Risk for heart disease with bad diabetes and chronic pancreatis

Submitted by Dr T on August 6, 2011 – 1:40pm

Question:

My husband is 32. He was recently diagnosed with Chronic Pancreatitis. He is a brittle Type I diabetic with multiple episodes of Diabetic Keto Acidosis (DKA). He also has a strong family history of heart disease(mother had MI @ age 32). Recently he had an EKG done while in the ER. EKG showed abnormal,sinus tachycardia, RSR of QR pattern in V1 suggests right ventricular conduction delay. Septal infarct with undetermined age. The doctors never mentioned anything about this. We only found out after obtaining his records. Is this possibly a computer error or something to worry about. He was diagnosed with DKA, treated in the ER and sent home.

This EKG reading is not an error. With a positive family history and repeatedly uncontrolled Diabetes, your husband is at risk for progressive heart disease (he already has it). However, there is a lot that can be done to modify his risk for coronary artery disease (CAD) with a variety of life style modifications. For that to be successful, it is essential his diabetes remains under control. If this continues to cause problems, other treatments that eventually may include a pancreas transplant are a solution, not only as treatment of his diabetes and all its potential complications, but also for control of his heart disease.

Apart from treatment for his diabetes and chronic pancreatitis, it takes about 10 years to develop atherosclerosis and CAD, but probably a lot faster with this type of diabetes. Under ideal circumstances, lifestyle modifications should be optimized during this period. A modest change in health behavior is associated with a 25% reduction in risk of death! In a new AHA report, Cardiovascular health can be determined by the following criteria:

Never having smoked or quitting over a year ago.
Control obesity: Keep your BMI < 25 kg/m2.
Exercising at moderate intensity $150 minutes (or 75 minutes at vigorous intensity) each week.
Eating a “healthy diet”: adhering to 4 of 5 important dietary components:
- Sodium intake ,1.5 g/d
- Sugar-sweetened beverage intake ,36 oz weekly
- ≥ 4.5 cups of fruits and vegetables/d
- ≥ three 1 oz servings of fiber-rich whole grains/d
- ≥ two 3.5 oz servings of oily fish/week.
- Maintaining total cholesterol < 200 mg/dL.
Keeping BP < 120/80 mm Hg.
Keep fasting blood glucose < 100 mg/dL.

The way forward is to start with a stress test. You might also want to check his risks for heart disease and stroke.
Otherwise, probably the most important thing your husband can do, is to look what he can do to modify his risk by living a healthy life style that includes diet (particularly the mediterranean diet) and exercise.

(For those who want more in-depth information, read this article on the management of chronic angina).

Hope this helps,
Dr T

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