Published online Aug 26, 2014. doi: 10.4330/wjc.v6.i8.802
Revised: April 24, 2014
Accepted: May 29, 2014
Published online: August 26, 2014
In patients with diabetes mellitus, cardiovascular disease is the principal cause of mortality and chest pain is the most frequent symptom in patients with stable and acute coronary artery disease. However, there is little knowledge concerning the pervasiveness of uncommon presentations in diabetics. The symptomatology of acute coronary syndrome, which comprises both pain and non-pain symptoms, may be affected by traditional risk factors such as age, gender, smoking, hypertension, diabetes, and dyslipidemia. Such atypical symptoms may range from silent myocardial ischemia to a wide spectrum of non-chest pain symptoms. Worldwide, few studies have highlighted this under-investigated subject, and this aspect of ischemic heart disease has also been under-evaluated in the major clinical trials. The results of these studies are highly diverse which makes definitive conclusions regarding the spectrum of atypical presentation of acute and even stable chronic coronay artery disease difficult to confirm. This may have a significant impact on the morbidity and mortality of coronary artery disease in diabetics. In this up-to-date review we will try to analyze the most recent studies on the atypical presentations in both acute and chronic ischemic heart disease which may give some emphasis to this under-investigated topic.
Core tip: Atypical presentations of both acute and chronic ischemic heart disease in diabetic patients is one of the most under-investigated subjects despite extensive research into coronary artery disease even in major clinical trials. To date, according to available data from numerous studies, the impact of atypical presentation on outcome is highly controversial making definitive conclusions difficult. This may have a significant impact on morbidity and mortality of acute and chronic coronary artery disease in diabetics.