The common systemic disorders that have associated cardiac manifestations are summarized in Table e31-1.
Table e31-1 Common Systemic Disorders and Their Associated Cardiac Manifestations |Favorite Table|Download (.pdf)
Table e31-1 Common Systemic Disorders and Their Associated Cardiac Manifestations
|Systemic Disorder||Common Cardiac Manifestations||Chapter|
|Diabetes mellitus||CAD, atypical angina, CMP, systolic or diastolic CHF||344|
|Protein-calorie malnutrition||Dilated CMP, CHF||75|
|Thiamine deficiency||High-output failure, dilated CMP||74|
|Obesity||CMP, systolic or diastolic CHF||77|
|Hyperthyroidism||Palpitations, SVT, atrial fibrillation, hypertension||341|
|Hypothyroidism||Hypotension, bradycardia, dilated CMP, CHF, pericardial effusion||341|
|Malignant carcinoid||Tricuspid and pulmonary valve disease, right heart failure||350|
|Pheochromocytoma||Hypertension, palpitations, CHF||343|
|Acromegaly||Systolic or diastolic heart failure||339|
|Rheumatoid arthritis||Pericarditis, pericardial effusions, coronary arteritis, myocarditis, valvulitis||321|
|Seronegative arthropathies||Aortitis, aortic and mitral insufficiency, conduction abnormalities||325|
|Systemic lupus erythematosus||Pericarditis, Libman-Sacks endocarditis, myocarditis, arterial and venous thrombosis||319|
|HIV||Myocarditis, dilated CMP, pericardial effusion||189|
|Amyloidosis||CHF, restrictive CMP, valvular regurgitation, pericardial effusion||112|
|Sarcoidosis||CHF, dilated or restrictive CMP, ventricular arrhythmias, heart block||329|
|Hemochromatosis||CHF, arrhythmias, heart block||357|
|Marfan syndrome||Aortic aneurysm and dissection, aortic insufficiency, mitral valve prolapse||363|
|Ehlers-Danlos syndrome||Aortic and coronary aneurysms, mitral and tricuspid valve prolapse||363|
(See also Chap. 344) Diabetes mellitus, both insulin- and non-insulin-dependent, is an independent risk factor for coronary artery disease (CAD; Chap. 241) and accounts for 14–50% of new cases of cardiovascular disease. Furthermore, CAD is the most common cause of death in adults with diabetes mellitus. In the diabetic population the incidence of CAD relates to the duration of diabetes and the level of glycemic control, and its pathogenesis involves endothelial dysfunction, increased lipoprotein peroxidation, increased inflammation, a prothrombotic state, and associated metabolic abnormalities.
Diabetic patients are more likely to have a myocardial infarction, have a greater burden of CAD, have larger infarct size, and have more postinfarct complications, including heart failure, shock, and death, than are nondiabetics. Importantly, diabetic patients are more likely to have atypical ischemic symptoms; nausea, dyspnea, pulmonary edema, arrhythmias, heart block, or syncope may be their anginal equivalent. Additionally, "silent ischemia," resulting from autonomic nervous system dysfunction, is more common in diabetic patients, accounting for up to 90% of their ischemic episodes. Thus, one must have a low threshold for suspecting CAD in diabetic patients. The treatment of diabetic patients with CAD must include aggressive risk factor management (Chap. 344). Pharmacologic therapy and revascularization are similar in diabetic patients and nondiabetics except that diabetic patients have higher morbidity and mortality rates associated with revascularization, have an increased risk of restenosis after percutaneous coronary intervention (PCI), and probably have improved survival when treated with surgical bypass compared with PCI for multivessel CAD.