‘Just like a normal pain’, what do people with diabetes mellitus experience when having a myocardial infarction: a qualitative study recruited from UK hospitals

Abstract

ObjectiveThe objective of the study was to investigate the symptoms people with diabetes experience when having a myocardial infarction (MI), their illness narrative and how they present their symptoms to the health service.SettingThree London (UK) hospitals (coronary care units and medical wards).ParticipantsPatients were recruited with diabetes mellitus (DM) (types 1 and 2) with a clinical presentation of MI (ST elevated MI (STEMI), non-ST elevated MI (NSTEMI), acute MI unspecified and cardiac arrest). A total of 43 participants were recruited, and 39 interviews met the study criteria and were analysed. They were predominantly male (n=30), aged 40–90 years and white British (18/39), and just over a half were from other ethnic groups. The majority had type 2 DM (n=35), 24 had an NSTEMI, 10 had an STEMI and five had other cardiac events.Definitions of selection/exclusion criteriaA diagnosis of MI and DM and the ability to communicate enough English to complete the interview. Ward staff made a clinical judgement that the participant was post-treatment, clinically stable and well enough to participate.MethodsA qualitative study using taped and transcribed interviews analysed using a thematic analysis.ResultsWhile most participants did experience chest pain, it was often not their most striking symptom. As their chest pain did not match their expectations of what a ‘heart attack’ should be, participants developed narratives to explain these symptoms, including the symptoms being effects of their DM (‘hypos’), side effects of medication (oral hypoglycaemics) or symptoms (such as breathlessness and indigestion) related to other comorbidities, often leading to delays in seeking care.ConclusionsWhile truly absent chest pain during MI among people with DM was rare in this study, patients’ attenuated symptoms often led to delay in seeking attention, and this may result in delays in receiving treatment.

Impact of acute diabetes decompensation on outcomes of diabetic patients admitted with ST-elevation myocardial infarction

“…Albeit intuitive, the findings of our study deserve more scrutiny: The lower prevalence of known coronary artery disease and the worse initial presentation (evident by the higher incidence of cardiogenic shock and cardiac arrest) in the DKA/HHS population are absorbing. Although speculative, these patients may have constituted a different cohort of patients at baseline that is characterized with worse chronic glycemic control, attenuated symptoms due to diabetic neuropathy, delayed presentations, and possibly larger infarcts [ 23 , 24 ]. The interrelation between DKA/HHS and worse outcomes in STEMI patients is rather complex and may be difficult to unravel from cohort analyses like the present one.…”

“…The lower prevalence of known coronary artery disease and the worse initial presentation (evident by the higher incidence of cardiogenic shock and cardiac arrest) in the DKA/HHS population are absorbing. Although speculative, these patients may have constituted a different cohort of patients at baseline that is characterized with worse chronic glycemic control, attenuated symptoms due to diabetic neuropathy, delayed presentations, and possibly larger infarcts [ 23 , 24 ].…”

Riesgo cardiovascular en la mujer diabética

“…En las mujeres posmenopáusicas es conocido que hay una igualdad relativa de incidencia en el riesgo de desarrollo de la enfermedad cardiovascular respecto a los hombres por la pérdida del factor protector que suponen los estrógenos en ellas, sin embargo, es interesante analizar que en las mujeres la presentación clínica de la enfermedad coronaria aguda tiende a ser diferente y más aún en las mujeres diabéticas, por lo que en este grupo podría suponer un reto clínico en muchas ocasiones y además está comprobado que las mujeres tienden a no ser tan conscientes de los síntomas de un infarto al momento de presentarlos [26][27][28][29][30] . Hay una tendencia mundial a no identificar a tiempo los factores de riesgo cardiovascular específicos en mujeres, menospreciar el mayor detrimento de la enfermedad cardiovascular en mujeres diabéticas, un inicio en general más tardío de terapias con estatinas, aspirina y manejo no farmacológico de factores de riesgo modificables [31][32][33] .…”

Особливості Больового Синдрому При Інфаркті Міокарда У Хворих На Цукровий Діабет

“…У нашому випадку частка безбольової форми становила 12,5 % від усієї досліджуваної групи. Нещодавно в Британському медичному журналі опублікували статтю, у якій автори проаналізували інтерв'ю 39 пацієнтів, госпіталізованих у лікувальні заклади Великої Британії з інфарктом міокарда та ЦД типу 1 і типу 2 [8]. Більшість пацієнтів скаржилися на біль у грудях та інші симптоми, але, за словами хворих, больові відчуття не були на- [21][22][23].…”

“…З огляду на частий розвиток нейропатії у хворих на діабет [4,5] існує думка, що для даної категорії пацієнтів характерна висока частота атипового перебігу гострого коронарного синдрому, але дані про це досить суперечливі [6][7][8].…”