The features of the pain syndrome in diabetic patients with myocardial infarction

Abstract

Background. Due to the frequent development of neuropathy in diabetic patients, it is believed that this category of patients is characterized by a high incidence of atypical acute coronary syndrome, but data about this are quite contradictory. The purpose of the study was to determine pain syndrome features and its severity in patients with acute coronary syndrome and diabetes mellitus. Materials and methods. The study involved 24 patients with diabetes (19 men and 5 women) aged 45–83 years, hospitalized urgently for the acute coronary syndrome. Assessment of pain syndrome was performed at the time of hospitalization and immediately after coronary artery revascularization according to the following criteria: visual analogue scale (VAS), numerical rating scale (NRS), clinical data (sweating, tremor, blood pressure, pulse), blood glucose level. Results. Most patients (87.5 %) at the time of hospitalization complained of chest pain, the rest were not bothered by any pain. Patients described pain as “burning” (29.17 %), “squeezing” (29.17\xa0%), “tightness” (25.0\xa0%), “tingling” (4.17 %). There were also complaints of difficulty breathing (12.5 %), shortness of breath (12.5\xa0%), palpitations (41.67 %), excessive sweating (16.67 %). There was no statistically significant difference between the results of pain assessment by VAS and NRS (p\xa0> 0.1). The results of the subjective assessment of pain syndrome by VAS and NRS indicate that before revascularization, moderate and severe pain occurred with equal frequency. There were no statistically significant fluctuations in blood pressure and heart rate before and after the intervention in patients with different pain severity (p\xa0>\xa00.1). At the time of hospitalization, the mean systolic blood pressure was 135.71 ± 18.70 mmHg, diastolic blood pressure was 83.71 ± 14.67 mmHg, heart rate was 73.08\xa0±\xa011.35 bpm. The mean value of glycemia at the time of hospitalization was 8.19\xa0±\xa03.45\xa0mmol/l (8.17 ± 3.61 mmol/l in men, 8.28\xa0± 3.13 mmol/l in women). Blood glucose level ≥ 10.0 mmol/l was detected in 5 patients, i.e. in 20.83 % of all patients. The majority of these individuals had severe pain (60.0 %). Conclusions. In patients with myocardial infarction and diabetes mellitus, the typical clinical picture of ACS (87.5 %) prevailed over the painless form. Before revascularization, moderate and severe pain occurred with equal frequency; there is no statistical difference between blood pressure, heart rate and blood glucose level (p > 0.1) in patients with severe and moderate pain. Hyperglycemia (≥ 10.0 mmol/l) was detected in 20.83\xa0% of patients, most of them had severe pain (60.0 %). The lack of difference between the values of the studied pain criteria may be due to the sample size, the low sensitivity of the criteria, the development of diabetic neuropathy. As a result, there is a need for further study of the phenomenon of pain syndrome in patients with ACS and diabetes mellitus.