diabetes and Its Burden in the United States. 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html.
Iqbal Z., Azmi S., Yadav R. et al. Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clinical Therapeutics. 2018. 40(6). https://www.clinicaltherapeutics.com/article/S0149-2918(18)30140-1/fulltext.
Wheeler S., Singh N., Boyko E.J. The Epidemiology of Diabetic Neuropathy. In: Veves A., Malik R.A. Diabetic Neuropathy: Clinical Management. Totowa, NJ: Humana Press; 2007. Р. 7-30. https://doi.org/10.1007/978-1-59745-311-0_2.
Symptoms and delay times during myocardial infarction in 694 patients with and without diabetes; an explorative cross-sectional study | BMC Cardiovascular Disorders | Full Text. https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-016-0282-7.
Canto J.G., Shlipak M.G., Rogers W.J., Malmgren J.A., Frederick P.D., Lambrew C.T. et al. Prevalence, Clinical Characteristics, and Mortality Among Patients With Myocardial Infarction Presenting Without Chest Pain. JAMA. 2000. 283(24). 3223-9.
Berman N., Jones M.M., Coster D.A.D. ‘Just like a normal pain’, what do people with diabetes mellitus experience when having a myocardial infarction: a qualitative study recruited from UK hospitals. BMJ Open. 2017. 7(9). https://bmjopen.bmj.com/content/7/9/e015736.
Галушко О.А., Болюк М.В. Небезпеки і труднощі під час діагностики інфаркту міокарда у пацієнтів з цукровим діабетом (огляд літератури та власний досвід). Медицина невідкладних станів. 2020. 16(2). 37-41.
Шлапак І.П., Маньковський Б.М., Галушко О.А., Кондрацька І.М. Інфузійна терапія в практиці лікаря-ендокринолога. Київ, 2016. 294 с.
Neumann F.-J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2019. 40(2). 87-165.
Уніфікований клінічний протокол екстреної, первинної, вторинної (спеціалізованої) та третинної (високоспеціалізованої) медичної допомоги та медичної реабілітації «Гострий коронарний синдром з елевацією сегмента ST». МОЗ України, 2014. https://www.dec.gov.ua/wp-content/uploads/2019/11/2014_455-ykpmd_gks.pdf.
Huskisson E.C. Measurement of pain. Lancet. 1974. 2(7889). 1127-31.
Барило О.С., Фурман Р.Л. Комплексний аналіз больового синдрому в пацієнтів з переломами нижньої щелепи при використанні перпарату «Нуклео ЦМФ форте». Современная стоматология. 2014. 3. 62-7.
Miщук В.Р. Оцінка больового синдрому у дітей. Сучасний стан проблеми. Медицина невідкладних станів. 2016. 8. 134-9.
Haefeli M., Elfering A. Pain assessment. Eur. Spine J. 2006. 15(Suppl. 1). S17-24.
Defining Adult Overweight and Obesity | Overweight & Obesity | CDC. 2020. https://www.cdc.gov/obesity/adult/defining.html.
Fu R., Li S.-D., Song C.-X., Yang J.-A., Xu H.-Y., Gao X.-J. et al. Clinical significance of diabetes on symptom and patient delay among patients with acute myocardial infarction — an analysis from China Acute Myocardial Infarction (CAMI) registry. J. Geriatr. Cardiol. 2019. 16(5). 395-400.
Arnold S.V., Spertus J.A., Lipska K.J., Tang F., Goyal A., McGuire D.K. et al. Association between diabetes mellitus and angina after acute myocardial infarction: analysis of the TRIUMPH prospective cohort study. Eur. J. Prev. Cardiol. 2015. 22(6). 779-87.
Read S.H., Fischbacher C.M., Colhoun H.M., Gasevic D., Kerssens J.J., McAllister D.A. et al. Trends in incidence and case fatality of acute myocardial infarction, angina and coronary revascularisation in people with and without type 2 diabetes in Scotland between 2006 and 2015. Diabetologia. 2019. 62(3). 418-25.
Draman M.S., Thabit H., Kiernan T.J., O’Neill J., Sreenan S., McDermott J.H. A silent myocardial infarction in the diabetes outpatient clinic: case report and review of the literature. Endocrinol. Diabetes Metab. Case Rep. 2013. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921998.
Silent Myocardial Infarction | Elsevier Enhanced Reader. https://reader.elsevier.com/reader/sd/pii/S073510971741432X? token=9EED8910E9978D6392A6CB476BC09E20731C416BA80CC7095E7264B5047205EF8B2560D153651A19121D91B58779AE57.
Silent myocardial ischemia and microalbuminuria in asymptomatic type-2 diabetic patients | Cochrane Library. https://www.cochranelibrary.com/central/doi/10.1002/central/CN-00727514/full?highlightAbstract=ischaemi%7Cischaemia%7Csilent%7Cmyocardial%7Cwithdrawn%7Cmyocardi%7Cischemia.
IASP Terminology — IASP. https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Pain.
Cowen R., Stasiowska M.K., Laycock H., Bantel C. Assessing pain objectively: the use of physiological markers. Anaesthesia. 2015. 70(7). 828-47.
Tracey I., Woolf C.J., Andrews N.A. Composite Pain Biomarker Signatures for Objective Assessment and Effective Treatment. Neuron. 2019. 101(5). 783-800.
Cosentino F., Grant P.J., Aboyans V., Bailey C.J., Ceriello A., Delgado V. et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur. Heart J. 2020. 41(2). 255-323.
Hirsch I.B., O’Brien K.D. How to Best Manage Glycemia and Non-Glycemia During the Time of Acute Myocardial Infarction. Diabetes Technol. Ther. 2012. 14 (Suppl. 1). S-22-S-32.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our edition uses the copyright terms of Creative Commons for open access journals.
Authors, who are published in this journal, agree with the following terms:
- The authors retain rights for authorship of their article and grant to the edition the right of first publication of the article on a Creative Commons Attribution 4.0 International License, which allows others to freely distribute the published article, with the obligatory reference to the authors of original works and original publication in this journal.
- Directing the article for the publication to the editorial board (publisher), the author agrees with transmitting of rights for the protection and using the article, including parts of the article, which are protected by the copyrights, such as the author’s photo, pictures, charts, tables, etc., including the reproduction in the media and the Internet; for distributing; for the translation of the manuscript in all languages; for export and import of the publications copies of the writers’ article to spread, bringing to the general information.
- The rights mentioned above authors transfer to the edition (publisher) for the unlimited period of validity and on the territory of all countries of the world.
- The authors guarantee that they have exclusive rights for using of the article, which they have sent to the edition (publisher). The edition (the publisher) is not responsible for the violation of given guarantees by the authors to the third parties.
- The authors have the right to conclude separate supplement agreements that relate to non-exclusive distribution of their article in the form in which it had been published in the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.
- The policy of the journal permits and encourages the publication of the article in the Internet (in institutional repository or on a personal website) by the authors, because it contributes to productive scientific discussion and a positive effect on efficiency and dynamics of the citation of the article.
- The rights to the article are deemed transferred by the authors to the edition (the publisher) since the moment of the publication of the article in the printed or electronic version of journal.