A STUDY ON ECG CHANGES IN DIABETIC PATIENTS AND ITS RELATION TO CARDIAC DYSAUTONOMIA.

Dr. G. Sai Prajna, Dr. S. Krishna Mohana Rao, Dr G. Swarnalatha Devi

Abstract


Background: Autonomic dysfunction in diabetics is common and often asymptomatic. Patients with diabetic autonomic neuropathy are more
prone for sudden cardiac death probably due to silent myocardial infarction or primary malignant ventricular arrhythmias. The ECG is liable to
show more abnormalities in people with diabetes than non-diabetics.
Materials and methods: The present study is an analytical study. ECG taken in 50 diabetic patients was analysed and compared to 50 age and sexmatched
controls coming to out-patient and admitted as in-patients in the Department of General Medicine in ASRAM from August 2017 to July
2018.Parameters assessed for cardiac dysautonomia-
Parasympathetic function:
1) Resting heart rate.
2) Abnormal Heart rate response to deep breathing. (HRBD) (<10 beats per minute)
Sympathetic function:
1) Blood pressure (BP) response to standing . (drop of SBP>30 mmHg)
2) QTc prolongation. (>460msec).
Results: The mean resting heart rate, P-R interval, QTc interval are significantly higher in the study group than the control group (p<0.05). The
QRS interval is prolonged in the study group as compared to that of controls but not significant. The QRS axis is significantly towards the left in the
study group compared to controls. The ECG changes of ischemia and intraventricular conduction blocks are significantly greater in the study
group. 28 % Of study group have abnormal HRBD(parasympathetic dysfunction and 6 % Of study group showed a significant drop of systolic
blood pressure(SBP) (sympathetic dysfunction).There is no sign. There is a positive correlation between QTc prolongation and postural fall in SBP.
The ECG changes of ischemia are significantly greater in the study group than the control group. The QRS duration is not significantly prolonged in
the study group.
Conclusions:This study highlights the importance of simple non-invasive investigation like ECG in diagnosing asymptomatic cardiac autonomic
dysfunction, a precursor of symptomatic cardiac neuropathy.


Keywords


Cardiac Autonomic Dysautonomia (CAN), Cardiac Autonomic Reflex Tests (CARTS), Heart Rate Response to Deep Breathing(HRDB), QTc (corrected) interval, beats per minute (bpm).

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